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ABSTRACT Introduction: Multiple myeloma (MM) is a hematologic malignancy caused by the intense indiscriminate proliferation of plasma cells in the bone marrow. In view of clinical suspicion of MM, clinic laboratory tests and imaging tests should be used, among others. Objectives: Evaluate the laboratory test for protein detection heat method Bence Jones (BJ) used to complementary diagnosis pathology and to characterize the epidemiological profile of patients diagnosed with MM. Material and methods: A retrospective study was conducted from January 2010 to July 2015 of the patients treated at Hospital de Clínicas of Universidade Federal do Paraná (HC/UFPR) in Curitiba, Paraná, Brazil. Results: In the patients analyzed, the average age at diagnosis of MM was 65.6 years, with a minimum percentage of difference between genders [males 52.6% (n = 10) and females 47.4% (n = 9)], predominantly in the white race [84.2% (n = 16)]. Among the patients analyzed, 85.2% (n = 104) had negative BJ exam and 14.8 (n = 18), positive exam; 84.4% (n = 103) had no diagnosis of MM, and 15.6% (n = 19) were diagnosed with the disease. Conclusion: The evaluation results of BJ protein detection by the heat method showed sensitivity of 47.4%, specificity of 91.3%, with positive and negative predictive values of 50% and 90.4%, respectively.
RESUMO Introdução: O mieloma múltiplo (MM) é uma neoplasia maligna hematológica causada pela intensa proliferação indiscriminada de plasmócitos na medula óssea. Diante da suspeita clínica de MM devem ser realizados exames laboratoriais e exames de imagem, entre outros. Objetivos: Avaliar o teste laboratorial de calor para detecção de proteína Bence Jones (BJ), utilizado como diagnóstico complementar da patologia, e caracterizar o perfil epidemiológico dos pacientes diagnosticados com MM. Material e métodos: Foi realizado um estudo retrospectivo de janeiro de 2010 a julho de 2015 dos pacientes atendidos no laboratório do Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brasil. Resultados: Dos pacientes avaliados, a média de idade no momento do diagnóstico de MM foi de 65,6 anos, com um percentual de diferença mínima entre os gêneros masculino [52,6% (n = 10)] e feminino [47,4% (n = 9)] e predomínio na raça branca [84,2% (n = 16)]. Entre os pacientes analisados, 85,2% (n = 104) apresentaram exame de BJ negativo e 14,8 (n = 18), positivo; 84,4% (n = 103) não apresentaram diagnóstico de MM e 15,6% (n = 19) foram diagnosticados com a patologia. Conclusão: Os resultados da avaliação do método de calor de detecção de proteína BJ mostraram sensibilidade de 47,4% e especificidade de 91,3%, com valores preditivos positivo e negativo de 50% e 90,4%, respectivamente.
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Objective To investigate the value of 18F-FDG PET/CT for differentiating multiple myeloma from bone metastases with undetermined origin.Methods A retrospective study was performed on patients with multiple bone destructions and without extraosseous primary malignant tumor in 18F-FDG PET/CT imaging.A total of 26 patients (12 males,average age 55.4 years) with multiple myeloma and 20 patients (9 males,average age 50.2 years) with multiple bone metastases confirmed by biopsy or histopathology from January 2011 to December 2013 were included into this study.The characteristics of 18F-FDG PET/CT and urine Bence-Jones protein were used to establish the diagnostic criteria.Myeloma was diagnosed if two or more of the following conditions could be satisfied:more than 10 bone lesions,osteolytic or mixed bone destruction,SUVmax＜4.0,and positive urine Bence-Jones protein.Two-sample t test and x2 test were used.Results The average number of bone lesions in multiple myeloma patients was 15.8,which was more than that (7.8) in patients with bone metastases.About 71.8％ (296/412) of bone lesions in multiple myeloma and 28.8％ (45/156) of bone metastases were osteolytic.The percentage of osteolytic lesions was significantly higher in multiple myeloma (x2=87.2,P＜0.05).The SUVmax of bone lesions of multiple myeloma and bone metastases were 3.81 ±2.17 and 5.82± 3.44 (t =8.29,P＜0.05) respectively.According to the diagnostic criteria,the sensitivity,specificity and accuracy of 18F-FDG PET/CT for the differentiation of myeloma from bone metastases were 88.5％ (23/26),85.0％ (17/20) and 87.0％ (40/46).Its diagnostic efficiency was higher than urine Bence-Jones protein (sensitivity:65.4％ (17/26);x2=3.90) and original 18 F-FDG PET/CT evaluation (specificity:10/18,accuracy:64.1％ (25/39);x2 =3.99,6.12) respectively (all P＜0.05).Conclusion Combining the evaluation of structural properties and metabolism on 18F-FDG PET/CT with urine Bence-Jones protein level may provide additional value for the differentiation of multiple myeloma from bone metastases with undetermined origin.
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In order to analyze the causes of delayed diagnosis and raise the level of early diagnosis of atypical multiple myeloma (MM),the differences of presenting features between the patients presented to nephrologists and those presented to hematologists were compared.MM patients in our hospital were studied retrospectively.Those who referred renal impairment were divided into two groups:group Ⅰ presented to nephrologists prior to MM diagnosis (n=29) and group Ⅱ presented to hematologists directly (n=62).The age,sex,initial symptoms,haematological and biochemical parameters,the phenotype of pamprotein,bone marrow biopsy and cytology were undertaken and analyzed.The results showed that the median time between the initial symptoms and diagnosis in the patients of group Ⅰ was longer than that in group Ⅱ (P＜0.001); patients in group Ⅰ had significantly lower incidence of bone pain (P＜0.01) and worse renal function (P＜0.05) on presentation.There were lower level of myeloma cells (P＜0.05),lower incidence of hypergammaglobulinemia (P＜0.05),lower positive rate of monoclonal immunoglobulin (M protein) (P＜0.05) and M protein level (P＜0.05) in the patients of group Ⅰ than those in group Ⅱ.The ratio of monoclonal to lambda monoclonal proteins in a population was 1:3.67 in patients of group Ⅰ,whereas 1∶0.90 in patients of group Ⅱ (P＜0.0 l).Moreover,patients with λ type had a higher degree of renal insufficiency than those with κ type (P＜0.05).It was suggested that the median time between the initial symptoms and diagnosis in the patients presented to nephrologists was longer than that in those presented to hematologists; the patients presented to nephrologists had the lower incidence of bone pain,lower level of myeloma cells and M protein,which made early diagnosis more difficult; more patients presented to nephrologists had the majority of λ light chain type,moreover,patients with λ light chain type had a higher incidence of renal insufficiency.
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Since Bence-Jones protein was discovered and used in multiple myeloma, many tumor markers have been used in diagnosis and treatment monitoring of various cancers. However the lack of specificity and sensitivity of most tumor markers is always limiting their application in research and clinical diagnosis currently. It is predicted that the future development of tumor marker research may mainly focus on the innovation of research strategies, such as combined detection of a set of related tumors marker and comprehensive interpretation of testing results.
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Las discrasias de células plasmáticas son llamadas también paraproteinemias o gammapatías monoclonales. Comprenden un grupo heterogéneo de enfermedades que se caracterizan por la presencia en el suero o en la orina de una inmunoglobulina monoclonal. Nos ocupa una variante de mieloma denominado enfermedad de cadenas ligeras; caracterizada por hipogamma-globulinemia y la presencia en la orina de proteína de Bence Jones. El diagnóstico se realizó en un paciente masculino de 44 años, con síntomas y signos específicos de mieloma múltiple y estudios morfológicos, radiográficos y de laboratorio, que confirmaron el diagnóstico.
Dyscrasias of plasmatic cells are also called papaproteinemias or monoclonal gammapathies, whic are composed of a heterogeneous group of diseases characterized by the presence of a monoclonal inmunoglobulin in seru or urine. A variant of myeloma called ligth chain disease, characterized by hypogammaglobulinemia and presence of Bence Jones protein with specfific signs and symtomps for multiple myeloma and morphologic, radiographic and laboratory studies that confirmed the diagnosis.
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AIM: To study the effect of Bene Jones protein (BJP) from multiple myeloma(MM) patient and TGF-? 1 on cultured renal proximal tubular cell(PTC) proliferation. METHODS:[ 3H] TdR incorporation was used to study the effect of ?BJP and TGF-? 1 on cultured rat NRK.52E PTC proliferation,the expression of TGF-? 1 in the supernatant of PTC cultured with BJP was assessed with ELISA. RESULTS:① [ 3H] TdR incorporation of PTC was inhibited by BJP in a dose-dependent manner,when co-cultured with 100-800 ?mol/L BJP and 2.0 ?g/L TGF-? 1, the [ 3H] TdR incorporation was lower than that of BJP alone, especially when BJP≥400 ?mol/L; ②The expression of TGF-? 1 in the supernatant of PTC cultured with BJP was increased ,especially when BJP≥400 ?mol/L( P