PRIMARNI PLAZMOCITOM LIMFNOG ČVORA – REDAK KLINIČKI ENTITET
Sažetak
Uvod: Ekstramedularna lokalizacija plazmocitoma u regiji glave i vrata čini manje od 1% tumora te regije. Primarna solitarna lokalizacija u limfnom čvoru, bez proliferacije plazmocita na bilo kojoj drugoj lokalizaciji, kao jedina manifestacija plazmocitoma, izuzetno je retka. Do sada je referisano manje od 50 slučajeva.
Prikaz slučaja: Muškarac, star 58 godina, zbog uvećane bezbolne žlezde na vratu, bez temperature, preznojavanja i gubitka u težini, obratio se lekaru. Tretiran je antibioticima širokog spektra u trajanju od 10 dana, ali nije bilo promene. Urađena kompletna krvna slika je imala uredan nalaz. Biohumoralni zapaljenski sindrom je bio negativan, a kompletna biohemija u referentnom opsegu. Urađen je eho vrata i registrovana jedna limfna žlezda promera 30 mm x 15 mm. Pacijent je upućen maksilofacijalnom hirurgu, žlezda je u celosti ekstirpirana i poslata na histopatološku analizu. Dobijen je sledeći patohistološki nalaz (PH): difuzna infiltracija plazmocitoidnim tumorskim ćelijama visoke pozitivnosti za: OCT2, BOB1, CD38, MUM1, lambda, CD31,VIM i CD79 alfa; negativne na kapa; Ki67 pozitivne u 30%. Zaključak patohistološkog nalaza je bio: plazmocitom lambda pozitivan. Biopsija koštane srži (BK) dala je sledeći patohistološki nalaz: plazmociti 4%. Snimanjem multislajsnim skenerom (MSCT) grudnog koša, abdomena i male karlice dobijen je uredan nalaz. Radiografski pregled skeleta je bio uredan. M komponenta u serumu i urinu je bila negativna. Virusologija je pokazala HBsAg pozitivnost, dok su HCV i HIV bili negativni. Indikovana je lokalna zračna terapija uz aktivno lečenje antiviroticima.
Zaključak: Svaka limfadenopatija zahteva ozbiljan i detaljan pristup kliničara. Da li je HBV infekcija bila okidač za nastanak plazmocitoma, ostaje za razmatranje.
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