以胸腔积液为首发症状的多发性骨髓瘤1例并文献复习

Multiple myeloma with pleural effusion as initial symptom： a report of one case and literature review

目的提高对多发性骨髓瘤（MM）诊断的认识。方法报道1例以胸腔积液就诊的MM病例，并对相关文献进行复习。结果45岁女性，胸闷、憋气3个月。近1个月有少尿及头痛、头晕症状。胸部CT示右侧液气胸，左侧大量胸腔积液，胸壁见扁丘状软组织影突出。胸腔镜下见胸腔内大量淡黄色液体，脏层胸膜和膈胸膜光滑，壁层胸膜大量大小不一的结节，质硬，活检不易出血的。病理示浆细胞瘤。胸骨穿刺骨髓象检查示大量的浆细胞瘤细胞骨髓浸润。结论MM患者以髓外病变就诊时，应结合临床表现考虑到MM的可能，及时行骨髓检查明确诊断。并发髓外病变时预后不良。

Objective To improve the understanding of multiple myeloma （MM）. Methods A case of MM with pleural effusion as initial symptom was reported, and relevant literatures were reviewed. Results The female patient was 45 years old,had dyspnoea for three months,and had oliguria,headache and dizziness for nearly one month. Chest computed tomography showed that there were hydropneumothorax in the right, a large number of pleural effusion in the left, and flat hillock-like protuberant soft tissue in the chest wall. Chest thoracoscopic showed that there was massive yellow pleural effusion,the visceral pleura and diaphragmatic pleura were smooth, many nodules on the parietal pleura were variable in size and shape,stiff and hardly hemorrhagic by biopsy. Pathology showed plasmacytoma. By sternal puncture,bone marrow examination revealed a large number of plasmacytoma cells infiltrated bone marrow. Conclusions MM patients with extramedullary disease should be considered to have MM, bone marrow examination should be taken in time to confirm diagnosis. The patient with concurrent extramedullary lesions has poor prognosis.