Sonoda Y, Kumabe T, Umezawa K, Shimizu H, Murakawa Y, Kanamaru R, Yoshimoto T
Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan.
No Shinkei Geka. 1998 Aug;26(8):737-41.
Rapid growth of a glioblastoma during therapy for multiple myeloma is reported. A 53-year-old man was admitted to our hospital with a right costal tumor, which was resected. The diagnosis was plasmocytoma. Urine protein electrophoresis showed a monoclonal peak in the region of gamma-globulin, and examination of the bone marrow revealed 17.8% of atypical plasma cells. Brain magnetic resonance (MR) imaging detected two small lesions, but these could not be identified as brain tumor. He received chemotherapy (melphalan 10 mg/day and predonin 30 mg/day for 4 days) and was discharged. Two weeks after discharge, he was readmitted because of left hemiparesis. T1-weighted MR imaging showed two large hypointense lesions in the right frontal lobe, with ring-like enhancement following Gd-DTPA infusion. 1H-MR spectroscopy showed typical findings of tumor with increased choline and lactic acid peaks. 201Tl SPECT revealed high accumulation in both early and delayed images. Right carotid angiography showed a hypervascular tumor with venous filling and mass effect. The lesions were resected via right frontal craniotomy, followed by intraoperative radiation and placement of an Ommaya reservoir. Histological examination showed the tumors were glioblastoma. The brain between the tumors also showed the typical appearance of glioblastoma, suggesting that the lesions were continuous. Postoperatively, the patient's left hemiparesis disappeared. He received local irradiation and chemotherapy and was then discharged. Coexistence of glioblastoma and multiple myeloma is rare. The cause may be genetic abnormality, but immunodeficiency due to multiple myeloma, surgical damage, or chemotherapy may have contributed to the rapid growth of the glioblastoma.
据报道，一名多发性骨髓瘤患者在治疗期间胶质母细胞瘤迅速生长。一名53岁男性因右侧肋骨肿瘤入院，该肿瘤被切除。诊断为浆细胞瘤。尿蛋白电泳显示γ球蛋白区域有单克隆峰，骨髓检查发现17.8%的非典型浆细胞。脑部磁共振成像检测到两个小病灶，但无法确定为脑肿瘤。他接受了化疗（美法仑10mg/天，泼尼松30mg/天，共4天）后出院。出院两周后，因左侧偏瘫再次入院。T1加权磁共振成像显示右侧额叶有两个大的低信号病灶，注入钆喷酸葡胺后呈环形强化。氢质子磁共振波谱显示肿瘤的典型表现，胆碱和乳酸峰升高。201铊单光子发射计算机断层扫描显示早期和延迟图像中均有高摄取。右侧颈动脉血管造影显示肿瘤血管丰富，有静脉充盈和占位效应。通过右侧额部开颅手术切除病灶，随后进行术中放疗并放置Ommaya储液器。组织学检查显示肿瘤为胶质母细胞瘤。肿瘤之间的脑组织也显示出胶质母细胞瘤的典型表现，提示病灶是连续的。术后，患者左侧偏瘫消失。他接受了局部放疗和化疗，然后出院。胶质母细胞瘤与多发性骨髓瘤并存罕见。病因可能是基因异常，但多发性骨髓瘤导致的免疫缺陷、手术损伤或化疗可能促使了胶质母细胞瘤的快速生长。
