{"title":"作为多发性骨髓瘤诊断线索的无症状皮损--病例报告","authors":"Anjana Jayaprakash, Thankappan Thonduparampil Pappen, Rhia Sebastian, Balachandran Parapattu Kunjukunju, Anju Joseph, Leny Mathew","doi":"10.25259/jsstd_3_2024","DOIUrl":null,"url":null,"abstract":"Multiple myeloma (MM) is a rare cancer of plasma cells in the bone marrow. Cutaneous plasmacytoma is an uncommon but specific skin lesion in MM with an incidence of 2%. Cutaneous plasma cell infiltration in pre-existing MM is a very rare phenomenon, with approximately 100 cases described in the literature. Here, we report a case of a 61-year-old male who presented with asymptomatic skin nodules and plaques over the chest, abdomen, and back of the trunk for five months. Histopathological examination showed mononuclear cells with moderate cytoplasm and round to ovoid nuclei. Immunohistochemistry showed CD138 and kappa positivity and lambda and CD20 negativity, confirming the diagnosis of cutaneous plasmacytoma. Bone marrow biopsy and immunohistochemistry revealed bone marrow plasmacytosis with kappa light chain restriction. Serum free light chain ratio was 106.61 and fluorescence in situ hybridization showed del 13q. The clinical features and investigations fulfilled the diagnostic criteria for MM, and the patient was started on chemotherapy, following which the skin lesions improved. Development of skin lesions is seen in the advanced stages of MM and is considered a bad prognostic sign. However, they can also be seen as initial manifestations of the disease, as in this case. Hence, meticulous investigations and early diagnosis are of paramount importance.","PeriodicalId":17051,"journal":{"name":"Journal of Skin and Sexually Transmitted Diseases","volume":"24 2","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Asymptomatic skin lesions as a diagnostic clue in multiple myeloma – A case report\",\"authors\":\"Anjana Jayaprakash, Thankappan Thonduparampil Pappen, Rhia Sebastian, Balachandran Parapattu Kunjukunju, Anju Joseph, Leny Mathew\",\"doi\":\"10.25259/jsstd_3_2024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Multiple myeloma (MM) is a rare cancer of plasma cells in the bone marrow. Cutaneous plasmacytoma is an uncommon but specific skin lesion in MM with an incidence of 2%. Cutaneous plasma cell infiltration in pre-existing MM is a very rare phenomenon, with approximately 100 cases described in the literature. Here, we report a case of a 61-year-old male who presented with asymptomatic skin nodules and plaques over the chest, abdomen, and back of the trunk for five months. Histopathological examination showed mononuclear cells with moderate cytoplasm and round to ovoid nuclei. Immunohistochemistry showed CD138 and kappa positivity and lambda and CD20 negativity, confirming the diagnosis of cutaneous plasmacytoma. Bone marrow biopsy and immunohistochemistry revealed bone marrow plasmacytosis with kappa light chain restriction. Serum free light chain ratio was 106.61 and fluorescence in situ hybridization showed del 13q. The clinical features and investigations fulfilled the diagnostic criteria for MM, and the patient was started on chemotherapy, following which the skin lesions improved. Development of skin lesions is seen in the advanced stages of MM and is considered a bad prognostic sign. However, they can also be seen as initial manifestations of the disease, as in this case. Hence, meticulous investigations and early diagnosis are of paramount importance.\",\"PeriodicalId\":17051,\"journal\":{\"name\":\"Journal of Skin and Sexually Transmitted Diseases\",\"volume\":\"24 2\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Skin and Sexually Transmitted Diseases\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.25259/jsstd_3_2024\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Skin and Sexually Transmitted Diseases","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25259/jsstd_3_2024","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
多发性骨髓瘤(MM)是一种罕见的骨髓浆细胞癌症。皮肤浆细胞瘤是多发性骨髓瘤中一种不常见但特殊的皮肤病变,发病率为 2%。已存在 MM 的皮肤浆细胞浸润是一种非常罕见的现象,文献中描述的病例约有 100 例。在此,我们报告了一例 61 岁男性患者的病例,患者胸部、腹部和躯干后部出现无症状皮肤结节和斑块长达 5 个月。组织病理学检查显示,患者为单核细胞,胞浆中等,核圆形至卵圆形。免疫组化显示 CD138 和 kappa 阳性,λ 和 CD20 阴性,确诊为皮肤浆细胞瘤。骨髓活检和免疫组化显示骨髓浆细胞增多症,kappa轻链受限。血清游离轻链比值为106.61,荧光原位杂交显示del 13q。临床特征和检查结果均符合 MM 的诊断标准,患者开始接受化疗,随后皮损有所改善。皮损出现在 MM 晚期,被认为是预后不良的征兆。然而,皮损也可作为疾病的初期表现出现,本病例就是如此。因此,细致的检查和早期诊断至关重要。
Asymptomatic skin lesions as a diagnostic clue in multiple myeloma – A case report
Multiple myeloma (MM) is a rare cancer of plasma cells in the bone marrow. Cutaneous plasmacytoma is an uncommon but specific skin lesion in MM with an incidence of 2%. Cutaneous plasma cell infiltration in pre-existing MM is a very rare phenomenon, with approximately 100 cases described in the literature. Here, we report a case of a 61-year-old male who presented with asymptomatic skin nodules and plaques over the chest, abdomen, and back of the trunk for five months. Histopathological examination showed mononuclear cells with moderate cytoplasm and round to ovoid nuclei. Immunohistochemistry showed CD138 and kappa positivity and lambda and CD20 negativity, confirming the diagnosis of cutaneous plasmacytoma. Bone marrow biopsy and immunohistochemistry revealed bone marrow plasmacytosis with kappa light chain restriction. Serum free light chain ratio was 106.61 and fluorescence in situ hybridization showed del 13q. The clinical features and investigations fulfilled the diagnostic criteria for MM, and the patient was started on chemotherapy, following which the skin lesions improved. Development of skin lesions is seen in the advanced stages of MM and is considered a bad prognostic sign. However, they can also be seen as initial manifestations of the disease, as in this case. Hence, meticulous investigations and early diagnosis are of paramount importance.