骨髓瘤性胸腔积液2例报告并文献复习

Myelomatous pleural effusion: two cases reports with literature review

目的研究多发性骨髓瘤(multiple myeloma,MM)合并胸腔积液的临床特点。方法回顾分析北京积水潭医院2004-2015年收治的骨髓瘤性胸腔积液患者的临床资料。结果我院近11年资料完整的胸腔积液患者共3 590例,其中MM患者348例,MM合并胸腔积液者34例,占MM患者的9.8%。仅2例骨髓瘤性胸腔积液(myelomatous pleural effusion,MPE),此2例MPE均经流式细胞学检查确诊。1例为女性,首发临床表现为胸腔积液,诊断为多发性骨髓瘤不分泌型Ⅲ期A型(DS分期),不分泌性Ⅰ期(ISS分期)。1例为男性,诊断为多发性骨髓瘤Ig A-κⅢ期A(DS分期),Ⅱ期(ISS分期)。结论 MPE的检出率很低。MPE为黄色渗出液,性状及理化指标缺乏特征。受骨髓瘤细胞浸润的胸壁可见多个黄色结节,结节有分叶且血供丰富。胸腔积液常规细胞病理学检查敏感性低,流式细胞学检查技术对于MPE的检测具有敏感性高、特异性高的优点,建议推广应用于胸腔积液的检查。

Objective To investigate the clinical characteristics of myelomatous pleural effusion（MPE）. Methods Two cases of MPE were described and relevant cases in the literature were reviewed. Results A total of 3 590 pleural effusion patients, including 348 MM patients, was enrolled into the study. There were 34 patients with MM and pleural effusion among them. The two MPE cases were diagnosed by flow cytometry. The first MPE case was female. The initial clinical manifestation was pleural effusion. Another patient was male. Medium amount of pleural effusion of right lung, pericardial effusion and ascites were found. Conclusion The MPE is yellow exudate, and lack of unique features and characteristics. Flow cytometry is helpful to improve the detection of MPE.