CAJ | 학술논문

目的分析脊柱孤立性浆细胞瘤的临床特征、影像表现、病理诊断与治疗.方法对13例脊柱孤立性浆细胞瘤作临床、放射和病理观察及随访,免疫组织化学EnVision法行白细胞共同抗原、CD20、CD79a、CD3、CD7、PC、MUM1、CD138、IgG、IgM、CD10、bcl-6、κ、λ、Ki-67染色分析免疫表型.结果 13例脊柱孤立性浆细胞瘤患者年龄42-69岁(平均年龄56岁),男女比例3.3∶1;9例发生于胸椎,4例发生于腰椎.病程从半个月到5年不等,病椎附近疼痛是共同的首发症状.X线多表现为椎体的溶骨性破坏;CT多为椎体骨质虫噬状破坏;MRI椎体信号失均,T1加权低信号,T2加权等或稍高信号,增强扫描有不均匀强化.病理学特征为:肿瘤细胞呈弥漫性浸润;分化成熟的瘤细胞形似正常浆细胞,分化不成熟的瘤细胞形似中心母细胞;世界间质少,血管丰富或形成血湖;淀粉样物质沉积.免疫表型:13例之瘤细胞均表达CU79a,均不表达CD20和CD3、CD7,呈轻链限制性表达;所有病例瘤细胞均表达PC,10例表达MUM1,10例表达CD138,5例表达IgG,1例表达IgM,Ki-67指数为10%-50%.治疗均进行局部手术,术后选择性放疗或化疗.结论脊柱孤立性浆细胞瘤具有特征性的临床、影像和病理学改变,诊断时应综合考虑,排除多发性骨髓瘤,提倡尽早影像学检查、全身骨扫描,治疗应手术切除局部病灶,选择性放疗及化疗并长期随访.
목적 분석척주고립성장세포류적림상특정、영상표현、병리진단여치료.방법 대13례척주고립성장세포류작림상、방사화병리관찰급수방,면역조직화학EnVision법행백세포공동항원、CD20、CD79a、CD3、CD7、PC、MUM1、CD138、IgG、IgM、CD10、bcl-6、κ、λ、Ki-67염색분석면역표형.결과 13례척주고립성장세포류환자년령42-69세(평균년령56세),남녀비례3.3∶1;9례발생우흉추,4례발생우요추.병정종반개월도5년불등,병추부근동통시공동적수발증상.X선다표현위추체적용골성파배;CT다위추체골질충서상파배;MRI추체신호실균,T1가권저신호,T2가권등혹초고신호,증강소묘유불균균강화.병이학특정위:종류세포정미만성침윤;분화성숙적류세포형사정상장세포,분화불성숙적류세포형사중심모세포;세계간질소,혈관봉부혹형성혈호;정분양물질침적.면역표형:13례지류세포균표체CU79a,균불표체CD20화CD3、CD7,정경련한제성표체;소유병례류세포균표체PC,10례표체MUM1,10례표체CD138,5례표체IgG,1례표체IgM,Ki-67지수위10%-50%.치료균진행국부수술,술후선택성방료혹화료.결론 척주고립성장세포류구유특정성적림상、영상화병이학개변,진단시응종합고필,배제다발성골수류,제창진조영상학검사、전신골소묘,치료응수술절제국부병조,선택성방료급화료병장기수방.
Objective To study the clinical, radiologic and pathologic features of solitary plasmacytorna of spine. Methods The clinical, radiologic and pathologic features, as well as treatment and fallow-up data, of 13 solitary plasmacytoma of spine cases were retrieved and analyzed. Immunohistochemical study using EnVision method for LCA, CD19, CD20, CD79a, CD3, CD7, PC,MUM1, CD138, IgG, IgM, kappa, lambda and Ki-67 was carried out. Results All the tumours were primarily located in the vertebrae (including 9 cases in thoracic vertebrae and 4 cases in lumbar vertebrae).years). The commonest symptom was pain in the surrounding regions. The degree of neurologic disturbance mostly depended on the extent of vertebral destruction and structural instability of the spine. Radiologic examination showed mainly osteolytic lesions in vertebrae. Magnetic resonance imaging demonstrated the presence of heterogeneous intensity inside the involved vertebrae (low in T1 weighted and high in T2 weighted images). Histologic examination showed diffuse infiltration by malignant cells. In welldifferentiated plasmacytomas, the tumor cells resembled normal plasma cells.In poorly differentiated examples, the cellular morphology mimicked that of the centroblasts. The interstitial stroma was scanty and contained plenty of vessels, sometimes with formation of blood lakes. Amyloid deposition was present in some of the cases.Immunohistochemical study showed that the tumor cells were positive for CD79a and negative for CD20. Light chain restriction was detected in all the 13 cases studied. Plasma cell marker PC was expressed in all cases, while IgG was positive in 5 cases, IgM in 1 case, MUM1 in 10 cases and CD138 in 8 cases. Ki-67 index varied from 10% to 50%. All cases were operated, with adjuvant chemotherapy and radiotherapy given. Conclusions Correlation of clinical, radiologic and pathologic features is important in diagnosis of solitary plasmacytoma of spine. The possibility of multiple myeloma needs to be excluded. Early detection by radiologic examination, local surgical resection, post-operative chemoradiotherapy and long-term follow-up are prudent for successful management of this condition.