PDF(Pubmed)
Abstract：
Multiple myeloma (MM) and bone metastases are both common malignant tumors of the skeleton that share similar clinical manifestations and radiological features. The development of MM following rectal cancer surgery is relatively rare in clinical practice and is easily misdiagnosed as bone metastasis. The present study reported on a patient with MM and postoperative rectal cancer. A 65-year-old man had been diagnosed with low rectal cancer (poorly differentiated, T3N1M0) 10 years prior and underwent curative treatment at that time. During the 6-year follow-up period, no recurrence or metastasis of rectal cancer was detected. The patient was evaluated for bone pain 4 years ago and underwent multiple imaging examinations, including computed tomography (CT), magnetic resonance imaging, emission CT and positron emission tomography/CT at several well-known hospitals in China. All of these hospitals diagnosed the patient with bone metastasis from rectal cancer, in view of the earlier history. The patient\'s condition did not show any significant improvement despite treatment for bone metastasis. Subsequently, 3 years ago, the patient underwent surgical treatment at our hospital (Affiliated Hospital of Zunyi Medical University, Zunyi, China) for a hernia near the colostomy site combined with incomplete intestinal obstruction. Post-operatively, the patient developed a hematoma in the surgical area, along with stubborn anemia and abnormal coagulation function. No improvement was observed with hemostasis and multiple blood transfusions. The bone marrow smear was consistent with MM, with a significant elevation in serum IgA and β2 microglobulin. The patient was ultimately diagnosed with MM (IgA-λ type), stage III, according to the Durie-Salmon staging system. The patient\'s condition improved with treatment for MM.
摘要：
多发性骨髓瘤（MM）和骨转移瘤都是常见的骨骼恶性肿瘤，具有相似的临床表现和放射学特征。直肠癌术后MM的发展在临床上较为少见,易误诊为骨转移。本研究报道了一名患有MM和术后直肠癌的患者。一名65岁的男性被诊断出患有低位直肠癌（低分化，T3N1M0）10年前，当时接受了治愈性治疗。在6年的随访期间，未发现直肠癌复发或转移。4年前对患者进行了骨痛评估，并接受了多次影像学检查，包括计算机断层扫描（CT），磁共振成像，中国几家知名医院的发射CT和正电子发射断层扫描/CT。所有这些医院都诊断出患者患有直肠癌骨转移，鉴于早期的历史。尽管治疗了骨转移，但患者的病情没有显着改善。随后，三年前,患者在我院（遵义医学院附属医院，遵义,中国）用于结肠造口附近的疝气并伴有不完全性肠梗阻。术后,病人在手术部位出现血肿,伴有顽固性贫血和凝血功能异常。止血和多次输血未观察到改善。骨髓涂片符合MM,血清IgA和β2微球蛋白显著升高。患者最终诊断为MM（IgA-λ型），第三阶段,根据Durie-Salmon的分期系统.患者的病情通过MM治疗得到改善。
