骨融解像を認めた血液疾患の2例

Blood Diseases Manifested by Osteolytic Lesions. Report of Two Cases

　脊椎，骨盤の骨融解像を認めた血液疾患2例を経験したので報告する．症例1は75歳の女性．右骨盤の骨融解像を認め，CT，MRIで右腸骨に占拠性病変を認めた．血液検査で白血球増多，高蛋白血症を認め成人T細胞白血病と診断し化学療法を行ったがカリニ肺炎を合併し死亡した．症例2は58歳の女性．第2，4腰椎に圧迫骨折，左腸骨の骨融解像を認め精査を行い，原発不明の転移性骨腫瘍として加療中，骨盤の打ち抜き像が進行し尿中Bence-Jones蛋白陽性で多発性骨髄腫と確定診断した．骨占拠性病変の鑑別診断として血液疾患が重要である．

　We report two cases of blood diseases manifested by osteolytic lesions. The first patient was a 75-year-old woman with an osteolytic lesion of the right ilium. The patient was diagnosed with some difficulty as having adult T-cell leukemia (ATL), and she died of Pneumocystis carinii pneumonia with ATL. The second patient was a 58-year-old woman with multiple myeloma that was also difficult to diagnose. Because at the first time, serum date, tumor marker, and organs were almost normal, so we thought metastatic tumor of unknown origin. After three months, the patient had a pelvic osteolytic lesion that appeared to be a tumor, so we diagnosed as multiple myeloma by urine Bence-Jones protein and sternum bone marrow puncture and it was treated by chemotherapy. These cases illustrate that examination for the presence of osteolytic bone lesions and analysis of serum and urine data (anemia, hypercalcemia, renal disturbance, urinary protein fraction) are very important for the diagnosis of patients with blood diseases.