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rmsjrmsjРоссийский медико-социальный журналRussian Medical and Social JournaladminadminМосковский медико-социальный институт имени Ф.П. ГаазаRU2658-77182658-772610.35571/RMSJ.2019.1.00737Clinical practice: case studiesПрактикующему врачу: клинические наблюденияЛучевая диагностика экстрамедуллярных поражений у пациента со множественной миеломойImaging in diagnostics and management of extramedullary lesions in a patient with multiple myelomaКозыревСергей Владимирович

Burdenko Main Military Clinical Hospital — X-ray diagnostics unit of the Radiodiagnosics Dept, Head of the X-ray diagnostics unit - deputy head of the Radiodiagnosics Dept

ФГБУ «ГВКГ им. академика Н.Н. Бурденко» Минобороны России — рентгеновское отделение центра лучевой диагностики, начальник рентгеновского отделения- заместитель начальника центра лучевой диагностики

КорабельниковДаниил Иванович

Moscow Medical - Social Institute named after Friedrich Haass — Rector

АНО ДПО "Московский медико-социальный институт имени Ф.П. Гааза" — Ректор

ПопВасилий Петрович

Burdenko Main Military Clinical Hospital — Hematology unit of the Hematology Center, Head of the Hematology unit

ФГБУ «ГВКГ им. академика Н.Н. Бурденко» Минобороны России — гематологическое отделение гематологического центра, заведующий гематологическим отделением

ТроянВладимир Николаевич

Burdenko Main Military Clinical Hospital — Radiodiagnosics Dept, Head of the Radiodiagnosics Dept, Chief radiologist

ФГБУ «ГВКГ им. академика Н.Н. Бурденко» Минобороны России — центр лучевой диагностики, начальник центра лучевой диагностики

РукавицынОлег Анатольевич

Main Military Hospital named after N.Burdenko under The Ministry of Defence of The Russian Federation — Hematology dept, Head of the Dept - Chief hematologist of The Hospital

ФГБУ "Главный военный клинический госпиталь им.академика Н.Н.Бурденко" Минобороны России — Гематологический центр, Начальник центра - главный гематолог госпиталя

ФГБУ «ГВКГ им. академика Н.Н. Бурденко» Минобороны России, Москва, РоссияАНО ДПО "Московский медико-социальный институт имени Ф.П. Гааза", Москва, РоссияФГБУ "Главный военный клинический госпиталь им.академика Н.Н.Бурденко" Минобороны России, Москва, Россия2019010720191147487Received: 2062019Copyright (c) 2019 Российский медико-социальный журнал2019Российский медико-социальный журнал<a rel="license" href="https://creativecommons.org/licenses/by-nc-sa/4.0/"><img alt="Лицензия Creative Commons" src="//i.creativecommons.org/l/by-nc-sa/4.0/88x31.png" /></a><p>Это произведение доступно по <a rel="license" href="https://creativecommons.org/licenses/by-nc-sa/4.0/">лицензии Creative Commons «Attribution-NonCommercial-ShareAlike» («Атрибуция — Некоммерческое использование — На тех же условиях») 4.0 Всемирная</a>.</p>Множественная миелома (ММ) - злокачественное онкогематологическое заболевание, которое чаще поражает костный мозг. При прогрессировании заболевания возможно поражение других органов с появлением разнообразных клинических проявлений. Поражение желудочно-кишечного тракта, особенно с развитием кишечного кровотечения, встречается крайне редко. Приводится обзор литературы по встречаемости внекостномозговых поражений при ММ и краткий обзор методов лучевых исследований при ММ, даются рекомендации по их использованию. Описывается диагностика и клиническое наблюдение случая вторичной экстрамедуллярной плазмоцитомы - поражения миеломными плазматическими клетками головки поджелудочной железы, двенадцатиперстной кишки, осложненной рецидивирующими кишечными кровотечениями и анемией тяжелой степени, манифестирующей у пациента с ММ, II стадией по ISS, с секрецией парапротеина IgА лямбда, после 6 лет лечения с применением химиотерапии, аутологичной трансплантации гемопоэтических стволовых клеток и лучевой терапии. Этот клинический случай демонстрирует возможности лучевых методов исследования в диагностике экстрамедуллярной плазмоцитомы как проявления эволюции ММ при динамическом наблюдении пациентов.Extraosseous manifestations are found in less than 5% of patients with multiple myeloma. Involvement of the gastrointestinal system in the course of multiple myeloma (MM) is extremely rare. Imaging is required for correct staging, in the followup after treatment and is predictor of prognosis. Several imaging technologies are used for the diagnosis and management of patients with MM. Conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine imaging - positron emission tomography (PET) combined with CT (PET/CT) and PET combined with MRI (PET/MRI) are all used in clarifying the extent of bone and soft tissue lesions in MM. The brief literature review on extramedullary lesions in MM and their imaging with recommendations is given. We describe the imaging in diagnostics and management of an rare case of secondary extramedullary plasmacytoma (EMP) in relapse involving the pancreas and duodenum with the bleeding in a patient with MM, IgA lambda, stage II, after 6-years treatment with chemotherapy, autologous peripheral blood stem cell transplantation and radiotherapy. EMP was detected by PET/CT before the appearance of obvious clinical signs, and then EMP was monitoring by PET/CT, X-ray and ultrasound.KeywordsMyelomaExtramedullary plasmacytomaPancreasDuodenumImagingMagnetic Resonance imagingComputer tomographyPositron Emission tomographyX-rayRadiation diagnosticsUlrasoundКлючевые словамножественная миеломаэкстрамедуллярная плазмоцитомаплазматические клеткидвенадцатиперстная кишкажелудочно-кишечные кровотечениялучевая диагностикакомпьютерная томографияпозитронно-эмиссионная томографиярентгенографиярентгеноскопияультразвуковая диагностикаэндосонографияissue-coverSwerdlow S, Campo E, Harris N, et al., eds. 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