Secondary plasma cell leukemia due to nonsecretory multiple myeloma (A case report)

Nonsekretuar multiple myeloma'ya sekonder gelişen plazma hücreli lösemi (Bir olgu sunumu)

Oral NEVRUZ,Cengiz BEYAN,Türker ÇETİN,Ferit AVCU,Ali Uğur URAL,Kürşad KAPTAN,Atilla YALÇIN

Abstract

Plasma cell leukemia is characterized by the presence of more than 2.000/mm3 plasma cells in the peripheral blood. 63-year old male patient with anaemia was admitted to our center for the evaluation of his anaemia. He had had the complaints of pain on the right arm reflecting to his shoulder, weakness, anorexia, and weight loss for 3-4 months. On physical examination there was severe tenderness by palpating his right shoulder and all ribs. His CBC was found as Hb: 8,7 g/dL, Hct: 25 %, WBC: 11.200/mL, platelet: 209.000/mL Peripheral smear revealed that 57 % PMNL, 10 % lymphocyte, 9 % monocyte, 19 % plasma cells, 3 % band, 2 % basophil, and ESR was 142 mm/h. The creatinin and LDH levels were found 1,4 mg/dl, and 1015 u/L, respectively. Protein electrophoresis showed hypogammagloblinemia but no monoclonal peak. In his immunological tests were found Ig G: 430 mg/dl, Ig M: 21,1 mg/dl, Ig A: 41,4 mg/dl, kappa: 259 mg/dl, lambda: 299 mg/dl. His craniography was showed lytic lesions. Bence-Jones proteinuria was not detected. Bone marrow aspiration was consisted with the infiltration 90,6 % of atypical plasma cells. Immunophenotyping of bone marrow showed CD 38 positivity (88,41 %). He was diagnosed as "plasma cell leukemia due to nonsecretory multiple myeloma" and treated with melphalan and prednisolone chemotherapy. He recovered rapidly and discharged until the second chemotherapy. This is an interesting case in which diagnosed as plasma cell leukemia as presenting features of nonsecretory myeloma seen rarely.

Özet

Plazma hücreli lösemi periferik kanda mutlak plazma hücresi sayısının 2.000/mm3ün üzerinde olduğu tablodur. 63 yaşında erkek hasta anemisi olması nedeniyle kliniğimize sevk edildi. Son 3-4 aydır, giderek artan sağ kolda, sağ omuza vuran ağrı, halsizlik, iştahsızlık, kilo kaybı yakınmaları mevcuttu.Fizik muayenede sağ omuzda ve kostalarda palpasyonla belirgin hassasiyet mevcuttu. Hemoglobin: 8,7 g/d/, hematokrit: % 25, lökosit: 11.200/mm3, trombosit: 209.000/mm3 idi. Periferik yaymada % 57 PMNL, % 10 lenfosit, % 9 monosit, % 19 plazma hücresi, % 3 stab, % 2 bazofil mevcuttu. Eritrosit sedimentasyon hızı 142 mm/saat, kreatinin: 1,4 mg/dl, LDH: 1015 u/l olarak bulundu. Protein elektroforezinde monoklonal pik izlenmiyordu ve hipogamaglobulinemi mevcuttu, immünolojik tetkiklerinde Ig G: 430 mg/dl, Ig M: 21,1 mg/dl, Ig A: 41,4 mg/dl, kappa: 259 mg/dl, lambda: 299 mg/dl olarak tespit edildi, iki yönlü kafa grafisinde litik lezyonlar mevcuttu, idrarda Bence-Jones proteini negatifti. Kemik iliği aspirasyonunda % 90,6 oranında atipik natürde plazma hücreleri ile infiltrasyon izlendi. İmmün fenotiplendirmede kemik iliğinde CD 38+ hücre oranı % 88,41 idi. Hasta "nonsekretuarmu/tiple myelomaya sekonder gelişen plazma hücreli lösemi" olarak değerlendirildi ve melfelan + prednizolon şeklinde kemoterapiye başlandı.Klinik yakınmaları hızla düzelen hasta ikinci tedaviye gelmek üzere taburcu edildi. Olgumuzun, nadir görülen nonsekretuar myelomanın prezantasyon bulgusu olarak yine nadir görülen plazma hücreli lösemi olması ilginçtir.