Coexisting glomerular IgA deposition and IgG-kappa multiple myeloma

Multiple myeloma (MM) is a common malignancy that often results in many kinds of kidney injuries for the abnormal monoclonal immunoglobulin. Here, we present an IgG-kappa type MM case accompanied by renal IgA deposition combined with IgG-kappa. The patient was treated with prednisone plus mycophenolate mofetil, and got a satisfactory remission. Although it cannot be determined whether the IgA deposition was secondary to MM, this was the first report of coexisting mesangial proliferative nephritis with IgA deposition and IgG-kappa type MM.     

Synchronous presentation of breast carcinoma with plasmacytoid cytomorphology and multiple myeloma

Plasmacytoid morphology is often encountered in both lobular and ductal carcinomas of the breast. The presentation of breast carcinoma in patients with a known history of lymphoma or multiple myeloma has been described in the literature. However, to the best of our knowledge, the synchronous presentation of breast carcinoma and multiple myeloma has not been reported. Here we report the first case of the simultaneous occurrence of breast carcinoma with plasmacytoid morphology and multiple myeloma in a 74-year-old patient, which presented challenges in making the diagnosis on fine-needle aspiration biopsy (FNAB) of the breast.     

Rare subtype of multiple myeloma presenting as sacroiliac joint pain in an avid golfer: a case report

ObjectiveKappa (κ) light chain multiple myeloma can be disguised as low back pain (LBP), and as such may present to a primary contact provider such as a chiropractor. The rarity and non-specific nature of the clinical presentation of this condition typically lead to a delayed diagnosis.Case presentationA 53-year old male avid golfer presented to a chiropractor with a chief complaint of LBP. He was diagnosed with sacroiliac joint dysfunction. His pain was initially improving with chiropractic management. The character of his pain changed, and the chiropractor referred for further imaging. He was subsequently diagnosed with κ light chain multiple myeloma.SummaryThis case presentation highlights that spinal malignancy is a possible cause of LBP. It reminds the clinician to investigate signs and symptoms that could lead to a suspicion of malignancy, to monitor patient progression, and consider further evaluations if the expected response to treatment is not achieved.     

Safety and efficacy of recombinant human erythropoietin treatment of anaemia associated with multiple myeloma in haemodialysed patients

Recombinant human erythropoietin (rHuEpo) was used to treatthe anaemia of four haemodialysed patients (3 males, 1 female)with advanced multiple myeloma; the type of serum M componentwas IgG kappa in all cases. During the 6-month period precedingrHuEpo therapy the patients received multiple blood transfusions(range 4–22 units of packed red cells per patient). Afterthe first month of treatment haematocrit increased from 23±3(SD) to 32±4% and during the last 3 months the maintenancedose of rHuEpo was 143±37 U/kg per week to achieve amean haematocrit of 35±1%. After introduction of rHuEpo,blood transfusions were no longer required and the patientsreported an improvement in wellbeing. No apparent worseningof multiple myeloma has been observed over the treatment periodranging from 5 to 34 months (cumulative duration of treatment55 months). Anti-hypertensive therapy was started in one caseand increased in two patients. We conclude that rHuEpo appearsto be effective and safe in treating anaemia associated withmultiple myeloma in patients requiring haemodialysis.     

多发性骨髓瘤的外科治疗探讨

目的 探讨多发性骨髓瘤外科治疗的手术指征、方式和效果。方法 总结分析了29例孤立性骨髓瘤和多发性骨髓瘤患者的临床表现及外科治疗情况。本组病例男17例,女12例。年龄38～76岁,平均59．5岁。原发病灶位于脊柱9例,肋骨1例,眩骨2例,股骨上端2例,股骨干4例,骨盆5例,骶骨6例、这29例患者分别进行了下列外科治疗：行单纯病灶清除12例,其中6例为骶骨骨髓瘤,5例为骨盆部骨髓瘤;行脊柱前路病灶清除减压、钛网置入钢板内固定6例;行脊柱后路病灶清除减压,经椎弓根内固定3例;5例病理性骨折患者分别行肿瘤刮除、骨水泥填充,髓内钉或DHS内固定;3例患者行肿瘤切除,人工假体置换。文章评估了手术后疼痛、神经损害症状、脊柱不稳等症状的改善,生活质量及生存情况。结果 疼痛改善最明显,所有患者均有疼痛减轻。3例截瘫患者,一例由Frankal分级B级变为C级,2例由C级变为D级。术后平均随访1．5年。3例局部复发。结论 对有严重神经功能损害和严重影响患者生存质量的合并症的多发性骨髓瘤患者来说,外科手术治疗是一种有效可行的治疗方法,再结合化疗和放疗,对改善患者的生活质量和延长生存期是非常有意义的。     

免疫吸附治疗多发性骨髓瘤伴肾功能衰竭初探

免疫吸附治疗多发性骨髓瘤伴肾功能衰竭初探罗乐宣于宗周近年来，不少经济发达的国家已采用免疫吸附（ｉｍｍｕｎｏａｄｓｏｒｐｔｉｏｎＩＡ）疗法来治疗心脑血管疾病和自身免疫性疾病。本院于１９９７年４月引进免疫吸附系统（瑞典产品），并投入临床使用。我们首次在国...     

多发性骨髓瘤肾病临床诊疗问题探讨

多发性骨髓瘤并肾脏损害者亦称多发性骨髓瘤肾病（ＭＭＮ）,我院从１９７４年１月～１９９９６年６月收治ＭＭ５２例,其中ＭＭＮ４２例,现将有关诊疗情况报告如下。临床资料１．诊断标准：本组ＭＭＮ患者符合ＫｙｌｅＲＡ的诊断标准（Ｆｕｎｄａｍｅｎｔａｌｓｏｆｃｌ...     

多发性骨髓瘤骨代谢指标的改变

本文测定了１０例多发性骨髓瘤患者的血钙、磷、ＡＫＰ、ＢＧＰ、２４小时尿ＨＯＰ及腰椎２～４正位ＢＭＤ，并且经化疗完全缓解后再次复查。结果（１）多发性骨髓瘤患者血Ｃａ、Ｐ、ＡＫＰ与正常对照无显著差异，化疗前后也无显著差异。（２）血ＢＧＰ低于正常对照，２４小时尿ＨＯＰ高于正常对照，化疗后ＢＧＰ增高，ＨＯＰ下降。（３）ＢＭＤ改变：１０例患者中有３例骨量减低，６例骨质疏松，化疗后ＢＭＤ有所增加。因此，血ＢＧＰ、尿ＨＯＰ和ＢＭＤ对观察多发性骨髓瘤治疗效果有一定的临床指导意义。还初步探讨了破骨细胞因子对骨质破坏的机理。     

多发性骨髓瘤肾损害

据国内外统计,多发性骨髓瘤肾损害发生率为60%～90%,肾衰竭为多发性骨髓瘤患者仅次于感染引起死亡的主要原因.     

脊柱多发性骨髓瘤的诊断与治疗———附36例报告

目的:探讨脊柱多发性骨髓瘤(multiple myeloma,MM)的诊断与外科治疗方法选择。方法:回顾性分析收治的脊柱MM患者36例的临床资料,平均年龄为55.5岁(34～78岁)。患者均有局部疼痛;伴有神经功能损害25例。26例行CT引导下穿刺活检,24例病理诊断为骨髓瘤,1例为淋巴瘤,1例为软骨组织;5例手术取得病理;5例通过骨髓穿刺涂片诊断。16例化疗(其中4例有难以控制的骨痛,神经损害轻或进展缓慢者辅以放疗,1例行骨髓移植),其中9例伴神经功能损害,7例脊柱不稳定(因骨质疏松严重或一般状况差而不宜手术);16例神经损害严重或进展迅速、脊柱不稳定者手术治疗(15例行化疗者中3例辅以放疗,1例行骨髓移植;2例行两次手术),其中14例伴神经功能损害,13例脊柱不稳定;2例放弃治疗;2例因失访而治疗不详。结果:32例获随访,平均随访31.5个月(2～108个月),20例存活,12例死亡,死亡者平均存活19.4个月(2～40个月)。化疗者6例死亡,1例失访,9例存活;存活者中3例伴神经功能损害,其中1例仅化疗,神经功能无明显改善;2例放疗+化疗,神经功能均有改善;5例脊柱不稳定,4例仅化疗,其中1例压缩骨折进一步加重,1例行放疗+化疗,症状缓解,但无随访影像学资料;7例患者化疗平均9.1个月后,病灶区未见明显成骨反应。16例手术者4例死亡,1例失访,11例存活,存活者中9例伴神经功能损害,其中77.8%(7/9)有神经功能改善;11例术前脊柱不稳定者,平均随访45.9个月,脊柱保持稳定;一期手术存活者有9例,3例前路,3例后路,3例前后联合入路,随访52个月(5～108个月),各手术入路患者临床效果相似。结论:CT引导下病灶穿刺活检是确诊MM的安全、有效的手段。放疗与手术均可改善MM患者的神经功能,但应严格掌握手术适应证。脊柱不稳定者可考虑手术治疗。     

Biphasic anti-osteoclastic action of intravenous alendronate therapy in multiple myeloma bone disease

Multiple myeloma is a malignancy of plasma cells with osteolytic bone destruction. Bisphosphonates inhibit osteoclast activity and are widely used for the treatment of myeloma bone disease. We analyzed the changes in urinary cross-linked N-telopeptides of collagen (u-NTx) and urinary calcium (u-Ca) after bisphosphonate alendronate therapy in ten patients with myeloma bone disease. In all patients, the levels of u-Ca and u-NTx decreased within a week. After the maximum decrease of u-NTx, u-NTx started increasing in half of the patients. However, this further increase in u-NTx decreased again without any additional therapy. Disease severity and pretreatment u-NTx concentrations did not differ between patients with and without the rebound. Patients who did not have rebound had decreased bone marrow monocytes and decreased serum concentrations of interleukin 18, which is produced by monocytes. Our results suggest that impaired activity of monocytes, which are possible osteoclast precursors, is related to reduced bone destruction in multiple myeloma.