摘要
目的探讨老年女性脊柱多发浆细胞瘤(MPS)患者的临床表现、诊断、治疗及预后。方法选择2024年7月于中国人民解放军陆军第七十二集团军医院确诊的1例老年女性MPS患者(患者1)为研究对象。采用回顾性分析法,对其病史、临床表现,入院后影像学检查、病理学检查结果,以及诊治经过进行分析。采用本研究设定的检索策略,对国内外数据库中MPS相关研究进行文献复习。本研究经过中国人民解放军陆军第七十二集团军医院医学伦理委员会的批准(伦理委员会批号:院〔2024〕6号)。结果患者1入院相关检查、入院诊断及治疗结果如下。①病史采集与骨科专科查体:女性,78岁,无明显诱因出现颈、背部伴左上肢疼痛3+个月;颈背部压痛明显,伸展、旋转活动稍受限,左侧颈、肩部至左手指感觉减退。②入院后实验室检查:红细胞计数(RBC)为3.12×1012/L,血红蛋白(Hb)为79 g/L,纤维蛋白原为1.81 g/L,均较正常值降低,球蛋白为50.6 g/L,较正常值增高。③入院后影像学检查:颈椎CT表现为C5棘突与C7棘突、椎弓、横突等多个附件及C7部分椎体溶骨性骨质破坏,骨皮质局部边缘硬化,其内呈软组织密度影。颈椎MRI表现为C5棘突与C7棘突、椎弓、横突等多个附件及C7部分椎体可见片状均匀等T1、等T2信号,脂肪抑制序列高信号,弥散加权成像(DWI)呈稍高信号,表观弥散系数(ADC)呈低信号,增强检查可见肿块被均匀强化,边界清晰,脊髓明显受压。患者1入院诊断为MPS患者。④治疗与术中切除病变组织病理学及免疫组化结果:在全身麻醉下对患者1进行颈后路切开C7椎体肿块切除术+脊髓松解术+椎体内固定术,术中见C7椎体与棘突破坏,肿块囊性包裹,打开后见呈果冻样,质地软,肿块囊壁与硬膜黏连。术中切除病变组织病理学及免疫组化结果显示,CD138(+)、CD38(+)、Ki-67(+,阳性率约为30%),病理诊断为浆细胞瘤。术后患者1颈部疼痛及左上肢麻痛明显改善,神经功能明显恢复。⑤文献检索结果:在国内外数据库中共计检索出2篇MPS相关研究文献,涉及MPS患者9例(患者2~10),加上本研究患者1,共计10例MPS患者。这10例MPS患者中,8例(患者2~9)由脊柱孤立性浆细胞瘤(SPS)进展为MPS,1例(患者10)为双下肢瘫痪术后临床确诊为MPS。对其中2例(患者1与10)采取单纯手术治疗,2例(患者2与7)采取手术联合放疗,1例(患者6)采取手术联合放、化疗,2例(患者5与8)采取化疗联合放疗,3例(患者3、4、9)采取单纯放疗;4例(患者1、2、7、8)预后良好;2例(患者3与9)进展为多发性骨髓瘤(MM)。随访结果显示,1例(患者3)随访结束时仍存活,1例(患者9)死亡;3例(患者5、6、8)进展为白血病后,2例(患者5与6)死亡,1例(患者8)随访结束时仍存活;1例(患者10)术后14 d出院后失访;1例(患者4)出院后失访。结论患者1为以下颈椎多个椎体附件受累为主的老年女性,结合实验室和影像学检查、术中切除病变组织病理学检查被确诊为MPS。国内外报道的MPS患者较少,对于该病患者治疗,以放、化疗为主,恰当的手术可及时改善患者神经系统功能,缓解相应疼痛症状。
Objective To explore the clinical manifestations,diagnosis,treatment,and prognosis of elderly female patients with multiple plasmacytoma of spine(MPS).Methods A case of elderly female MPS(patient 1)diagnosed in the 72nd Group Army Hospital of the Chinese People's Liberation Army in July 2024 was selected as the research subject.A retrospective study was conducted to analyze the medical history,clinical manifestations,imaging,and pathological examination results of patient 1 after admission,as well as the diagnosis and treatment process.The literature review of MPS-related research in domestic and foreign databases was conducted using the search strategy set in this study.This study was approved by the Medical Ethics Committee of the 72nd Group Army Hospital of the Chinese People's Liberation Army(Approval No.2024-6).Results The admission-related examinations,admission diagnosis and treatment results of patient 1 were as follows.①Medial history and orthopedic examination:Patient 1 was a 78-year-old female who had neck,back and left upper limb pain for more than 3 months without obvious cause.Orthopedic examination showed obvious neck and back tenderness,slightly limited stretching and rotational movements,and decreased sensation in the left neck,shoulder,and left fingers.②Laboratory examination after admission:The red blood cell count(RBC)was 3.12×1012/L,hemoglobin(Hb)was 79 g/L,and fibrinogen was 1.81 g/L,all of which were lower than normal,and the globulin was 50.6 g/L,which was higher than normal.③Post-admission imaging examination:Cervical spine CT showed lytic bone destruction of the C5 spinous process,C7 spinous process,vertebral arch,transverse process,and part of the vertebral body,and the local edge of bone cortex was hardened,and a soft tissue density shadow was shown in it.Cervical spine MRI showed T1-weighted iso intensity and T2-weighted iso intensity in C5 spinous process,C7 spinous process,vertebral arch,transverse process,and and part of the vertebral body.And fat suppression sequences had hyperintensity,slightly elevated intensity in diffusion-weighted imaging(DWI),and hypointensity in apparent diffusion coefficient(ADC)images.These areas showed homogeneous enhancement in the enhancement scan,with clear borders,and the spinal cord was markedly compressed.④Treatment and intraoperative resection histopathology and immunohistochemistry results:Patient 1 underwent posterior cervical incision,C7 vertebral lumpectomy,spinal cord release,and vertebral fixation under general anesthesia,and the C7 vertebra had cortical destruction.The tumor was cystic and encapsulated,with a jelly-like opening and a soft texture.The cyst wall of the mass was adherent to the dura mater.Histopathology of intraoperative resection tissue and immunohistochemistry revealed positive results for CD138(+),CD38(+),and Ki-67(+,approximately 30%).The pathologic diagnosis was plasmacytoma.After the operation,neck pain and numbness,and pain in the left upper limb of patient 1 were significantly improved,her neurological function was significantly r estored.⑤Literature search results:Two pieces of MPS related literature were retrieved in domestic and foreign databases,involving 9 patients(patients 2-10),plus patient 1 in this study,a total of 10 MPS patients.Among these 10 patients,8 cases(patients 2-9)progressed from solitary plasmacytoma of spine(SPS)to MPS,and 1 case(patient 10)was clinically diagnosed as MPS after double lower limb paralysis.Two cases(patients 1 and 10)was treated with surgery alone,2 cases(patients 2 and 7)were treated with surgery combined with radiotherapy,1 case(patient 6)was treated with surgery combined with radiotherapy and chemotherapy,2 cases(patients 5 and 8)were treated with chemotherapy combined with radiotherapy,and 3 cases(patients 3,4,and 9)were treated with radiotherapy alone.Four patients(patients 1,2,7,and 8)had a good prognosis;2 patients(patients 3 and 9)progressed to multiple myeloma(MM),1 patient(patient 3)was still alive at the end of follow-up,and 1 patient(patient 9)died;3 patients(patients 5,6,and 8)progressed to leukemia,and 2 patients(patients 5 and 6)died,and 1 patient(patient 8)was still alive at the end of follow-up;1 patient(patient 10)was discharged 14 d after surgery and was lost to follow-up,and 1 patient(patient 4)was lost to follow-up after discharge.Conclusions In this study,one elderly female patient with MPS who mainly had multiple appendages involved in the lower cervical segment was diagnosed by combining laboratory and imaging examinations and intraoperative resection histopathological examination.There are few reported MPS patients at home and abroad,and the treatment of patients with MPS is mainly radiotherapy and chemotherapy,appropriate surgery can improve the patient's neurological function and alleviate the corresponding pain symptoms in time.
作者
沈钰
张步环
黄祖金
唐杰
李世俊
Yu Shen;Buhuan Zhang;Zujin Huang;Jie Tang;Shijun Li(Department of Radiology,the 72nd Group Army Hospital of the Chinese People's Liberation Army,Huzhou 313000,Zhejiang Province,China;Department of Radiology,Third Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华妇幼临床医学杂志(电子版)》
2025年第2期237-244,共8页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
