Kurosu T, Sakashita C, Yamamoto K, Tohda S, Miki T, Koyama T, Miura O, Murakami N, Nemoto T, Miyasaka N, Kamiyama R, Hirosawa S
First Department of Internal Medicine, Faculty of Medicine, Tokyo Medical and Dental University.
Rinsho Ketsueki. 1997 Jan;38(1):58-63.
A 49-year-old man was admitted with swelling in the left lower extremity, and a mass in the left lower abdomen. Laboratory findings showed an increased WBC of 15,000/microliter with 41% plasma cells, and immunoglobulin (Ig) A of 2,557mg/dl with a monoclonal component. A roentgenogram and computed tomograph of the abdomen revealed that a 5 x 10 cm mass with calcification located in the iliopsoas muscle. Plasma cell leukemia with extramedullary plasmacytoma was diagnosed, and the patient was treated with high-dose dexamethasone (40 mg/day for 4 days), resulting in a good response with the disappearance of plasma cells in peripheral blood and a marked decrease in serum Ig A. However, the patient's condition deteriorated in spite of various treatments, and he died of heart failure 5 months after admission. With informed consent from relatives, a necropsy was performed and infiltration of plasma cells in the mass in the iliopsoas muscle was noted. We reported this case because plasma cell leukemia with amyloid deposition and osteogenesis at the site of extramedullary plasmacytoma is very rare.
一名49岁男性因左下肢肿胀及左下腹肿块入院。实验室检查结果显示白细胞计数升高至15,000/微升,浆细胞占41%,免疫球蛋白(Ig)A为2,557mg/dl,存在单克隆成分。腹部X线片和计算机断层扫描显示,髂腰肌有一个5×10 cm伴有钙化的肿块。诊断为伴有髓外浆细胞瘤的浆细胞白血病,患者接受了高剂量地塞米松治疗(40 mg/天,共4天),外周血浆细胞消失,血清Ig A显著降低,反应良好。然而,尽管进行了各种治疗,患者病情仍恶化,入院5个月后死于心力衰竭。经亲属知情同意后进行了尸检,发现髂腰肌肿块中有浆细胞浸润。我们报告此病例是因为伴有淀粉样沉积和成骨的浆细胞白血病在髓外浆细胞瘤部位非常罕见。