以腹泻为主的华氏巨球蛋白血症1例并文献复习

doi:10.6040/j.issn.1671-7554.0.2021.1377

摘要/Abstract

摘要： 目的提高临床医生对华氏巨球蛋白血症消化道受累的认识。方法报告1例慢性腹泻伴体质量减轻最终诊断为华氏巨球蛋白血症病例,回顾文献讨论该病累及消化道的特点。结果我们报告1例华氏巨球蛋白血症明显胃肠道受累的病例,表现为慢性腹泻伴体重减轻和低蛋白血症。小肠活检淀粉样变阴性。患者接受利妥昔单抗联合苯达莫司汀治疗腹泻很快缓解。我们检索文献回顾性分析华氏巨球蛋白血症与消化道症状的关联。结论提高对华氏巨球蛋白血症胃肠道表现的认识可能有助于解释和治疗这种惰性、潜在危及生命的淋巴系统恶性疾病。

关键词: 华氏巨球蛋白血症, 腹泻, 低蛋白血症, 体质量减轻

Abstract: Objective To enhance clinicians understanding of the involvement of gastrointestinal tract in Waldenström macroglobulinemia(WM). Methods A case of chronic diarrhea with weight loss diagnosed as WM was reported. Relevant literature was reviewed. Results The WM case was associated with significant gastrointestinal involvement, manifested as chronic diarrhea with weight loss and hypoproteinemia. Small bowel biopsy was negative for amyloidosis. Rituximab in combination with bendamustine soon relieved the diarrhea. Literature about the association of WM with gastrointestinal symptoms was reviewed. Conclusion An increased awareness of the gastrointestinal manifestations of WM may help to explain and treat the indolent, potentially life-threatening lymphatic malignancy.

Key words: Waldenströ, m macroglobulinemia, Diarrhea, Hypoproteinemia, Weight loss

中图分类号:

R553

安雯,黄刚,于岩波,左秀丽,李延青. 以腹泻为主的华氏巨球蛋白血症1例并文献复习[J]. 山东大学学报 (医学版), 2022, 60(8): 84-90.

AN Wen, HUANG Gang, YU Yanbo, ZUO Xiuli, LI Yanqing. Diarrhea as the principal presentation of Waldenström macroglobulinemia: a case report and literature review[J]. Journal of Shandong University (Health Sciences), 2022, 60(8): 84-90.

参考文献

[1] Vijay A, Gertz MA. Waldenström macroglobulinemia [J]. Blood, 2007, 109(12): 5096-5103.
[2] Kyle RA, Larson DR, McPhail ED, et al. Fifty-year incidence of Waldenstrom Macroglobulinemia in Olmsted County, Minnesota, from 1961 through 2010: a population-based study with complete case capture and hematopathologic review [J]. Mayo Clin Proc, 2018, 93(6): 739-746.
[3] Kyrtsonis MC, Vassilakopoulos TP, Angelopoulou MK, et al. Waldenströms macroglobulinemia: clinical course and prognostic factors in 60 patients. Experience from a single hematology unit [J]. Ann Hematol, 2001, 80(12): 722-721.
[4] Owen RG, Treon SP, Al-Katib A, et al. Clinicopathological definition of Waldenstroms macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstroms Macroglobulinemia [J]. Semin Oncol, 2003, 30(2): 110-115.
[5] 易树华, 李剑. 淋巴浆细胞淋巴瘤/华氏巨球蛋白血症诊断与治疗中国专家共识(2016年版)[J]. 中华血液学杂志, 2016, 37(09): 729-734. YI ShuHua, LI Jian. Chinese expert consensus on diagnosis and treatment of Lymphoplasmacytic Lymphoma/Waldenström macroglobulinemia(2016 version)[J]. Chinese Journal of Hematology, 2016, 37(9): 729-734.
[6] Schuster SR, Rajkumar SV, Dispenzieri A, et al. IgM multiple myeloma: disease definition, prognosis, and differentiation from Waldenströms macroglobulinemia [J]. Am J Hematol, 2010, 85(11): 853-855.
[7] Treon SP, Xu L, Yang G, et al. MYD88 L265P somatic mutation in Waldenströms macroglobulinemia [J]. N Engl J Med, 2012, 367(9): 826-833.
[8] Morel P, Duhamel A, Gobbi P, et al. International prognostic scoring system for Waldenstrom macroglobulinemia [J]. Blood, 2009, 113(18): 4163-4170.
[9] Castillo JJ, Olszewski AJ, Kanan S, et al. Overall survival and competing risks of death in patients with Waldenstrom macroglobulinaemia: an analysis of the surveillance, epide-miology and end results database [J]. Br J Haematol, 2015, 169(1): 81-89.
[10] Varettoni M, Tedeschi A, Arcaini L, et al. Risk of second cancers in Waldenstrom macroglobulinemia [J]. Ann Oncol, 2012, 23: 411-415.
[11] Dimopoulos MA, Kastritis E, Owen RG, et al. Treatment recommendations for patients with Waldenström macroglobulinemia(WM)and related disorders: IWWM-7 consensus [J]. Blood, 2014, 124(9): 1404-1411.
[12] Gertz MA. Waldenström macroglobulinemia: 2021 update on diagnosis, risk stratification, and management [J]. Am J Hematol, 2021, 96(2): 258-269.
[13] Nayak HK, Kar P, Bagchi A, et al. Waldenstrom macroglobulinemia presenting with pancreatic mass: a case report and review of literature [J]. JOP, 2013, 14(1): 92-95.
[14] 孙慧琳, 苏瑞, 朱静, 等. 以消化道炎症为首发表现的华氏巨球蛋白血症1例[J]. 吉林医药学院学报, 2021, 42(2): 116-117. SUN HuiLin, SUN Rui, SU Jin, et al. One case of Waldenström macroglobulinemia was first manifested by inflammation of the digestive tract[J]. Journal of Jilin Medical University, 2021, 42(2): 116-117.
[15] Amado Garzón SB, Villanueva Ortega MM, Botero Bahamón JD. Chronic diarrhea: a case of Waldenström macroglobulinemia [J]. Rev Gastroenterol Mex(Engl Ed), 2018, 83(4): 467-469.
[16] Kantamaneni V, Gurram K, Khehra R, et al. Distal ileal ulcers as gastrointestinal manifestation of waldenstrom macroglobulinemia [J]. ACG Case Rep J, 2019, 6(4): e00058. doi: 10.14309/crj.0000000000000058.
[17] Tatara R, Nagai T, Kobayashi H, et al. AA amyloidosis associated with macroglobulinemia [J]. Int J Hematol, 2010, 92(4): 675-677.
[18] Rusynyk RA, Ghosh MS, Babameto GP, et al. Endoscopic diagnosis of Waldenströms macroglobulinemia masquerading as chronic diarrhea [J]. Gastrointest Endosc, 2003, 57(6): 800-801.
[19] Koivisto PV, Karhunen PJ, Färkkilä MA, et al. Endoscopic appearance of intestinal involvement in Waldenströms macroglobulinemia [J]. Endoscopy, 21(3): 155-156.
[20] Parrish FJ, Hemming JD, Matthewson K. Endoscopic diagnosis of Waldenströms macroglobulinemia [J]. Gastrointest Endosc, 1994, 40(1): 102-104.
[21] Veloso FT, Fraga J, Saleiro JV. Macroglobulinemia and small intestinal disease. a case report with review of the literature [J]. J Clin Gastroenterol, 1988, 10(5): 546-550.
[22] Brandt LJ, Davidoff A, Bernstein LH, et al. Small-intestine involvement in Waldenströms macroglobulinemia. Case report and review of the literature [J]. Dig Dis Sci, 1981, 26(2): 174-180.
[23] Beker S, Grases PJ, Merino F, et al. Intestinal malabsorption in macroglobulinemia [J]. Am J Dig Dis, 1971, 16(7): 648-656.
[24] Harris M, Burton IE, Scarffe JH. Macroglobulinaemia and intestinal lymphangiectasia: a rare association [J]. J Clin Pathol, 1983, 36(1): 30-36.
[25] Pratz KW, Dingli D, Smyrk TC, et al. Intestinal lymphangiectasia with protein-losing enteropathy in Waldenström macroglobulinemia [J]. Medicine(Baltimore), 2007, 86(4): 210-214.
[26] Cooke RE, Kalnins RM, Ho WK. Waldenström macroglobulinaemia and intestinal lymphangiectasia [J]. Br J Haematol, 2014, 167(3): 292.
[27] Salamone F, Catanzaro R, Mangiameli A, et al. Clinical challenges and images in GI. Intestinal Waldenström macroglobulinemia[J]. Gastroenterology, 2008, 134(4): 920, 1276. doi:10.1053/j.gastro.2008.02.043.
[28] Teo E, Brennan C, Cooper JE, et al. Images of interest. Gastrointestinal: white small bowel, macroglobulinemia and splenic marginal-zone lymphoma [J]. J Gastroenterol Hepatol, 2005, 20(10): 1620.
[29] Bradley J, Hawkins CF, Rowe DS, et al. Macroglobulinaemia and steatorrhoea [J]. Gut, 1968, 9(5): 564-568.
[30] Francis FF, Kulich S, Hashash JG. Duodenal Scalloping Indicate Waldenström Macroglobulinemia [J]. Clin Gastroenterol Hepatol, 2019, 17(9): A17-A18.
[31] 田秋实, 陈喆. 继发于华氏巨蛋白血症小肠毛细淋巴管扩张症1例[J]. 中国中西医结合消化杂志, 2020, 28(10): 809-810. TIAN Qiushi, CHEN Zhe. A case of small intestinal capillary lymphadenopathy secondary to Waldenström Macroglobulinemia[J]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion, 2020, 28(10): 809-810.
[32] 杨小兰, 崔德军, 杨柳婵, 等. 以消化性溃疡为首发表现的华氏巨球蛋白血症[J]. 当代医学, 2018, 24(25): 128-130. YANG XiaoLan, CUI DeJun, YANG LiuChan,et al. Waldenström Macroglobulinemia with peptic ulcer as the first manifestation[J]. Contemporary Medicine, 2018, 24(25): 128-130.
[33] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3-1990. A 66-year-old woman with Waldenströms macroglobulinemia, diarrhea, anemia, and persistent gastrointestinal bleeding [J]. N Engl J Med, 1990, 322(3): 183-192.

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