- 期刊
多發性骨髓瘤之口腔病變－二病例報告
Multiple Myeloma with Oral Manifestations - Report of Two Cases
摘要
多發性骨髓瘤（multiple myeloma）是一種起源於骨髓細胞的腫瘤，常侵犯造血機能較旺盛之骨。好發年紀為五十至八十歲，且男性多於女性。早期症狀為骨疼痛、腫大，最後常因骨頭破壞而發生病理性骨折。在口腔徵象方面，病灶較常發生於下顎骨，尤其是下顎枝、下顎角及大臼齒區等造血機能活躍部位。顎骨可能會腫痛、膨大；牙齒會動搖；軟組織感覺異常；牙齦可能會腫大，且容易出血；放射線檢查時在受侵犯之骨頭有鑽孔狀骨缺損（punched-out lesion）出現；血液檢查則有免疫球蛋白過多，尿液內可能出現本期瓊司氏蛋白（Bence-Jones protein）；組織病理檢查則可發現群集之細胞，其型態類似漿細胞。本篇報告之第一個病例是一位64歲女性，已知罹患多發性骨髓瘤（lgG，lambda），並接受過化學治療及放射療法，因牙齦流血腫痛轉介至本院治療。第二個病是一位60歲女性，因牙齦間歇性出血而來本院求診，經血液、尿液及骨髓活體檢查診斷為多發性骨髓瘤（lgG，lambda）。本篇報告此二病例之臨床徵象及治療時應注意事項。
關鍵字
無資料並列摘要
Multiple myeloma is a neoplastic disorder of bone that originates from cells of bone marrow. It is most commonly seen within the age range of 50-80 years, cases under the age of 40 being rare. Men are affected more frequently than are women. Bone pain is the cardinal clinical symptom in multiple myeloma. Because of the destruction of bone, pathologic fracture is fairly common. In the oral manifestations, the mandible is involved far more frequently than the maxilla, especially the most active hematopoietic areas-the remus, angle and molar region of the mandible. Other signs and symptoms of jaw involvement include swelling, pain, and increased tooth mobility. Extraosseous lesions may result in paresthesia of soft tissue and gingival enlargement with bleeding tendency. Roentgenographic examination will usually numerous punched-out lesions in a variety of bones. In addition, blood examination will reveal hyperglobulinemia and Bence-Jones protein may be present in the urine of myeloma patients. The histological features of myeloma are closely packed cells resembling plasma cells. Case 1 in this report is a 64-year-old female, who has been diagnosed as having multiple myeloma (lgG, lambda). She was referred to our hospital because of gingival swelling, bleeding from spontaneous gingival bleeding. After blood, urine examination and bone marrow biopsy, multiple myeloma was diagnosed (lgG, lambda). This paper reports the clinical manifestations and treatment courses of these two cases, and the concerns of treatment of multiple myeloma are also discussed.