文章摘要

骨痛、高钙、贫血——伪装成多发性骨髓瘤的华氏巨球蛋白血症1例并文献复习

作者: 1梁璐, 2张江勃, 2化罗明, 3周欢, 4檀艳丽, 2薛华
1 河北大学附属医院急诊科，河北 保定 071000
2 河北大学附属医院血液科，河北 保定 071000
3 河北大学附属医院影像科，河北 保定 071000
4 河北大学附属医院病理科，河北 保定 071000
通讯: 薛华 Email: xh-xuehua@163.com
DOI: 10.3978/j.issn.2095-6959.2022.08.038

摘要

以骨骼受累、骨痛、骨质破坏为首发表现的华氏巨球蛋白血症/淋巴浆细胞淋巴瘤(Waldenström macroglobulinemia/lymphoplasmacytic lymphoma，WM/LPL)非常少见。本文回顾性分析河北大学附属医院血液科收治的1例合并溶骨性病变的WM/LPL诊治经过，并复习相关文献。该患者为老年男性，起病时以骨痛、高钙及贫血为首发表现，伴有免疫球蛋白M(immunoglobulin M，IgM)型M蛋白，影像学提示多发溶骨性骨质破坏，椎体及骨髓活检病理及组织化学提示CD5−CD10−小B细胞淋巴瘤，结合分子生物学结果确诊为WM/LPL。经CD20单克隆抗体为基础的方案及苯达莫司汀治疗后，患者症状明显改善。WM/LPL合并溶骨性病变易与IgM型多发性骨髓瘤(multiple myeloma，MM)相混，其诊断可依赖于CD20表达、IgH/CCND1及MYD88突变。
关键词： 华氏巨球蛋白血症/淋巴浆细胞淋巴瘤；骨痛；溶骨；骨病

Waldenström macroglobulinemia disguised as multiple myeloma with first manifestations of bone pain, hypercalcemia and anemia: A case report and literature review

Authors: 1LIANG Lu, 2ZHANG Jiangbo, 2HUA Luoming, 3ZHOU Huan, 4TAN Yanli, 2XUE Hua
1 Department of Emergency, Affiliated Hospital of Hebei University, Baoding Hebei 071000, China
2 Department of Hematology, Affiliated Hospital of Hebei University, Baoding Hebei 071000, China
3 Department of Radiography, Affiliated Hospital of Hebei University, Baoding Hebei 071000, China
4 Department of Pathology, Affiliated Hospital of Hebei University, Baoding Hebei 071000, China

CorrespondingAuthor: XUE Hua Email: xh-xuehua@163.com

DOI: 10.3978/j.issn.2095-6959.2022.08.038

Abstract

Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) combined with bone involvement, bone pain, and bone destruction is very rare, so the summary of clinical and imaging manifestations can enable precise treatment of patients. We retrospectively analyzed the diagnosis and treatment of one case of WM/LPL with osteolytic lesions in our department, and then reviewed the relevant literatures. Results showed that the patient was an elderly male with bone pain, hypercalcemia, and anemia as the first manifestations at the onset, accompanied by immunoglobulin M (IgM)-type M protein. Imaging showed multiple osteolytic bone destruction. Pathology and immunohistochemistry results of vertebral body and bone marrow showed the patient with CD5−CD10− small B-cell lymphoma. Combined with molecular biology results, this patient was diagnosed as WM/LPL. After treatment with CD20 monoclonal antibody-based regimen and bendamustine, the patient’s symptoms improved significantly. WM/LPL with osteolytic lesions is easily confused with IgM-type multiple myeloma (MM), and its diagnosis can depend on CD20 expression, IgH/CCND1 and MYD88 mutation.

Keywords： Waldenström macroglobulinemia/lymphoplasmacytic lymphoma; bone pain; osteolysis; bone disease

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