B型肝炎帶原之眼窩漿細胞瘤轉型為雙株伽碼球蛋白之多發性骨髓瘤併原發性肝癌之案例報告

Plasmacytoma of the Orbit in a Hepatitis B Virus Carrier transformed into Multiple Myeloma with Biclonal Gammopathy Accompanied Hepatoma - A Case Report

A 32-year-old man with a rare orbital plasmacytoma and hepatitis B virus (HBV) infection transformed into multiple myeloma (MM) with biclonal gammopathy accompanied by hepatoma is reported. The man was found to have a tumor at left supraorbital region by magnetic resonance imaging and the tumor tissue with neoplastic plasma cells invaded into the skull bone. Whole body single photon emission computed tomography (SPECT/CT) showed no significant abnormality elsewhere. The serological data revealed HBV surface antigen (HBsAg) positive, anti-HCV negative and others were normal. Serum immunofixation electrophoresis (IFE) showed a normal pattern. This patient received post-operative radiation therapy, with a total dose of 5,040 cGy. Six months later, abdominal sonography and CT scan revealed splenomegaly and multiple tumors in liver with typical vascular pattern of hepatocellular carcinoma. Through SPECT/CT, multiple bony lesions were found. Biochemistry data were abnormal, HBV viral load was high and HBeAg was positive. Serum IFE showed the biclonal gammopathy. Hepatitis viruses may be the important etiologic agents of monoclonal gammopathies. However, the interrelation between HBV-related hepatocellular carcinoma and biclonal gammopathies MM has never been reported.

一名32歲B型肝炎帶原男性發生罕見的眼窩漿細胞瘤，半年後轉型為具有雙株伽碼球蛋白的多發性骨髓瘤，伴隨原發性肝癌。患者經由核磁共振照影發現左側眼眶上有一處腫瘤且腫瘤性漿細胞已侵入頭蓋骨。單一光子發射電腦斷層掃描（SPECT／CT）顯示身體其他部位並無異常。血清學檢查B型肝炎（HBV）表面抗原陽性、抗C型肝炎抗體陰性，其他血清學檢查正常，血清免疫固定電泳（IFE）正常。病人接受手術後放射線治療，總劑量為5,040 cGy。六個月後，腹部超音波及CT發現，脾臟腫大且肝臟多處典型血管類型的肝細胞腫瘤。透過SPECT／CT發現，多處骨骼損傷。多項生化血清報告異常，HBV病毒量高且HBV e抗原陽性，IFE呈現雙株伽碼球蛋白。肝炎病毒可能是單株伽碼球蛋白的致病物質，然而，HBV關聯的肝癌與具雙株伽碼球蛋白的多發性骨髓瘤之間的相互關係未曾被發表。