ABSTRACT
Objetivo: Describir la presentación histopatológica atípica en médula ósea de mieloma múltiple. Reporte de Caso: Presentamos el caso de un varón de 75 años, quien manifiesta lumbalgia de intensidad variable asociada a disminución del flujo urinario, por lo que acude a emergencia. Al examen físico se encuentran funciones vitales dentro de parámetros normales, disminución generalizada del tejido adiposo y palidez terrosa, el resto del examen no contributorio. En estudios de médula ósea se reporta 13% de células plasmáticas, observándose células neoplásicas tetranucleadas con 1 y 2 nucleolos, citoplasma basófilo con presencia de vacuolas; es corroborado en citometría de flujo con fenotipo patológico en relación a neoplasia de células plasmáticas. Paciente recibe esquema terapéutico con ciclofosfamida, dexametasona y talidomida. Conclusión: La presentación tetranucleada es una variante histopatológica del mieloma múltiple poco frecuente; por lo que este hallazgo peculiar, debe ser valorado en el diagnóstico microscópico de la entidad clínica.
Objetive: To describe the atypical histopathologic presentation in bone marrow of multiple myeloma. Case Report: We present the case of a 75-year- old male who manifested low back pain of variable intensity associated with decreased urinary flow, for which he went to the emergency room. On physical examination, vital functions were within normal parameters with generalized decrease in adipose tissue and earthy pallor, the rest of the examination being non-contributory. Bone marrow studies showed 13% of plasma cells with tetranucleated neoplastic cells with 1 and 2 nucleoli, basophilic cytoplasm with presence of vacuoles, which was corroborated in flow cytometry with pathological phenotype in relation to plasma cell neoplasia. The patient receives a therapeutic regimen with cyclophosphamide, dexamethasone and thalidomide. Conclusion: Tetranucleated presentation is a rare histopathologic variant of multiple myeloma, so this peculiar finding should be appreciated in the microscopic diagnosis of this clinical entity.
ABSTRACT
Introducción: la mortalidad asociada a los pacientes con mieloma múltiple (MM) son los únicos datos disponibles en Ecuador. El presente estudio tiene por objetivo caracterizar la enfermedad, definir la tasa de mortalidad y describir los factores relacionados en los casos de MM tratados en el Hospital Carlos Andrade Marín. Materiales y métodos: análisis retrospectivo de datos demográficos, características clínicas de los pacientes con MM, recogidos de enero a diciembre de 2011. Resultados: 52 pacientes entre 29 a 89 años (media 61), 15 fueron mujeres (29%). 73% tenía un mieloma IgG, el 28% IgA y 19% fueron cadenas ligeras. Según el sistema de estadificación Durie y Salmon (D&S), 13% en etapa I, 25% en etapa II, 33% en estadío III. Fue excluido el 41% ya que la información no estaba disponible. Mortalidad en el estadío clínico avanzado del Mieloma (D&S etapa III) fue de 10%, en las etapas I y II no fueron registradas muertes. El daño renal fue más frecuente en la etapa III (33%) comparado con las etapas I (13%) y II (25%). Conclusiones: la mortalidad se asoció a un estadío avanzado del MM (etapa III) y al daño renal presente (29%).
Introduction: mortality associated with patients with multiple myeloma (MM) is the only data available in Ecuador. This study aims to characterize the disease, determine its mortality rate and describe related factors in the cases of MM treated at the Carlos Andrade Marin Hospital. Materials and methods: retrospective analysis of demographic data, clinical characteristics of patients with MM, collected between january and december 2011. Results: 52 patients between 29 to 89 years (mean 61), 15 were women (29%). 73% had an IgG myeloma, 28% IgA and 19% were light chains. According to the staging system Durie and Salmon (D & S) 13% in stage I, stage II 25%, 33% stage III. 41% was excluded because information was not available. Mortality in the advanced clinical stage of myeloma (D & S stage III) was 10% in stages I and II were not registering deaths. Renal damage was more frequent in stage III (33%) compared with stages I (13%) and II (25%). Conclusions: mortality was associated with advanced stages of MM (stage III) and kidney damage present (29%).
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Women , Bone Marrow , Myeloma Proteins , Mortality , Multiple Myeloma , Neoplasms , Renal Insufficiency , Hypercalcemia , AnemiaABSTRACT
Background: Mortality rate records are the only data available in Chile about the prognosis of patients with multiple myeloma (MM). Aim To characterize clinical features, survival rate and factors related to mortality in cases with MM treated in six large medical centers in Chile. Material and Method: Retrospective analysis of demographic data, clinical features and survival rate records of patients with MM, collected between 1998 and 2002. Survival curves were generated and a multivariate analysis of factors associated to early mortality was carried out. Results: Data from 245patients aged 38 to 95years (129 women) was collected. Fifty two percent had an IgG myeloma, 25 percent had and IgA and 6.1 percent had light chains myeloma. According to Durie and Salmon staging system, 8,2 percent were in Stage 112.6 percent in Stage II, 60.5 percent in Stage III and in 18.8 percent the information about staging was not available. Fifty percent had an hemoglobin level below 10 g/dL, 30 percent had a serum creatinine over 2 mg/dL and 28 percent had a serum calcium level over 10.5 mg/dL. Median survival was 33 months. Twenty percent of patients died within the first six months after diagnosis (early mortality). Predictive factors for early mortality were male sex, thrombocytopenia, anemia, renal failure, hypercalcemia, a beta2-microglobulin >5.5 mg/L and a serum albumin level <3.5 g/dL. There was a correlation between the number of bad prognosis factors present and the probability of early mortality. Conclusions: This group of Chilean patients with MM presented a short survival time, and 20 percent died within the first six months after diagnosis. More than a half of cases were diagnosed at an advanced stage (Durie and Salmon Stage III). Several factors were associated to early mortality, two of which (beta 2-microglobulin and serum albumin), are included in the new International Staging System for MM.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multiple Myeloma/mortality , Renal Insufficiency , Anemia/complications , Chile/epidemiology , Epidemiologic Methods , Hypercalcemia/complications , Multiple Myeloma/immunology , Multiple Myeloma/pathology , Neoplasm Staging , Prognosis , Serum Albumin/analysis , Sex Factors , Thrombocytopenia/complications , Time Factors , /bloodABSTRACT
A case of IgD(kappa light chains type)multiple myeloma with intracytoplasmic crystalline inclusions is reported.Light microscopic and electron microscopic exeminat-ions are carried out with a view to compare the morphologic and ultrastructural features of myeloma cells.Moreover, the relationship between the biochemistry of intra-cytoplasmic crystalline inclusions and that of Russell's bodies are discussed.