骨骼病变为首发表现的急性淋巴细胞白血病1例

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摘要患者,男,33岁,因全身多处游走性疼痛于2012-11行X线片及CT检查,提示颈椎、肱骨、髂骨、股骨骨质破坏,股骨头见小囊状骨质破坏( 图1)。以多发性骨髓瘤(multiple myeloma,MM)收入我科。骨髓穿刺涂片检查考虑为急性淋巴细胞性白血病(acute lymphoblastic leukemia, ALL)。组织化学染色提示:过氧化物酶阴性,糖原染色阳性,糖原原始细胞积分高,醋酸萘酚酯酶染色阴性。流式细胞学检查:主要可见原始细胞群、成熟淋巴细胞群和粒系细胞群,原始细胞约占有核细胞32%,表达CD34、HLA-DR、CD19、CD10和CD13(部分阳性),少数细胞表达CD20、CD38,不表达cIgM、cCG79a,不表达cCD3、CD5、CD33和cMP0。骨髓活检:有核细胞核脂肪比值为2∶1,部分为中等偏小幼稚细胞。基因检测提示BCR-ABL融合基因阳性。综合诊断为B淋巴细胞系急性淋巴细胞性白血病L2(B-ALL-L2)。给予长春新碱、柔红霉素、环磷酰胺和泼尼松联合进行诱导缓解治疗,化疗方案6周期,预防性鞘内注射甲氨喋呤6次,最后一次化疗完成于2013-05。转入维持治疗(甲氨喋呤和巯嘌呤与泼尼松和长春新碱交替治疗)。期间于2013-01骨髓穿刺检查仅见3%幼稚淋巴细胞,评估为缓解。2013-05骨髓穿刺检查仅见1%幼稚淋巴细胞,评估为缓解。治疗过程中患者游走性疼痛症状减轻,PTH 2610 ng/L ,血钙 2121 mmol/L。2013-05 CT检查仍示胸椎多个椎体融骨性骨质破坏。2013-07患者双侧髋关节疼痛,逐渐加重,给予膦酸盐类药物治疗。患者开始口服伊马替尼。2013-08再次复查CT仍示双侧髂骨及股骨骨质破坏(图2)。继续止痛及膦酸盐类药物治疗,患者疼痛症状减轻。2014-04患者骨髓检查呈示缓解。

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关键词 ：急性淋巴细胞白血病, 骨骼病变

收稿日期: 2014-04-25

ZTFLH:

R733.71

作者简介: 邹春华,本科学历,主任医师,E-mail:zouchun_hua@163.com

引用本文:

邹春华,谢勇久,王绎,明华,黄涛金,林争. 骨骼病变为首发表现的急性淋巴细胞白血病1例[J]. 武警医学, 2014, 25(9): 950-951.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2014/V25/I9/950

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