Multiple Myeloma with Hyperamylasaemia：a Case Report and Literature Review

doi:10.12114/j.issn.1007-9572.2018.00.256

Abstract

Abstract: Multiple myeloma （MM） is a terminally differentiated B-cell malignancy with clinical presentations of osteolytic bone lesions，impaired renal function，and pathological secretion of monoclonal immunoglobulin.Hyperamylasemia is a presentation mostly found in acute pancreatitis.Hyperamylasaemia associated with MM appears to be a fairly unusual phenomenon.We reported a case of MM with hyperamylasemia with a detailed description of the diagnosis and treatment process.Moreover，we investigated the clinical manifestations，treatments，prognosis and pathological mechanisms of this disease on the basis of the review of the related studies.The study can deepen clinicians' understanding of this disease.

Key words: Multiple myeloma, Hyperamylasemia, Case reports

摘要： 多发性骨髓瘤（MM）是一类发生于终末分化阶段B细胞的恶性肿瘤性疾病，临床以溶骨性骨质破坏、贫血、肾功能损害及病理性分泌M蛋白为特征。高淀粉酶血症常见于急性胰腺炎。MM合并高淀粉酶血症临床少见。本研究报道1例以血清淀粉酶水平异常升高为特点的MM患者的诊治过程，并结合文献复习，通过对MM合并高淀粉酶血症的临床特点、治疗方法、预后及发病机制等进行探讨分析，以期提高临床医生对该病的认识水平。

关键词: 多发性骨髓瘤, 高淀粉酶血症, 病例报告

GUO Maodong,DING Jin,CHEN Yanping, et al. Multiple Myeloma with Hyperamylasaemia：a Case Report and Literature Review　[J]. Chinese General Practice, 2019, 22(11): 1372-1376. DOI: 10.12114/j.issn.1007-9572.2018.00.256.
郭茂东,丁进,陈燕萍等. 多发性骨髓瘤合并高淀粉酶血症一例报道并文献复习[J]. 中国全科医学, 2019, 22(11): 1372-1376. DOI: 10.12114/j.issn.1007-9572.2018.00.256.

References

［1］TERPOS E，NTANASIS-STATHOPOULOS I，GAVRIATOPOULOU M，et al．Pathogenesis of bone disease in multiple myeloma：from bench to bedside［J］．Blood Cancer J，2018，8（1）：7．DOI：10.1038/s41408-017-0037-4.
［2］MORIYAMA T，TOZAWA T，NOBUOKA M，et al．Sialyl salivary-type amylasemia associated with immunoglobulin D-type multiple myeloma［J］．Clin Chim Acta，1995，233（1/2）：127-134．DOI：10.1016/0009-8981（94）05971-T.
［3］HATA H，MATSUZAKI H，TANAKA K，et al．Ectopic production of salivary-type amylase by a IgA-lambda-type multiple myeloma［J］．Cancer，1988，62（8）：1511-1515．DOI：10.1002/1097-0142（19881015）62：8.
［4］OK S J，KIM I S，LEE E Y，et al．A case of salivary-type amylase-producing multiple myeloma presenting as mediastinal plasmacytoma and myelomatous pleural effusion［J］．Ann Lab Med，2014，34（6）：463-465．DOI：10.3343/alm.2014.34.6.463.
［5］SOSNOFF D R，FRIEND R B，BERKOVIC M，et al．Salivary amylase-producing multiple myeloma：case report and review of the current literature［J］．J Clin Oncol，2013，31（19）：e309-311．DOI：10.1200/JCO.2012.46.4677.
［6］KANNO M，OHTAKE S，OKAFUJI K，et al．IgD-type multiple myeloma associated with tumour of the pancreas［J］．Rinsho Ketsueki，1988，29（12）：2312-2316．DOI：10.11406/rinketsu.29.2312.
［7］TAGAWA S，DOI S，TANIWAKI M，et al．Amylase-producing plasmacytoma cell lines，AD3 and FR4 with der（14）t（8；14） and dic（8）t（1；8） established from ascites［J］．Leukemia，1990，4（8）：600-605.
［8］NATAZUKA T，OGAWA R，FUJII Y，et al．Ectopic salivary amylase producing IgA lambda type multiple myeloma with expression of MDR 1/P glycoprotein［J］．Rinsho Ketsueki，1991，32（6）：686-689．DOI：10.11406/rinketsu.32.686.
［9］MORIYAMA T，TOZAWA T，YAMASHITA H，et al．Separation and characterization of sialic acid-containing salivary-type amylase from patients' sera with immunoglobulin A-type myeloma［J］．J Chromatogr，1991，571（1/2）：61-72．DOI：10.1016/0378-4347（91）80434-E.
［10］HIROTA K，WAGA K，NAGASHIMA S，et al．Amylase producing plasma cell dyscrasia：genomic analysis in a case of intramuscular tumour formation and a review of the literature［J］．Rinsho Ketsueki，1993，34（2）：177-182．DOI：10.11406/rinketsu.34.177.
［11］NAKAJIMA T，NOGUCHI T，KUMAHAR Y，et al．Neuron specific enolaseproducing IgD multiple myeloma with high serum amylase activity［J］．Rinsho Ketsueki，1995，36（4）：359-364．DOI：10.11406/rinketsu.36.359.
［12］PINELLI M，BINDI M，ROSADA J，et al．Amylase：a disease activity index in multiple myeloma？［J］．Leuk Lymphoma，2006，47（1）：151-154．DOI：10.1080/10428190500262144.
［13］HARBORNE S L，CURLEY R，BULLIMORE D W，et al．A case report of a salivary amylase secreting plasmacytoma in a patient with multiple myeloma［J］．BMJ Case Rep，2009，2009：bcr08.2008.0639．DOI：10.1136/bcr.08.2008.0639.
［14］CALVO-VILLAS J M，ALVAREX I，CARRETERA E，et al．Paraneoplastic hyperamylasaemia in association with multiple myeloma［J］．Acta Haematol，2007，117（4）：242-245．DOI：10.1159/000100931.
［15］LOPEZ J，ULIBARRENA C，GONZALEZ-PORGUE P，et al．Amylase-producing Bence Jones multiple myeloma with pancreatitis-like symptoms［J］．Acta Haematol，1993，90（2）：99-101．DOI：10.1159/000204384.
［16］ROSS C M，DEVGUN M S，GUNN I R.Hyperamylasaemia and multiple myeloma［J］．Ann Clin Biochem，2002，39（Pt 6）：616-620．DOI：10.1177/000456320203900615.
［17］BLOEMENDAL H J，LOBATTO S.Hyperamylasaemia in multiple myeloma［J］．Neth J Med，1996，49（1）：38-41．DOI：10.1016/0300-2977（95）00110-7.
［18］WADA H，OHTSUKI T，SUGIHARA T，et al．Ectopic production of amylase by a non-producing type multiple myeloma［J］．Rinsho Ketsueki，1990，31（7）：1022-1027．DOI：10.11406/rinketsu.31.1022.
［19］KANEKO H，OHKAWARA Y，TANIGUCHI K，et al．Simultaneous complication of multiple myeloma with Sj?gren syndrome［J］．Asian Pac J Allergy Immunol，2006，24（4）：245-248.
［20］DELANNOY A，HAMELS J，MECUCCI C，et al．Amylase-producing IgD-type multiple myeloma［J］．J Intern Med，1992，232（5）：457-460．DOI：10.1111/j.1365-2796.1992.tb00615.x.
［21］NAIR S，SACHAN P，HERTAN H，et al．Metastatic multiple myeloma with hyperamylasaemia and hyperlipasaemia［J］．Postgrad Med J，1998，74（876）：621-623．DOI：10.1136/pgmj.74.876.621.
［22］YAMAKAWA T，NAGOSHI H，TAKAHJASHI A，et al．Acquired amylase production induced by radiotherapy in a myeloma patient［J］．Rinsho Ketsueki，1995，36（10）：1175-1181．DOI：10.11406/rinketsu.36.1175.
［23］安娜，谢亚萍，徐颖，等．多发性骨髓瘤合并高淀粉酶血症一例［J］．中华血液学杂志，2016，37（10）：845．DOI：10.3760/cma.j.issn.0253-2727.2016.10.003.
AN N，XIE Y P，XU Y，et al．Multiple myeloma associated with hyperamylasaemia：a case report［J］．Chinese Journal of Hematology，2016，37（10）：845．DOI：10.3760/cma.j.issn.0253-2727.2016.10.003.
［24］吴小娟，汤绍辉，刘秋荣，等．多发性骨髓瘤伴高淀粉酶血症1例［J］．实用医学杂志，2012，28（10）：1729．DOI：10.3969/j.issn.1006-5725.2012.10.061.
WU X J，TANG S H，LIU Q R，et al．Multiple myeloma associated with hyperamylasaemia：a case report［J］．The Journal of Practical Medicine，2012，28（10）：1729．DOI：10.3969/j.issn.1006-5725.2012.10.061.
［25］熊瑶，韦宏成，冯淑芬.以肺部感染、血淀粉酶升高为表现的多发性骨髓瘤误诊一例［J］．海南医学，2016，27（21）：3594-3595．DOI：10.3969/j.issn.1003-6350.2016.21.053.
XIONG Y，WEI H C，FENG S F，et al．A misdiagnosed case of multiple myeloma with pulmonary infection and hyperamylasaemia as the initial manifestation［J］．Hainan Medical Journal，2016，27
（21）：3594-3595．DOI：10.3969/j.issn.1003-6350.2016.21.053.
［26］刘肇修，倪润洲.IgD型多发性骨髓瘤合并高淀粉酶血症一例［J］．中华消化杂志，2012，32（7）：491．DOI：10.3760/cma.j.issn.0254-1432.2012.07.019.
LIU Z X，NI R Z.Hyperamylasaemia associated with immunoglobulin D-type multiple myeloma：a case report［J］．Chinese Journal of Digestion，2012，32（7）：491．DOI：10.3760/cma.j.issn.0254-1432.2012.07.019.
［27］MATULL W R，PEREIRA S P，O DONOHUE J W.Biochemistry makes of acute pancreatits［J］．J Clin Pathol，2006，59 （4）：340-344．DOI：10.3760/cma.j.issn.0254-1432.2012.07.019.
［28］SAKAI M，ISHIKAWA S，YAMAMOTO T，et al．A direct measurement of serum amylase levels producedby lung cancer［J］．Ann Thorac Surg，2005，79（4）：1409-1411．DOI：10.1016/j.athoracsur.2003.10.069.
［29］MORIYAMA T.Sialyl salivary-type amylase associated with ovarian cancer［J］．Clin Chim Acta，2008，391（1/2）：106-111．DOI：10.1016/j.cca.2008.01.025.
［30］中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南（2013，上海）［J］．中华消化杂志，2013，33（4）：217-222．DOI：0.3760/cma.j.issn.0254-1432.2013.04.001.
Acute Pancreatitis Working Group in Chinese Society of Gastroenterology.The guidelines for diagnosis and management of acute pancreatitis in China （2013，Shanghai）［J］．Chinese Journal of Digestion，2013，33（4）：217-222．DOI：10.3760/cma.j.issn.0254-1432.2013.04.001.
［31］吴东，刘晓红.慢性高淀粉酶血症［J］．中国实用内科杂志，2007，27（19）：1552-1553．DOI：10.3969/j.issn.1005-2194.2007.19.021.
WU D，LIU X H.Chronic hyperamylasaemia［J］．Chinese Journal of Practical Internal Medicine，2007，27（19）：1552-1553．DOI：10.3969/j.issn.1005-2194.2007.19.021.
［32］MIZUNO S，HANAMURA I，OTA A，et al．Overexpression of salivary type amylase reduces the sensitivity to bortezomib in multiple myeloma cells［J］．Int J Hematol，2015，102（5）：569-578．DOI：10.1007/s12185-015-1859-0.
［33］OHTSUKI T，YAWATA Y，WADA H，et al．Two human myeloma cell lines，amylase-producing KMS-12-PE and amylase-non-producing KMS-12-BM，were established from a patient，having the same chromosome marker，t（11；14）（q13；q32）［J］．Br J Haematol，1989，73（2）：199-204．DOI：10.1111/j.1365-2141.1989.tb00252.x.

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