浆细胞胞浆含明显颗粒κ轻链型多发性骨髓瘤临床回顾分析

doi:10.3969/j.issn.1673-8640.2021.08.008

检验医学 ›› 2021, Vol. 36 ›› Issue (8): 818-822.DOI: 10.3969/j.issn.1673-8640.2021.08.008

浆细胞胞浆含明显颗粒κ轻链型多发性骨髓瘤临床回顾分析

王洪玲¹, 李莉¹, 张春玲¹, 蔺丽慧¹, 丁静¹, 李会丹¹, 魏道林², 白萍¹()

1.上海交通大学医学院附属第一人民医院检验科,上海 201600
2.上海交通大学医学院附属第一人民医院血液科,上海 201600

收稿日期:2020-08-11 出版日期:2021-08-30 发布日期:2021-08-30
通讯作者: 白萍
作者简介:白萍,E-mail： baipingxx@126.com。
王洪玲,女,1988年生,硕士,技师,主要从事血液病相关形态学检验及诊疗研究。
基金资助:
第一轮促进市级医院临床技能与临床创新三年行动计划(16CR3098B)

Retrospective clinical analysis of κ light chain multiple myeloma with cytoplasmic granules

WANG Hongling¹, LI Li¹, ZHANG Chunling¹, LIN Lihui¹, DING Jing¹, LI Huidan¹, WEI Daolin², BAI Ping¹()

1. Department of Clinical Laboratory,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201600,China
2. Department of Hematology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201600,China

Received:2020-08-11 Online:2021-08-30 Published:2021-08-30
Contact: BAI Ping

摘要/Abstract

摘要：

目的分析多发性骨髓瘤浆细胞胞浆中的常见包涵体,为多发性骨髓瘤浆细胞形态学诊断提供参考。方法采用瑞-吉染色法,查找1例κ轻链型多发性骨髓瘤患者骨髓细胞涂片中极罕见的浆细胞,并结合国内外相关文献,对类似病例进行回顾分析。结果形态学检查发现可能为嗜天青颗粒的大小不等、较不规则、紫红色的包涵体样颗粒。相关研究结果表明,多发性骨髓瘤的浆细胞胞浆常见包涵体样颗粒包括Russell小体、Mott细胞、Dutcher小体、类Auer小体等,可能有一定的临床意义。结论罕见异常浆细胞的形态学诊断对轻链型多发性骨髓瘤和浆细胞中出现包涵体的多发性骨髓瘤的诊断有重要的参考价值。

关键词: 浆细胞, 嗜天青颗粒, 形态学诊断, 轻链型多发性骨髓瘤

Abstract:

Objective To analyze cytoplasmic inclusions in plasma cells of multiple myeloma,that will be useful for the morphological diagnosis of multiple myeloma with abnormal plasma cells. Methods A rare kind of plasma cells was found in the bone marrow smear of κ light chain multiple myeloma using Wright-Giemsa staining. The case was analyzed retrospectively,and the relevant literatures in Pubmed were searched. Results Abnormal plasma cell cytoplasma in this case showed obvious,different-sized,irregular and purple-red granules. The granules in this case may be azurophilic granules. Russell bodies,Mott cells,Dutcher bodies and Auer rod-like inclusions were common intra-cytoplasmic inclusions in plasma cells. These inclusions may play roles in clinic. Conclusions The morphological diagnosis of multiple myeloma with abnormal plasma cells plays a role in the diagnosis of light chain multiple myeloma or multiple myeloma with abnormal plasma cell inclusions.

Key words: Plasma cell, Azurophilic granule, Morphological diagnosis, Light chain multiple myeloma

中图分类号:

R446.1

王洪玲, 李莉, 张春玲, 蔺丽慧, 丁静, 李会丹, 魏道林, 白萍. 浆细胞胞浆含明显颗粒κ轻链型多发性骨髓瘤临床回顾分析[J]. 检验医学, 2021, 36(8): 818-822.

WANG Hongling, LI Li, ZHANG Chunling, LIN Lihui, DING Jing, LI Huidan, WEI Daolin, BAI Ping. Retrospective clinical analysis of κ light chain multiple myeloma with cytoplasmic granules[J]. Laboratory Medicine, 2021, 36(8): 818-822.

图/表 7

图1 血清蛋白电泳结果

图2 骨髓细胞浆细胞系统形态学检查结果（×100）注：→ 所示为胞浆含颗粒的异常浆细胞;→ 所示为中幼粒细胞。

图3 骨髓细胞特殊化学染色结果（×100）注：箭头所指为过氧化物酶阳性的髓系细胞。

图4 患者第2次和第4次化疗后的骨髓细胞涂片（×100）注：（a）第2次化疗后涂片;（b）第4次化疗后涂片。

图5 流式细胞免疫分型结果

表1 浆细胞胞浆含嗜天青颗粒浆细胞瘤病例报道

性别	年龄/岁	M蛋白	诊断	参考文献
女	82	阴性	非分泌型多发性骨髓瘤	[17]
未知	未知	IgG κ轻链	多发性骨髓瘤	[23]
男	80	IgG κ轻链	多发性骨髓瘤Ⅲ期B组	[16]
男	45	IgG κ轻链	多发性骨髓瘤	[24]
女	74	IgG κ轻链	浆细胞骨髓瘤	[18]

图6 已报道的浆细胞胞浆含嗜天青颗粒的多发性骨髓瘤病例图片总结注：（a）~（f）分别为文献[26]、[27]、[17]、[24]、[18]、[19]中图片。

参考文献 26

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浆细胞胞浆含明显颗粒κ轻链型多发性骨髓瘤临床回顾分析

Retrospective clinical analysis of κ light chain multiple myeloma with cytoplasmic granules

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