抄録
A case of multiple myeloma of IgG 1 (λ) type associated with myelofibrosis was reported. A 63-year-old man was admitted in August 1978 because of lumbar pain and fever. Severe anemia was noted. Liver was palpable 2 finger breadths below the right costal margin. Slight enlargement of the spleen on percussion was noted.
Investigations on admission were as follows; Bence Jones protein in the urine was positive. Leukoerythroblastic picture of the peripheral blood was demonstrated with appearance of a small number of myeloma cells. Bone marrow aspirations on two occasions were dry tap. Serum IgG level was 6,000 mg/dl, IgA 55 mg/dl, and IgM 36 mg/dl. Electrophoretic picture of the serum showed monoclonal spike of IgG 1 (λ) type. On skeletal survey, scattered osteolytic lesions and osteosclerosis were demonstrated. The patient died of pneumonia four months after admission.
At autopsy, myelomatous infiltrations with fibrosis were noted in the bone marrow from the spines. Myeloid metaplasia and myelomatous involvement were revealed in the liver and spleen. Pathological diagnosis of myeloma associated with myelofibrosis was made. In this case, these two diseases were found concurrently at the time of diagnosis.
Our case was discussed with relation to the literature. From a point of clinical view, there was no evidence suggesting the occrrence of myelofibrosis due to myelomatous involvement of the bone marrow. Further study including abnormalities of stem cell should be done to clarify the nature of the association of these two diseases.
