髄液中に異常形質細胞が出現した骨髄腫の1例

ABNORMAL CEREBROSPINAL FLUID PLASMA CELLS IN A CASE OF MYELOMA

　抄録　髄膜炎様症状を呈し，髄液中に異常形質細胞が出現したIgG，λ型全身性骨髄腫の1例を報告した。症例は70歳，男性で，肺炎症状で発症し，その経過中に意識障害，項部硬直およびKernig徴候が出現した。髄液所見は，初圧155mmH2O，細胞数207／3mm³，蛋白33mg／dl，糖54mg／dlで，形質細胞が25.5％と高率に出現していた。形質細胞は大小の形を呈し，核は不整で多核のものもあり，flaming cellおよびgrape cellが観察された。この異常な形質細胞はIgG・λ鎖の抗血清と反応し，monoclonalなIgG，λ型骨髄腫細胞であることが証明された。セルロースアセテート膜電気泳動で血清中にM蛋白がみられ，血清免疫電気泳動でmonoclonalなIgGの増加が認められた。全身性骨髄腫で脳脊髄液にまでその侵襲が及ぶことは稀であり，髄液中異常形質細胞の出現を契機に全身性骨髄腫が明らかとなったのはこれまで1例の報告をみるのみである。

Cerebrospinal fluid (CSF) involvement in mye-loma is rarely seen. Recently we experienced a case with this lesion.

A 70-year-old man developed consciousness le-vel disorder during the course of bronchopneumo-nia. Neurological examination revealed stuporous consciousness, neck stiffness and Kernig's sign. Immunoelectrophoresis showed monoclonal IgG in serum. CSF which was obtained through lumbar puncture was clear and its pressure was 155 mm H²O. It contained 207 white cells/3 mm³ ; glucose, 54 mg/dl ; and protein, 33 mg/dl. The differential count of the CSF was (in %) monocytes, 48. 0 ; plasma cells, 25.5 ; neutrocytes, 15. 5 ; and lym-phocytes, 11. 0. Cytoplasm and nucleus of the plasma cells were in various sizes. Some irregular multiple nuclei, flaming cells and grape cells were also observed in them. The cytoplasm of the plasma cells fluoresced with antisera against lambda chains IgG.

The value of immunofluorescent technique in identifying plasma cells in the CSF is emphasized.