一名年轻患者的多发性骨髓瘤

Miguel Ricardo Quetzal, Jorge Soler González
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摘要

多发性骨髓瘤是一种以恶性浆细胞克隆性增殖为特征的 B 型血癌。确诊时的中位年龄为 70 岁,但在年轻患者中很少见,30 岁以下的患者不到 0.5%。患者是一名 33 岁的男性,开始时出现进行性急性肾损伤,伴有严重的下背部疼痛,无法行走。腰椎CT扫描显示,T12、L2、肋骨、骨盆和股骨近端有多处溶骨性病变。放射学、组织学、骨髓抽吸和蛋白质电泳分析确定了多发性骨髓瘤 III 期的诊断,随后患者接受了化疗。尽管多发性骨髓瘤在年轻患者中较为罕见,但当临床、生物学和放射学征兆均显示有可能患上多发性骨髓瘤时,就应该做出诊断。虽然年轻患者的存活期较长,但年轻患者和老年患者在疾病表现上似乎没有区别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multiple myeloma in a young patient
Multiple myeloma is a type B blood cancer characterized by clonal proliferation of malignant plasma cells. The median age at diagnosis is 70 years, however, it is rare among younger patients, and less than 0.5% are younger than 30 years. A 33-year-old man, who began with progressive acute kidney injury is presented, accompanied by a severe lower back pain and impossibility to walk. A dorso-lumbar spine CT scan showed an extensive process consisting of multiple osteolytic lesions at T12, L2, ribs, pelvic and proximal femur. Radiology, along with histology, bone marrow aspiration and protein electrophoresis analysis allowed to establish the diagnosis of stage III multiple myeloma, after which the patient received chemotherapy. Despite the rarity of multiple myeloma among young patients, this diagnosis should be evoked when clinical, biological and radiological signs are in favour. There appears to be no difference between younger and older patients in disease presentation, although longer survival was reported among younger patients.
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