گزارش یک مورد توده اسکروتوم اولین تظاهر بالینی مولتیپل میلوما

ﻣﻘﺪﻣﻪ: ﺗﻮﻣﻮر ﺑﯿﻀﻪ ﺑﻪ ﻋﻨﻮان ﯾﮑﯽ از ﻧﺎدرﺗﺮﯾﻦ ﺗﻮﻣﻮرﻫﺎ، 1-2 درﺻﺪ از ﺗﻮﻣﻮرﻫﺎی ﻣﺮدان را ﺷﺎﻣﻞ ﻣﯽﺷﻮد و 95 درﺻﺪ آنﻫﺎ از ﻧﻮع ﺳﻠﻮلﻫﺎی زاﯾﺎ ﻫﺴﺘﻨﺪ. در ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ، ﮔﺰارش ﯾﮏ ﻣﻮرد ﺗﻮده اﺳﮑﺮوﺗﻮم اوﻟﯿﻦ ﺗﻈﺎﻫﺮ ﺑﺎﻟﯿﻨﯽ ﻣﻮﻟﺘﯿﭙﻞ ﻣﯿﻠﻮﻣﺎ )multiple myeloma( ﺗﺸﺮﯾﺢ ﺷﺪه اﺳﺖ. ﻣﻌﺮﻓﯽ ﺑﯿﻤﺎر: ﺑﯿﻤﺎر ﻣﺮدی 48 ﺳﺎﻟﻪ ﺑﺎ ﻣﺸﮑﻞ ﺗﻮده ﺑﺰرگ ﺑﺪون درد در اﺳﮑﺮوﺗﻮم ﭼﭗ ﺑﻪ درﻣﺎﻧﮕﺎه اروﻟﻮژی ﻣﺮاﺟﻌﻪ ﮐﺮد. در ﻣﻌﺎﯾﻨﻪ ﺑﺎﻟﯿﻨﯽ وی دردﻫﺎی اﺳﺘﺨﻮاﻧﯽ، ﺑﯽ ﺣﺎﻟﯽ و ﺿﻌﻒ وﺟﻮد ﻧﺪاﺷﺖ. ﻋﻼﺋﻢ ﺣﯿﺎﺗﯽ، ﻣﻌﺎﯾﻨﺎت ﻗﻠﺐ و رﯾﻪ و ﺷﮑﻢ ﻫﻤﮕﯽ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ. در ﺳﻮﻧﻮﮔﺮاﻓﯽ اﻧﺠﺎم ﺷﺪه، ﺗﻮده ﺑﺰرگ اﯾﺰواﮐﻮ ﺑﺎ ﻗﻄﺮ 10 ﺳﺎﻧﺘﯿﻤﺘﺮ در ﻫﻤﯽ اﺳﮑﺮوﺗﻮم ﭼﭗ ﻫﻤﺮاه ﺑﺎ اﻟﺘﻬﺎب و ادم دﯾﻮاره اﺳﮑﺮوﺗﻮم ﮔﺰارش ﺷﺪ. ﺑﺎ ﺗﺸﺨﯿﺺ ﺗﻮﻣﻮر ﺑﯿﻀﻪ ﭼﭗ ﺗﺼﻤﯿﻢ ﺑﻪ اﻧﺠﺎم ﻋﻤﻞ ﺟﺮاﺣﯽ ﮔﺮﻓﺘﻪ ﺷﺪ. روز ﭼﻬﺎرم ﭘﺲ از ﻋﻤﻞ، ﺑﯿﻤﺎر دﭼﺎر ﻫﻤﺎﺗﻮم ﺑﺰرگ در ﻫﻤﯽ اﺳﮑﺮوﺗﻮم ﭼﭗ ﺷﺪ ﮐﻪ ﺑﺎر دﯾﮕﺮ ﻋﻤﻞ ﺟﺮاﺣﯽ اﻧﺠﺎم و ﻫﻤﺎﺗﻮم ﺗﺨﻠﯿﻪ ﺷﺪ. در آزﻣﺎﯾﺶﻫﺎی اﻧﺠﺎم ﺷﺪه، ﮐﺎﻫﺶ ﻫﻤﻮﮔﻠﻮﺑﯿﻦ ﺧﻮن ﺗﺎ ﻣﯿﺰان 6/5 و ﮐﺎﻫﺶ ﭘﻼﮐﺖ ﺗﺎ 32000 و اﻓﺰاﯾﺶ ﮐﺮاﺗﻨﯿﻦ ﺧﻮن ﻣﺸﺎﻫﺪه ﺷﺪ. ﻫﻢ زﻣﺎن ﺑﺎ اﻗﺪاﻣﺎت و درﻣﺎنﻫﺎی ﺣﻤﺎﯾﺘﯽ ﺑﺮای اﺻﻼح ﮐﻢ ﺧﻮﻧﯽ و ﭘﻼﮐﺖ و ﻫﻤﭽﻨﯿﻦ اﺻﻼح ﻋﻤﻠﮑﺮد ﮐﻠﯿﻪ ﻫﺎ ﮐﻪ اﻟﺒﺘﻪ ﻣﻮﺛﺮ ﻫﻢ ﺑﻮد، ﺑﻪ دﻟﯿﻞ ﺑﺎﻻ ﺑﻮدن ﺳﺮﻋﺖ رﺳﻮب ﮔﻠﺒﻮل ﻗﺮﻣﺰ )erythrocyte sedimentation rate( و ﭘﺮوﺗﺌﯿﻦ ﺗﺎم، ﮔﺮاﻓﯽ ﺟﻤﺠﻤﻪ ﮔﺮﻓﺘﻪ ﺷﺪ ﮐﻪ ﺣﺎوی ﺿﺎﯾﻌﺎت lytic ﺑﻮد. ﺑﯿﻤﺎر ﺑﺎ ﻇﻦ ﺑﺎﻻی اﺑﺘﻼ ﺑﻪ ﻣﻮﻟﺘﯿﭙﻞ ﻣﯿﻠﻮم ﺗﺤﺖ ﻣﺸﺎوره ﺑﺎ ﻣﺘﺨﺼﺺ داﺧﻠﯽ ﻗﺮار ﮔﺮﻓﺖ. ﻧﺘﯿﺠﻪ ﮔﯿﺮی: در اﯾﻦ ﺑﯿﻤﺎر اﺣﺘﻤﺎﻻً اﺧﺘﻼل اﻧﻌﻘﺎدی و ﺑﻪ دﻧﺒﺎل آن ﺗﺮوﻣﺎی ﺧﻔﯿﻒ ﺑﻪ ﺑﯿﻀﻪ، ﻣﻮﺟﺐ ﺧﻮن رﯾﺰی در ﺑﯿﻀﻪ و اﯾﺠﺎد ﺗﻮده در آن ﺷﺪه اﺳﺖ. اﻟﺒﺘﻪ در وﺿﻌﯿﺖ ﯾﺎد ﺷﺪه ﺑﻪ ﺧﺎﻃﺮ وﺟﻮد آﻧﻤﯽ ﺑﺎﯾﺪ ﺳﺎﯾﺮ ﺗﺸﺨﯿﺺ ﻫﺎی اﻓﺘﺮاﻗﯽ ﻧﯿﺰ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﻮد. ﺑﻪ ﻫﺮ ﺣﺎل، ﻋﺪم ﮔﺰارش ﺗﻮﻣﻮر در ﻧﻤﻮﻧﻪ ارﺳﺎﻟﯽ ﺑﻪ آزﻣﺎﯾﺸﮕﺎه، ﻟﺰوم ﺑﺮرﺳﯽﻫﺎی ﺑﯿﺸﺘﺮ را ﻣﻄﺮح ﮐﺮد. ﻋﻮد ﻣﮑﺮر ﻫﻤﺎﺗﻮم ﻣﺤﻞ ﻋﻤﻞ در اﯾﻦ ﺑﯿﻤﺎر و ﻋﺪم اﻣﮑﺎن ﺗﻌﯿﯿﻦ ﮔﺮوه ﺧﻮﻧﯽ و در ﻧﺘﯿﺠﻪ ﺷﮏ ﺑﻪ ﺑﺎﻻ ﺑﻮدن ﭘﺮوﺗﺌﯿﻦﻫﺎ درﺧﻮن ﮐﻪ ﺑﺎ ﺑﺎﻻ ﺑﻮدن esr ﺳﺮم ﺑﺎ وﺟﻮد ﺳﻦ ﺑﻪ ﻧﺴﺒﺖ ﭘﺎﺋﯿﻦ ﺑﯿﻤﺎر ﻫﻤﺮاه ﺑﻮد، ﺗﺸﺨﯿﺺ ﻣﺎﻟﺘﯿﭙﻞ ﻣﯿﻠﻮﻣﺎ را ﺑﺮای اﯾﻦ ﻓﺮد ﻣﻄﺮح ﮐﺮد.

a case report of scrotal mass the first clinical manifestation of multiple myeloma

introduction: testicular tumor is one of the rarest tumors that accounts for 1-2% of male tumors and 95% of them are germ cells. the present study reported a case of scrotum mass, the first clinical manifestation of multiple myeloma.case report: the patient was a 48-year-old man with a large mass without pain in the left scrotum and referred to a urology clinic. there was no bone pain, lethargy, or weakness on clinical examination. vital signs, heart, lung, and abdominal examinations were all normal. ultrasound showed a large 10-cm-diameter izuaco mass in the left hemiscrotum with inflammation and edema of the scrotum wall. with the diagnosis of a left testicular tumor, the decision was made to perform surgery.conclusion: in this patient, coagulation disorder and subsequent mild trauma to the testicle, which the patient does not remember, may have caused bleeding in the testicle and a mass in it. of course, the presence of anemia should suggest other differential diagnoses. however, the lack of tumor reporting in the sample sent to the laboratory necessitates further investigation. recurrent hematoma at the site of surgery in this patient and the impossibility of determining blood type raised the suspicion of high proteins in the blood, which together with high esr serum despite the relatively young age of the patient led us to the diagnosis of multiple myeloma.