肾透明细胞癌合并多发性骨髓瘤1例并文献复习

doi:10.3969/j.issn.1004-583X.2024.10.010

摘要/Abstract

摘要：

目的探讨肾癌骨转移同时合并多发性骨髓瘤的鉴别诊断及经验分享。方法回顾河北医科大学第三医院收治的肾透明细胞癌合并多发性骨髓瘤1例, 并复习相关文献。结果患者中年男性,肾癌病史3年。因“背部疼痛”就诊,系统检查后取椎体肿物病理活检发现肾癌骨转移合并多发性骨髓瘤。结论提高临床医生对这两种恶性肿瘤合并存在的认识,尤其是当肾细胞癌患者出现新的溶解性骨病变时,通过全面检查鉴别骨转移与多发性骨髓瘤。

关键词: 癌, 肾细胞, 多发性骨髓瘤, 重复癌

Abstract:

Objective To explore the differential diagnosis of kidney cancer with bone metastasis combined with multiple myeloma and to share experience. Methods A case of renal clear cell carcinoma combined with multiple myeloma admitted to the Third Hospital of Hebei Medical University was retrospectively analyzed, and the related literature was reviewed. Results The middle-aged male had the history of renal cancer with 3 years. The patient was treated for “back pain”, and pathological biopsy of vertebral mass after systematic examination revealed that the patient had kidney cancer with bone metastasis complicated with multiple myeloma. Conclusion Clinicians should improve the understanding of the coexistence of these two malignant tumors, especially when new osteolytic lesions are present in patients with renal cell carcinoma, a comprehensive examination is conducted to distinguish bone metastasis and multiple myeloma.

Key words: carcinoma, renal cell, multiple myeloma, multiplicity carcinoma

中图分类号:

R730.26

田馨, 赵丽, 刘会晶. 肾透明细胞癌合并多发性骨髓瘤1例并文献复习[J]. 临床荟萃, 2024, 39(10): 925-928.

Tian Xin, Zhao Li, Liu Huijing. Renal clear cell carcinoma complicated with multiple myeloma: A case report and literature review[J]. Clinical Focus, 2024, 39(10): 925-928.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.10.010

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I10/925

图/表 2

图1 腰椎MRI显示 L1、L2、L4椎体骨质破坏及局部脊髓受压,L1椎体后缘局部后凸。DWI示腰椎L1及上缘不规则高信号团块。T1:纵向弛豫时间;T2:横向弛豫时间;T2FS:T2加权脂肪抑制图像;DWI:扩散加权成像;ADC:表观扩散系数图像

Fig.1 Lumbar MRI showed L1, L2, and L4 vertebral bone destruction and local spinal cord compression, the posterior margin of L1 vertebral body local kyphosis. DWI showed irregular high signal mass at L1 and upper margin of the lumbar vertebra. T1: longitudinal relaxation time; T2: transverse relaxation time; T2FS: T2-weighted fat-suppressed images; DWI: diffusion weighted imaging; ADC: apparent diffusion coefficient image

图2 腰椎穿刺活检,HE染色和免疫组织化学染色(×100) a.病理切片可见红色箭头指向透明细胞癌呈腺泡状、巢状结构,胞质透明,核大小不一,黑色箭头指向合并浆细胞瘤胞体和胞核呈圆形或不规则形;b.Pax-8免疫组化;c.CA-9免疫组化;d.CD38免疫组化

Fig.2 Needle biopsy of lumbar HE staining and immunohistochemical staining(×100) a. Pathology visualized an alveolar and nest-like structure of clear cell carcinoma (red arrow), with clear cytoplasm and nucleus at varying sizes. A plasmacytoma merges clear cell carcinoma cells (black arrow), with round or irregular cell body and nucleus. b. Immunohistochemical expression of Pax-8; c. Immunohistochemical expression of CA-9; d. Immunohistochemical expression of CD38

参考文献 14

[1]	Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013[J]. CA Cancer J Clin, 2013, 63(1): 9-11.
[2]	Rajkumar SV. Multiple myeloma: 2016 Update ondiagnosis, risk stratification, and management[J]. Am J Hematol, 2016, 91(7):719-734. doi: 10.1002/ajh.24402 pmid: 27291302
[3]	肾细胞癌诊疗指南(2022年版)编写审定专家组. 肾细胞癌诊疗指南(2022年版)[EB/OL]. http://www.nhc.gov.cn/yzygj/s2911/202204/a0e67177df1f439898683e1333957c74/files/71c1a3953bcd42059e1bda2859305cef.pdf.html, 2022-03-25.
[4]	Ojha RP, Evans EL, Felini MJ, et al. The association between renal cell carcinoma and multiple myeloma: Insights from population-based data[J]. BJU Int, 2011, 108(6): 825-830. doi: 10.1111/j.1464-410X.2010.09892.x pmid: 21091979
[5]	Choueiri TK, Baz RC, McFadden CM, et al. An association between renal cell carcinoma and multiple myeloma: A case series and clinical implications[J]. BJU Int, 2008, 101(6): 712-715. pmid: 17970789
[6]	Kurtz JE, Andrès E, Maloisel F, et al. Renal clear-cell adenocarcinoma and type B lymphomatous proliferation: A fortuitous association?[J]. Rev Med Interne, 1999, 20(4):329-332. pmid: 10327476
[7]	颜灵芝, 商京晶, 施晓兰, 等. 多发性骨髓瘤合并实体肿瘤6例报道并文献复习[J]. 中国血液流变学杂志, 2019, 29(3): 293-295.
[8]	谭至柔, 黄雪, 黄振宁, 等. 结肠癌与多发性骨髓瘤重复癌1例[J]. 临床荟萃, 2012, 27(5): 442.
[9]	McDougal WS, Cramer SF, Miller R. Invasive carcinoma of the renal pelvis following cyclophosphamide therapy for nonmalignant disease[J]. Cancer, 1981, 48(3): 691-695. pmid: 7248895
[10]	Shields LB, Kalebasty AR. Concurrent renal cell carcinoma and hematologic malignancies: Nine case reports[J]. World J Clin Oncol, 2020, 11(8):644-654. doi: 10.5306/wjco.v11.i8.644 pmid: 32879850
[11]	Sakai A, Kawano M, Kuramoto A. Interleukin-6 produced by renal-cell carcinoma cells and progression of multiple myeloma[J]. N Engl J Med, 1991, 324(26): 1893-1894.
[12]	Laber DA. Risk factors, classification, and staging of renal cell cancer[J]. Med Oncol, 2006, 23(4): 443-454. pmid: 17303902
[13]	Eder K, Baffy N, Falus A, et al. The major inflammatory mediator interleukin-6 and obesity[J]. Inflamm Res, 2009, 58(11): 727-736. doi: 10.1007/s00011-009-0060-4 pmid: 19543691
[14]	Zhu W, Chen W. Bortezomib-based treatment for multiple myeloma patients with renal impairment: A systematic review and meta-analysis of observational studies[J]. Medicine (Baltimore), 2016, 95(46):e5202.

[1]	陈瑾, 吕鸿雁, 刘晗, 刘建宁, 卢佳配, 张金巧. 靶向BCMA的嵌合抗原受体T细胞治疗三重难治性多发性骨髓瘤的研究进展[J]. 临床荟萃, 2023, 38(7): 654-658.
[2]	冷婉铜, 陶洁. 多发性骨髓瘤患者治疗后发生静脉血栓栓塞的危险因素[J]. 临床荟萃, 2023, 38(4): 340-345.
[3]	张丽红, 马兵. 血清β-CTx及TRACP-5b与多发性骨髓瘤骨病病情严重程度及预后关系[J]. 临床荟萃, 2021, 36(7): 623-627.
[4]	李枫，王飞，岳延华，郭嫣婷，董伟民，林艳. 红细胞分布宽度在多发性骨髓瘤患者中预后的相关性研究[J]. 临床荟萃, 2019, 34(10): 915-920.
[5]	张雯洁，张启科，魏小芳，冯友繁. 胸苷激酶1在多发性骨髓瘤治疗及预后中的临床意义[J]. 临床荟萃, 2019, 34(1): 68-71.
[6]	杨建柱a，吕鸿雁b，张金巧b，孙丽霞b. 多发性骨髓瘤出现皮肤髓外病变及梗阻性黄疸1例[J]. 临床荟萃, 2018, 33(7): 615-617.
[7]	杨建柱a，张金巧b，王晓萌a，吕鸿雁b，孙丽霞b. 初诊时伴髓外病变的多发性骨髓瘤患者预后及影响因素分析[J]. 临床荟萃, 2018, 33(6): 490-493,497.
[8]	武贤达，孙丽霞，吕鸿雁，张金巧. 多发性骨髓瘤治疗新进展[J]. 临床荟萃, 2017, 32(7): 627-632.
[9]	任金海，郭晓楠. 多发性骨髓瘤诊断与治疗的研究进展[J]. 临床荟萃, 2017, 32(2): 177-180.
[10]	王连庆a，程瑶a，郝洪岭b，陈英敏a. 以脑膜脑侵犯为首发的多发性骨髓瘤1例[J]. 临床荟萃, 2017, 32(12): 1088-1090.
[11]	马愔花, 李莉娟, 刘树梅, 刘洋, 张连生. 免疫治疗在多发性骨髓瘤中的研究进展[J]. 临床荟萃, 2016, 31(4): 447-450.
[12]	范玉芳;郑翠苹;吴圣豪. 多发性骨髓瘤周围神经病变研究进展[J]. 临床荟萃, 2015, 30(6): 710-714.
[13]	马李洁;李莉娟;张连生. 多发性骨髓瘤治疗现状及前景[J]. 临床荟萃, 2015, 30(4): 476-480.
[14]	付向男;孟建波. 双克隆IgG-λ、IgA-κ多发性骨髓瘤1例[J]. 临床荟萃, 2015, 30(10): 1186-1188.
[15]	陈广华;林凤茹. 多发性骨髓瘤的误诊因素分析[J]. 临床荟萃, 2015, 30(10): 1120-1122.