原发性肾髓外浆细胞瘤1例报告及文献复习

Yin-Yin Peng
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摘要

髓外浆细胞瘤(EMPs)通常发生在上呼吸道,发生在肾脏是极其罕见的。本研究报告一例46岁男性原发性肾浆细胞瘤患者,因肾功能衰竭而尿频、尿急、夜尿增多。计算机断层扫描(CT)显示右肾下极60×58mm强化肿块。在根治性肾切除术后,切除标本的组织病理学和免疫组织化学分析支持浆细胞瘤的诊断。骨髓活检和全身骨骼调查显示没有多发性骨髓瘤(MM)和骨骼病变的证据。因此,诊断原发性肾EMP被提出。随后患者接受VAD(长春新碱、表柔比星、地塞米松)+环磷酰胺+沙利度胺化疗4个疗程,随访4年无疾病。本文还对相关文献进行了综述。原发性肾EMP的治疗是手术、放疗、化疗或这些治疗的组合,甚至造血干细胞移植也是一种选择。长期随访是系统性控制的必要条件,因为有可能转化为MM。
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Primary Extramedullary Plasmacytoma of the Kidney: A Case Report and Literature Review
Extramedullary plasmacytomas (EMPs) usually occur in the upper respiratory tract, the occurrence in the kidney is extremely rare. The present study reported a case of primary renal plasmacytoma in a 46‑year‑old male patient with frequent and urgent urination, nocturia increased due to renal failure. Computed tomography (CT) imaging showed a 60×58mm enhanced mass at the lower pole of the right kidney. Following the radical nephrectomy, histopathological and immunohistochemistry analysis of the resected specimen supported the diagnosis of plasmacytoma. Bone marrow biopsy and total body skeletal survey was performed to demonstrate that there were no evidence of multiple myeloma (MM) and bone lesions. Consequently, a diagnosis of a primary renal EMP was proposed. Subsequently, the patient was treated with 4 course of chemotherapy VAD (vincristine, epirubicin and dexamethasone) + cyclophosphamide + thalidomide, and he was disease-free during 4 years’ follow-up time. The current study also presents a review of the literatures. Treatment of primary renal EMP is surgery, radiotherapy, chemotherapy or a combination of those, even hematopoietic stem cell transplantation may be also an option. Long-term follow-up is a necessity for systemic control due to the possibility to transform into MM.
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