Tadashi Ohnaka

Meningeal Involvement in Multiple Myeloma

Meningeal involvement in multiple myeloma is a rare occurrence. We report a case of IgG myeloma with neoplastic cell infiltration into the cerebrospinal fluid as determined by a protein A plaque-forming cell assay. Electrophoresis of the cerebrospinal fluid revealed a monoclonal band in the same position as the monoclonal band in the serum. Meningeal involvement may probably be more common at the terminal stage in multiple myeloma than has been previously considered.

Nucleolus-associated J chains in myeloma cells: Clinical significance

Bone marrow aspirates from 20 patients with multiple myeloma (MM), 4 with smoldering multiple myeloma (S‐MM), 1 with idiopathic Bence Jones proteinuria (I‐BJP), and 6 with primary macroglobulinemia (PMG) were examined for nucleolus‐associated J chain. The incidence of nucleolar J chain‐positive (J +) cells among nucleolated cells producing M‐component was measured. This incidence (94.0–100%) in terminal MM was significantly higher than that (0–58.0%) in non‐terminal MM. Judging from a low incidence in the remission phase, chemotherapy might cause a selective elimination of less differentiated myeloma cells with J + nucleoli and might have some effect on J chain synthesis. The incidence of nucleolar J+ cells was very low in S‐MM. The IgM cells in PMG, where J chain is present in a disulfide‐linked form, had no or few J+ nucleoli. No correlation between the incidence of nucleolar J + cells among nucleolated plasma cells and the percentage of nucleolated cells or that of J + cells was found. Large J + nucleoli seemed to be another morphological feature indicating anaplastic myeloma cells. A high incidence of nucleolar J + cells may be one of the indicators for progressive disease.

Combined method of PAP immunocytochemistry and autoradiography: application to cell kinetic study in plasma cell dyscrasias.

The plasma cell labeling index (LI), in spite of being a reliable indicator for diagnosis and prognosis of multiple myeloma, has been measured in a limited number of laboratories because of technical difficulties. We have developed a new combined technique, using the peroxidase-antiperoxidase (PAP) method and autoradiography, which has several advantages over previously described methods. The primary advantages of our method in the determination of lymphoid-plasma cell LI% are: (a) no damage to slides during storage of more than 1 year; (b) an exact LI measurement in each morphological variety of pleomorphic immunoglobulin-containing cells; (c) no problem in differentiation of lymphoid plasma cells from early red cell precursors; and (d) a separate LI measurement for those lymphoid-plasma cells composed chiefly, if not exclusively, of monoclonal or neoplastic cells. Because of these advantages, this accurate and less difficult technique will facilitate performance of lymphoid plasma cell LI in a number of laboratories.

A case of idiopathic bence jones proteinuria - Some notes on the clinical significance of bence jones proteinuria.

1975年本誌上に発表した“10年にわたり観察されたasymptomatic Bence Jones蛋白尿”と題するわれわれの報告は,今日いう特発性Bence Jones蛋白尿症の端緒となつた.その後10数例の報告があるが症例集積の段階にある.最近,新しい症例を経験した機会に,既報告例をまとめ本症の臨床像を検討し, Bence Jones蛋白尿(BJP)の臨床的意義について再び本誌上を借りて考察したい.症例. 1930年生,主婦. 1978年腎盂腎炎,その後も反復. 1979年ネフローゼ症候群,少量のステロイド(隔日1錠)服用. 1983年4月κ型BJP陽性,骨髄中形質細胞増加(11%)より骨髄腫と診断.同年5月～8月melphaian間歇投与,無顆粒球症をきたして中止.定型的骨髄腫と考え難いので京大第一内科紹介, 1984年2月同病院入院.尿BJP 3.2g/日,貧血軽度, γ-グロブリンと正常Ig減少.骨髄中形質細胞8.4%,異型性(+),標識率0%.電解質正常,クレアチニン軽度上昇, RI-レノグラム糸球体病変を示唆.骨X線像,心エコー, ECG, GIS,直腸生検像など異常なし.腎生検像では間質の炎症反応と線維化,小動脈壁の肥厚.糸球体と尿細管の基底膜にIgの沈着(-). BJP証明1年後,経過は安定,また尿蛋白の90%以上がBJPであり5年前からの蛋白尿もBJP尿と推定される.以上より特発性Bence Jones蛋白尿症と診断.本症は骨髄腫への進展を確認するまで化学療法を行なわないで腎不全に注意する. BJ型骨髄腫の診断には本症を除外する必要がある.