骨单发性浆细胞瘤的诊治

Clinical study of solitary bone plasmacytoma

目的 探讨骨的单发性浆细胞瘤 (SBP)的临床特点和影响预后的因素。 方法 5年间诊治 10例SBP患者 ,8例男性 ,2例女性 ;年龄 45～ 64岁 ,平均 51岁。单一病变发生在骶骨 2例 ,骨盆 2例 ,胸椎、肋骨、股骨粗隆、股骨干、肱骨近端和肩胛骨各 1例。术前化验血红蛋白正常 ,血尿素氮、肌酐、钙、磷正常 ,血沉高于正常 ,血浆白蛋白和球蛋白比值 7例正常 ,3例倒置。 10例患者均行手术治疗 ,术后病理诊断为浆细胞瘤 ,但骨髓穿刺检查示浆细胞占有核细胞比例正常 ,2例免疫球蛋白IgG高于正常 ,8例正常 ,蛋白电泳有 2例出现异常M峰 ,尿本周氏蛋白 3例阳性 ,7例阴性。所有患者均予以术后放疗。 结果 除外随访少于 10个月的 4例病人 ,其他 6例病人随访 18～ 48个月 ,平均2 8 2个月。 1例年龄较大髂骨病变患者术后 6个月出现多发病灶 ,M蛋白持续阳性 ,骨髓穿刺检查浆细胞异常升高 ,予以M2方案化疗 ,但于发病后 2 1个月死亡。另 5例患者放疗后一般情况良好 ,随诊复查化验及骨髓检查正常 ,其他部位骨骼未出现新病灶。 结论 与多发性骨髓瘤 (MM)相比 ,SBP患者发病年龄较小 ,症状较轻 ,术后辅助放疗 ,可能长期维持单发病变。年龄 ,病变大小 ,中轴骨病变 ,有无软组织包块 ,放疗后M蛋白的变化情况及诊治的早晚等是影响?

Objective To study the clinical characteristics and the prognosis of solitary bone plasmacytoma(SBP). Methods From June 1997 to June 2002, ten SBP patients were treated in our department. Two lesions were in sacrum, two in pelvis, the other six lesions were in proximal femur, femoral diaphyseal, scapula, thoracic vertebra, proximal humus, and rib respectively. The preoperative laboratory tests were normal. Operation was performed on all patients. The pathologic diagnose was plasmacytoma and then they underwent further laboratory examination, urine Bence Jone protein is positive in 3 patients, serous IgG value was higher than normal in 2 patients, abnormal M protein was found in electrophoresis in 2 patients. All patients received radiotherapy postoperatively. Results Four patients were excluded, whose follow up were lessen than ten months, the other six patients′s average follow up is 28.2 months(from 18 to 48 months), one patient who developed multiple myeloma(MM) six months postoperatively received chemotherapy using M2 protocol and died 21 months after operation. The other five patients had disease free survive and remain solitary bone lesion after the treatment of surgery and radiology. Conclusion Compared with MM, SBP patients are younger, the therapeutic results and prognosis are better. The main prognostic factors include age, the size of lesion, the axial bone lesion, persistence of myeloma protein after radiotherapy, early diagnosis and treatment, and so on.