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Abstract
Plasma cell gingivitis (PCG) is an inflammatory condition that affects the gingival mucosa of the oral cavity. It is characterized by polyclonal dense plasma cell infiltrate in the connective tissue. Lesions do not respond to prophylactic treatment. Etiology is most likely hypersensitivity to certain antigens (eg, toothpastes, oral rinses, chewing gums, spices). Differential diagnosis of PCG includes reactive, granulomatous, and neoplastic lesions. The diagnostic workup is based on patient's history and the clinicopathologic correlation to rule out mimics of PCG. Dermatologic patch test may be indicated in chronic conditions to identify the allergen.
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Thankappan S, Nedumpillil S. Multiple myeloma with oral manifestations as maxillary ulceroproliferative lesion: A case report. J Cancer Res Ther 2023; 19:S1005-S1008. [PMID: 38384103 DOI: 10.4103/jcrt.jcrt_336_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/24/2022] [Indexed: 02/23/2024]
Abstract
ABSTRACT Multiple Myeloma (MM) is the most common malignant neoplasm of bone and can manifest with different clinical features in oral cavity. MM lesions in skull and jaws have characteristic punched out lesions but are often confused with meningioma when they occur in skull as solitary lesions. We report a case of MM that reported in oral cavity for which prompt diagnosis was done, but there were symptoms that persisted for years and a skull lesion that was diagnosed and treated as meningioma before MM was diagnosed from the oral lesions. This is the first case where the patient has been actually treated for meningioma, and then diagnosed with MM after months. In that case, SBP or MM should be included in the differential diagnosis of a dural mass, particularly when a patient is complaining of neurological deficits. Also, the role of oral physician in the diagnosis of MM should be stressed in diagnosis and multidisciplinary management, thus facilitating better clinical outcomes.
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Affiliation(s)
- Simi Thankappan
- Department of Oral Medicine and Radiology, Government Dental College, Calicut, Kerala, India
| | - Sherin Nedumpillil
- Department of Oral Pathology and Microbiology, Government Dental College, Calicut, Kerala, India
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Akyol R, Şirin Sarıbal G, Amuk M. Evaluation of mandibular bone changes in multiple myeloma patients on dental panoramic radiographs. Oral Radiol 2022; 38:575-585. [PMID: 35132575 DOI: 10.1007/s11282-022-00590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to assess the mandibular bone structures of multiple myeloma (MM) patients on panoramic radiographs using fractal analysis (FA) and radio-morphometric indices. METHODS The study group consisted of 67 MM patients, and the control group consisted of 67 individuals without any systemic disease. The mandibular cortical index (MCI) classification, antegonial index (AGI), gonial index (GI), mandibular cortical width (MCW), panoramic mandibular index (PMI) and fractal dimensions (FD) were evaluated on panoramic radiographs. FD measurements were made by identifying 4 related areas. Shapiro-Wilk test was used to determine the normal distribution of the data. Chi-square and independent t tests were used to compare the findings between the two groups. RESULTS The FD values of the study group in ROI1, ROI2, ROI3, ROI4 regions and GI values were found to be statistically significantly lower than the control group (p < 0.001). There was no statistically significant difference between the two groups in terms of AGI, MCW and PMI values (p > 0.05). While C1 was the most common type in the control group, C2 was the most common type in the study group. C2 and C3 were detected more in the study group than in the control group (p < 0.001). CONCLUSION Our study showed a consensus with the studies advocating that fractal analysis and radio-morphometric indices are methods that can be used to determine mandibular bone density. The low bone density of MM patients is a condition that physicians should be aware of for interventional dental procedures.
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Affiliation(s)
- Rıdvan Akyol
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey.
| | - Gamze Şirin Sarıbal
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey
| | - Mehmet Amuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey
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Costa AMDD, Costa CRD, Pereira DL, Antunes HS. Avaliação Radiográfica da Maxila e da Mandíbula de Pacientes Diagnosticados com Mieloma Múltiplo: Estudo Retrospectivo. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n2.2186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Introdução: O mieloma múltiplo e caracterizado como uma neoplasia maligna plasmocitária com a proliferação anormal de plasmócitos clonais na medula óssea de etiologia desconhecida. Objetivo: Caracterizar os pacientes com mieloma múltiplo atendidos no Setor de Estômato-Odontologia e Prótese do INCA, por meio de dados sociodemográficos, clínicos, laboratoriais e radiográficos. Método: Estudo transversal retrospectivo de pacientes com diagnostico de mieloma múltiplo, no período de 2000 a 2018, que realizaram radiografia panorâmica no período do diagnóstico da doença. Os dados sociodemográficos e clinico-radiográficos da população em estudo foram coletados nos prontuários dos pacientes, armazenados em banco de dados, analisados de forma descritiva e submetidos ao teste não paramétrico X2 (qui-quadrado). Resultados: Na amostra final, foram totalizados 163 casos. A maioria era de homens (56,4%), brancos (55,8%), com idade ≤55 anos (54%), ensino fundamental incompleto (30,7%), não fumantes (54,6%) e não bebedores (54,6%). Havia lesões líticas em 46 pacientes (28,2%) com predileção pela mandíbula (82,6%; p=0,000). Houve maior frequência de margens parcialmente definidas (50,0%), não escleróticas (78,2%) e de aspecto unilocular (43,5%). Dos 46 pacientes que apresentaram lesão lítica maxilomandibular, 27 pacientes tinham >55 anos (p=0,042). Conclusão: Ha maior ocorrência de lesões ósseas na mandíbula quando comparada a maxila.
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Imaginological characterization of multiple myeloma lesions of the jaws through cone-beam computed tomography. Oral Radiol 2019; 36:168-176. [PMID: 31222625 DOI: 10.1007/s11282-019-00394-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To establish an evaluation protocol for the identification and description of the variations in multiple myeloma (MM) lesions of the jaws, by means of cone-beam computed tomography (CBCT). MATERIALS AND METHODS Tomography exams from 33 MM patients were evaluated in this retrospective observational study. The reconstructions were analyzed simultaneously, according to the established protocol, with the following description criteria: anatomic location, size, margins, inner aspect, relationship with adjacent structures, and presence or absence of a punched-out aspect. The exams were further subdivided into groups of patients using, or not bisphosphonates. RESULTS There were osteolytic lesions in 100% of cases, most of which were extended to more than one anatomical region. Poorly defined margins were more frequent in the maxilla than in the mandible. Extensive bone resorption presenting multilocular areas was the most frequently observed aspect, being 86.2% for maxilla and 87.9% for mandible. In relation to bisphosphonates, patients who used the medication had more poorly defined bone margins and contortions (68.6%) than those who did not undergo drug therapy (31.4%). No well-defined lesions were observed (p = 0.34%). CONCLUSION It was possible to establish a protocol for evaluation of MM lesions in CBCT images and to identify that when evaluated three-dimensional, lesions tend to be poorly defined and have no pattern of description, as described in two-dimensional "punched-out".
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Biun J, Lok V, Koong B, Huang TC. A significant incidental finding on cone beam computed tomography: multiple myeloma. Aust Dent J 2019; 64:293-296. [PMID: 31002386 DOI: 10.1111/adj.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
Abstract
Cone beam computed tomography is widely used in dentistry. Incidental findings are common, with many requiring intervention or monitoring. We present a rare case of previously undiagnosed, asymptomatic multiple myeloma first identified incidentally on cone beam computed tomography and panoramic radiography. This case highlights the diverse range of lesions that may appear on cone beam computed tomography and the importance of radiologic interpretation.
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Affiliation(s)
- J Biun
- Private Practice, Melbourne, Victoria, Australia
| | - V Lok
- Private Practice, Perth, Western Australia, Australia
| | - B Koong
- School of Human Science, Faculty of Science, The University of Western Australia, Western Australia, Australia
| | - T C Huang
- Private Practice, Perth, Western Australia, Australia
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Abed H, Burke M, Nizarali N. Oral and dental management for people with multiple myeloma: clinical guidance for dental care providers. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/denu.2018.45.5.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Hassan Abed
- Special Care Dentist, Department of Sedation and Special Care Dentistry, Floor 26, Tower Wing, Guy'S Hospital, London Bridge, SE1 9RT, UK
| | - Mary Burke
- Consultant in Sedation and Special Care Dentistry, Department of Sedation and Special Care Dentistry, Floor 26, Tower Wing, Guy's Hospital, London Bridge, SE1 9RT, UK
| | - Najla Nizarali
- Consultant in Sedation and Special Care Dentistry, Department of Sedation and Special Care Dentistry, Floor 26, Tower Wing, Guy's Hospital, London Bridge, SE1 9RT, UK
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Abstract
Multiple myeloma (MM) is a malignant neoplasm of plasma cell origin. It usually has a multicentric origin within the bone. It contributes to about 1% of all malignancies and 15% of all hematologic malignancies. There is a monoclonal proliferation of abnormal plasma cells in this disease that results from a single malignant precursor that has undergone an uncontrolled mitotic division. Later, these cells produce one type of immunoglobulin light chain, either kappa or lambda. We present a case of a 46‑year‑old male patient who presented with a swelling of the mandible. The punched-out radiolucencies in the skull radiograph and the immunohistochemistry confirmed the case as MM.
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Affiliation(s)
- Ibrahim K Ali
- Oral Medicine and Radiology, Nair Hospital Dental College
| | - Amit R Parate
- Oral Medicine and Radiology, Govt. Dental College, Aurangabad
| | - Vikrant O Kasat
- Oral Medicine and Radiology, Govt. Dental College, Aurangabad
| | - Amaresh Dora
- Oral Medicine and Radiology, Nair Hospital Dental College
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Almeida TMXD, Cavalcanti ÉFF, Freitas ADS, Magalhães RJPD, Maiolino A, Torres SR. Can dentists detect multiple myeloma through oral manifestations? Rev Bras Hematol Hemoter 2017. [PMID: 29519372 PMCID: PMC6003103 DOI: 10.1016/j.bjhh.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To review published data on oral manifestations of multiple myeloma. Methods An electronic database search was performed of articles published from 1971 to November 2016 in order to identify studies that reported oral manifestations of patients with multiple myeloma. Case reports and case series with oral manifestations of multiple myeloma in English were included in the study. An additional search was performed of the references of the selected articles. Results Thirty-seven articles that reported 81 patients with oral manifestations of multiple myeloma were selected: 30 case reports (82%) and seven case series (18%). The most common clinical features in the dental cavity were swelling (65.4%), bone pain (33.3%), paresthesia (27.1%) and amyloidosis lesions (11.1%). Osteolytic lesions detected on imaging exams were reported in the majority of the patients (90.1%) as plasmacytomas or ‘punched-out’ lesions. Conclusions Swelling and osteolytic lesions represent the most common clinical and radiographic signs of the jaws relating to multiple myeloma, respectively.
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Affiliation(s)
| | | | | | | | - Angelo Maiolino
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Fregnani ER, Leite AA, Parahyba CJ, Nesrallah ACA, Ramos-Perez FMDM, Perez DEDC. Mandibular destructive radiolucent lesion: The first sign of multiple myeloma. J Clin Exp Dent 2016; 8:e465-e468. [PMID: 27703618 PMCID: PMC5045697 DOI: 10.4317/jced.52832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/10/2016] [Indexed: 12/22/2022] Open
Abstract
The occurrence of a mandibular lesion as the first sign of multiple myeloma (MM) is uncommon. This report describes a case of MM diagnosed because of a mandibular lesion. A 62-year-old woman presented a destructive radiolucent lesion in the right mandibular ramus. The lesion caused rupture of the anterior cortical bone and extended from the retromolar area to the coronoid process. An incisional biopsy was performed. Histopathological examination revealed numerous pleomorphic plasma cells, some with binucleated nuclei. The tumor cells showed kappa light-chain restriction. Bone marrow biopsy showed findings of massive infiltration of neoplastic plasma cells, besides lesions in the vertebrae. The diagnosis of MM was established. The patient underwent autologous hematopoietic stem-cell transplantation. Currently, the patient is under regular follow up after 40 months of initial treatment. In conclusion, MM should be considered in the differential diagnosis of destructive mandibular lesions.
Key words:Mandible, multiple myeloma, radiolucent lesion.
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Affiliation(s)
| | - Amanda-Almeida Leite
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | | | - Danyel-Elias-da Cruz Perez
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Dawoud BES, Ariyaratnam S. Amyloidosis Presenting as Macroglossia and Restricted Tongue Movement. DENTAL UPDATE 2016; 43:641-647. [PMID: 29148674 DOI: 10.12968/denu.2016.43.7.641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Amyloidosis (AL) is a well recognized cause of macroglossia. A case of localized deposition of systemic amyloidosis secondary to multiple myeloma is reported in a 63-year-old female presenting with restricted tongue movement in the dental setting. Amyloidosis secondary to multiple myeloma is well documented in the literature, with amyloid deposits being found at various sites throughout the oral cavity and systemically. This case emphasizes the importance of a full oral soft tissue examination, including the need to examine mobility of the tissues, as it was the restricted movement of the tongue that ultimately alerted the clinician to the diagnosis. This report also highlights other dental implications of managing patients with multiple myeloma and amyloidosis. Clinical relevance: To provide an understanding of what multiple myeloma and amyloidosis are whilst, importantly, relating this to how these conditions can impact on routine dental treatment.
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Tsunematsu K, Kanno T, Sekine J. A case of recurrent multiple myeloma showing clinical features similar to medication-related osteonecrosis of the jaw (MRONJ). JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Maxillary Swelling as the First Evidence of Multiple Myeloma. Case Rep Dent 2015; 2015:439536. [PMID: 26640721 PMCID: PMC4659956 DOI: 10.1155/2015/439536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/01/2015] [Indexed: 12/18/2022] Open
Abstract
Multiple myeloma is a malignant neoplasm of plasma cells characterized by proliferation of a single clone of abnormal immunoglobulin-secreting plasma cells. Since the amount of hemopoietic bone marrow is decreased in the maxilla, oral manifestations of multiple myeloma are less common in the maxilla than in the mandible. We report the case of 33-year-old Japanese man who presented with a mass in the right maxillary alveolar region. Computed tomography and magnetic resonance images showed a soft tissue mass in the right maxilla eroding the anterior and lateral walls of the maxillary sinus and extending into the buccal space. The biopsy results, imaging, and laboratory investigations led to the diagnosis of multiple myeloma. This case report suggests that oral surgeons and dentists should properly address oral manifestations as first indications of multiple myeloma.
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Lee BD, Park MR, Kwon KH. Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features. Imaging Sci Dent 2015; 45:199-203. [PMID: 26389064 PMCID: PMC4574059 DOI: 10.5624/isd.2015.45.3.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/11/2015] [Accepted: 05/24/2015] [Indexed: 11/18/2022] Open
Abstract
A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.
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Affiliation(s)
- Byung-Do Lee
- Department of Oral and Maxillofacial Radiology and Wonkwang Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Moo-Rim Park
- Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Korea
| | - Kyung-Hwan Kwon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, Korea
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Ramaiah KKK, Joshi V, Thayi SR, Sathyanarayana P, Patil P, Ahmed Z. Multiple myeloma presenting with a maxillary lesion as the first sign. Imaging Sci Dent 2015; 45:55-60. [PMID: 25793184 PMCID: PMC4362992 DOI: 10.5624/isd.2015.45.1.55] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 11/23/2022] Open
Abstract
Multiple myeloma is a clonal neoplastic proliferation of terminally differentiated B-lymphocytes involving the skeletal system in a multifocal fashion. Its oral manifestations are less common in the maxilla than in the mandible due to the lower amount of hemopoietic bone marrow in the maxilla. We report the case of a 50-year-old man who presented with a mass in the left maxillary alveolar region with tooth mobility. The mass had become enlarged after the teeth were extracted 15 days previously. Radiographs demonstrated multiple punched-out radiolucent lesions in the skull and pelvic region. Computed tomography images showed a soft tissue density mass in the left maxilla, eroding the floor and walls of the maxillary sinus. Although several analytical techniques were used to characterize the lesion, it was finally confirmed as multiple myeloma through immunohistochemistry.
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Affiliation(s)
| | - Vajendra Joshi
- Department of Oral Medicine and Radiology, Navodaya Dental College and Hospital, Raichur, India
| | | | | | - Prashant Patil
- Department of Oral Medicine and Radiology, Navodaya Dental College and Hospital, Raichur, India
| | - Zaheer Ahmed
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, India
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Pushpanshu K, Punyani S, Kaushik R. Mandibular mass as the primary manifestation of multiple myeloma. Braz J Otorhinolaryngol 2014; 80:266-7. [PMID: 25153114 PMCID: PMC9535485 DOI: 10.1016/j.bjorl.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/03/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kumar Pushpanshu
- Department of Oral Medicine and Radiology, Dr BR Ambedkar Institute of Dental Sciences & Hospital, Patna, India
| | - Silky Punyani
- Department of Oral Medicine and Radiology, People's Dental Academy, Bhopal, India
| | - Rachna Kaushik
- Department of Periodontics, Dr BR Ambedkar Institute of Dental Sciences & Hospital, Patna, India
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Troeltzsch M, Oduncu F, Mayr D, Ehrenfeld M, Pautke C, Otto S. Root Resorption Caused by Jaw Infiltration of Multiple Myeloma: Report of a Case and Literature Review. J Endod 2014; 40:1260-4. [DOI: 10.1016/j.joen.2013.12.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 11/11/2013] [Accepted: 12/23/2013] [Indexed: 12/26/2022]
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George S, Shameena P, Sudha S, Sherin N. Plasma cell myeloma infiltrating the dental pulp: An interesting finding. J Oral Maxillofac Pathol 2014; 17:417-9. [PMID: 24574663 PMCID: PMC3927346 DOI: 10.4103/0973-029x.125210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Plasma cell myeloma (PCM) is a clonal neoplastic proliferation of terminally differentiated B lymphocytes (plasma cells/myeloma cells) that involves the skeletal system in a multifocal fashion. Even though jaw involvement has been reported in as many as 30% of cases, myeloma cells infiltrating into the pulpal tissue is extremely rare. Here, we present a case of PCM in which myeloma cells are seen infiltrating into the pulpal tissue of 46.
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Affiliation(s)
- Sanjith George
- Department of Oral Pathology and Microbiology, Government Dental College, Calicut, Kerala, India
| | - Pm Shameena
- Department of Oral Pathology and Microbiology, Government Dental College, Calicut, Kerala, India
| | - S Sudha
- Department of Oral Pathology and Microbiology, Government Dental College, Calicut, Kerala, India
| | - N Sherin
- Department of Oral Pathology and Microbiology, KMCT Dental College, Mukkom, Calicut, Kerala, India
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Zhao XJ, Sun J, Wang YD, Wang L. Maxillary pain is the first indication of the presence of multiple myeloma: A case report. Mol Clin Oncol 2013; 2:59-64. [PMID: 24649308 DOI: 10.3892/mco.2013.200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 09/11/2013] [Indexed: 12/20/2022] Open
Abstract
Multiple myeloma is a primary malignancy of bone marrow characterized by the clonal proliferation of plasma cells and production of monoclonal immunoglobulin. The disease occurs more frequently in males, with the average age at diagnosis being ∼60 years. The first manifestation of multiple myeloma is varied and depends on the sites and extent of involvement. The predominant clinical symptoms of multiple myeloma are associated with bone pain and renal dysfunction. Neoplastic cells usually produce large amounts of monoclonal immunoglobulin light or heavy chains that can be detected in serum or urine, while plasmacytoma may be identified on marrow biopsy. The present study reported on the case of a 69-year-old male patient presenting with a complaint of a painful lesion in the left maxilla. Physical examination, imaging, laboratory investigations and biopsy were conducted, confirming the diagnosis of multiple myeloma. The results obtained suggest that the dentist should address oral manifestations as first indications of multiple myeloma.
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Affiliation(s)
- Xiao Jiao Zhao
- Divisions of Nephrology, Shanghai Ninth Peoples' Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
| | - Jian Sun
- Oral and Maxillofacial Surgery, Shanghai Ninth Peoples' Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
| | - Ying Deng Wang
- Divisions of Nephrology, Shanghai Ninth Peoples' Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
| | - Li Wang
- Divisions of Nephrology, Shanghai Ninth Peoples' Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
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An SY, An CH, Choi KS, Heo MS. Multiple myeloma presenting as plasmacytoma of the jaws showing prominent bone formation during chemotherapy. Dentomaxillofac Radiol 2013; 42:20110143. [PMID: 23520399 DOI: 10.1259/dmfr.20110143] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 65-year-old female visited our hospital complaining of a swelling on the left cheek area of 2 years' duration. A panoramic radiograph revealed an ill-defined osteolytic radiolucent bony lesion involving the left mandibular angle, ascending ramus, coronoid process and condylar process. Histological examination showed the mandibular lesion to be a plasmacytoma, and a systemic work-up was obtained to rule out multiple myeloma. Contrast-enhanced CT images showed a well-defined and slightly enhanced round mass on the left ramal area, accompanied by the destruction of the left ramus and posterior maxilla. An (18)F-fluorodeoxy-glucose positron emission tomography CT ((18)F-FDG PET/CT) scan revealed a hypermetabolic mass extending from the left mandible to the left maxillary sinus. The patient had M-protein in serum and urine, plasma cells up to 36.5% on bone marrow biopsy and anaemia as a clinical complication. The patient was diagnosed with multiple myeloma and received chemotherapy with thalidomide, cyclophosphamide and dexamethasone. A PET/CT scan taken 6 months later revealed that the hypermetabolic mass had disappeared and there was remarkable bone formation on the left mandible compared with a previous PET/CT scan. A panoramic radiograph taken 8 months later also demonstrated a prominent bone formation of the affected site. To the best of our knowledge, the current case is the first report of multiple myeloma presenting as plasmacytoma of the mandible with an FDG PET/CT scan. The lesion was solitary at diagnosis, and remarkable bone formation was newly observed on the radiographic examination during chemotherapy.
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Affiliation(s)
- S-Y An
- Department of Oral and Maxillofacial Radiology, Kyungpook National University, Daegu, Republic of Korea
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Cherif E, Ben Hassine L, Azzabi S, Kaoueche Z, Boukhris I, Khalfallah N. [An unusual toothache!]. REVUE DE STOMATOLOGIE, DE CHIRURGIE MAXILLO-FACIALE ET DE CHIRURGIE ORALE 2013; 114:94-96. [PMID: 23838248 DOI: 10.1016/j.revsto.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/27/2012] [Accepted: 01/04/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Dental pain is a frequent reason for consulting. It may have non-odontogenic causes such as lesions of vascular, neurologic, muscular, or bone structures. The diagnosis and management of this acute or chronic pain syndrome may be difficult. We report a case of atypical dental pain leading to the diagnosis of a plasmocytic mandibular tumor revealing a multiple myeloma. CASE REPORT A 50-year-old female patient consulted for dental pain during the 3 previous months. Bilateral mandibular swelling was noted during the clinical examination. Radiological examinations revealed a tumoral process associated with osteolytic lesions. The pathological examinations of biopsy samples revealed plasmocytic proliferation. A myelogram and immunoglobulin electrophoresis supported a diagnosis of multiple myeloma with kappa light chains. DISCUSSION Discovering a mandibular tumor with lytic lesions is an indication for an etiological assessment and screening for a blood disease. A mandibular plasmacytoma may be isolated or present as a multiple myeloma, justifying a complete initial assessment. The bone localization of a plasmacytoma is a bad prognostic factor for survival for patients presenting with multiple myeloma.
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Affiliation(s)
- E Cherif
- Service de médecine interne B, hôpital Charles-Nicolle, faculté de médecine de Tunis, université de Tunis El Manar, boulevard du 9-Avril-1938, Tunis, Tunisia.
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Dabell M, Oda D, Thompson RE. Primary lesion of multiple myeloma presenting as gingival swelling. J Oral Maxillofac Pathol 2012; 16:425-7. [PMID: 23248479 PMCID: PMC3519222 DOI: 10.4103/0973-029x.102508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
It is rare that multiple myeloma (MM) occurs as a primary lesion in the jaws; we report such a case in an elderly patient involving the gingiva of the left posterior mandible. Multiple myeloma is a monoclonal malignant neoplasm of plasma cell origin which occurs in the bone marrow and may result in extensive destruction of skeletal structures. If the jaws are involved, it usually indicates an advanced stage of the disease.Thi s makes our case very unique due to the fact no other osteolytic lesions were identified at the time of the diagnosis of multiple myeloma. We report a rare case of multiple myeloma which was diagnosed from an intraoral gingival lesion on the lower left mandible.
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Affiliation(s)
- Michael Dabell
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA
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Islam NM, Bhattacharyya I, Cohen DM. Common Oral Manifestations of Systemic Disease. Otolaryngol Clin North Am 2011; 44:161-82, vi. [DOI: 10.1016/j.otc.2010.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shah A, Ali A, Latoo S, Ahmad I. Multiple Myeloma presenting as Gingival mass. J Maxillofac Oral Surg 2010; 9:209-12. [PMID: 22190790 DOI: 10.1007/s12663-010-0050-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 04/18/2010] [Indexed: 12/15/2022] Open
Abstract
Maxillofacial presentations in patients with multiple myeloma are not uncommon, but multiple myeloma is often overlooked. Because the symptoms are various, it is very difficult to diagnose multiple myeloma in the oral and maxillofacial region. On the basis of the pathologic and clinical findings, the patient was diagnosed with multiple myeloma. Hematologic screening and a radiographic survey further confirmed the diagnosis.
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Mehdi G, Ansari HA, Haider N. Cytological diagnosis of multiple myeloma presenting as a jaw swelling. J Cytol 2009; 26:80-2. [PMID: 21938159 PMCID: PMC3168025 DOI: 10.4103/0970-9371.55228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multiple myeloma is a systemic B-cell lymphoproliferative disease with varied manifestations. Its diagnosis can therefore pose difficulties for both the clinicians and pathologists. Jaw lesions, though not uncommon, rarely present as the first sign in multiple myeloma. We present here the case of a 45 year-old female who presented with a swelling of the jaw and on subsequent work-up, was diagnosed with multiple myeloma. Recent research regarding this disease has also been highlighted.
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Affiliation(s)
- Ghazala Mehdi
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
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Feller L, White J, Wood NH, Bouckaert M, Lemmer J, Raubenheimer EJ. Extramedullary myeloma in an HIV-seropositive subject. Literature review and report of an unusual case. Head Face Med 2009; 5:4. [PMID: 19152712 PMCID: PMC2649913 DOI: 10.1186/1746-160x-5-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 01/20/2009] [Indexed: 11/29/2022] Open
Abstract
Myeloma is characterized by monoclonal bone marrow plasmacytosis, the presence of M-protein in serum and/or in urine and osteolytic bone lesions. HIV-seropositive subjects with myeloma are younger at the time of diagnosis of the tumour and usually the myeloma has a more aggressive clinical course than it does in HIV-seronegative subjects. A case of an HIV-seropositive woman in whom myeloma was diagnosed following progressive swelling of the face, is reported. In addition to bone marrow plasmacytosis and the presence of M-protein in the serum, the patient had an extramedullary lesion affecting the oral cavity, maxilla, parotid gland and paranasal sinuses, and extending intracranially and intraorbitally.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Limpopo, Pretoria, South Africa.
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Stoopler ET, Vogl DT, Stadtmauer EA. Medical management update: Multiple myeloma. ACTA ACUST UNITED AC 2007; 103:599-609. [PMID: 17291793 DOI: 10.1016/j.tripleo.2006.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 10/20/2006] [Accepted: 10/23/2006] [Indexed: 02/08/2023]
Abstract
Multiple myeloma (MM) is a hematologic malignancy characterized by abnormal proliferation of immunoglobulin-secreting plasma cells. Manifestations of MM may include anemia, osteolytic lesions, and renal dysfunction. Treatment for this disease chiefly consists of corticosteroids, bisphosphonates, chemotherapy, and hematopoietic stem-cell transplantation. This medical management update will review recent clinical and therapeutic advances in the field of MM and highlight issues that are important to the oral health care provider.
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Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA.
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Souza LN, Farias LC, Santos LAN, Mesquita RA, Martelli H, De-Paula AMB. Asymptomatic expansile lesion of the posterior mandible. ACTA ACUST UNITED AC 2006; 103:4-7. [PMID: 17178487 DOI: 10.1016/j.tripleo.2006.06.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Revised: 04/26/2006] [Accepted: 06/18/2006] [Indexed: 11/16/2022]
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Baykul T, Aydin U, O Carroll MK. Unusual combination of presenting features in multiple myeloma. Dentomaxillofac Radiol 2005; 33:413-9. [PMID: 15665237 DOI: 10.1259/dmfr/25951078] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Initial oral signs of multiple myeloma may involve pain, paraesthesia, swelling, tooth mobility and radiolucency. A 62-year-old female patient presented with the chief complaint of numbness in the right lower jaw. Intraoral examination revealed no abnormalities and her history was non-contributory. A panoramic radiograph revealed an irregular, small radiopacity in the premolar region and small, multiple and diffuse osteolytic alterations in the mandible. Computed tomography revealed maxillary and mandibular cortical destruction. An incisional biopsy was performed. The histopathological diagnosis was plasma cell myeloma and further investigations lead to the diagnosis of multiple myeloma. Dysfunction of a nerve coursing through diseased bone is an ominous sign and may be an indication that a malignant process is present.
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Affiliation(s)
- T Baykul
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Suleyman Demirel University, Isparta, Turkey
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