Multiple myeloma presenting as plasmacytoma of the jaws showing prominent bone formation during chemotherapy

Evaluation of mandibular bone changes in multiple myeloma patients on dental panoramic radiographs

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.

Rare case of anaplastic plasmacytoma in the sinonasal tract

BACKGROUND

Extramedullary plasmacytomas are tumors that develop from plasma cells and rarely express anaplastic features. To our knowledge, there have only been three reported cases of anaplastic plasmacytomas of the sinonasal tract in the English literature. We detail the fourth case.

METHODS

A 70-year-old male was seen with a 4-month history of nasal congestion, bloody mucous, and left sided nasal obstruction. On positron emission tomography/computed tomography, the lesion was FDG-avid with an SUV_max of 25.1. A biopsy of the lesion and subsequent immunohistochemical staining confirmed the diagnosis of an anaplastic plasmacytoma.

RESULTS

The patient is undergoing a 5-week course of curative-intent radiation therapy.

CONCLUSION

Extramedullary plasmacytomas with anaplastic features are very rare. We highlight the value of thorough histopathological review and detailed immunostains to arrive at a diagnosis of anaplastic extramedullary plasmacytoma.

Solitary plasmacytoma of jaw bone: A case report and systematic review of fifty cases from literature

Solitary plasmacytoma of bone (SPB) is a localized form of plasma cell neoplasm where jaw involvement is rare. Distinguishing SPB from other plasma cell neoplasms is critical for treatment and survival. Here, a case of SPB of mandible in an elderly female is reported. Histopathological diagnosis of plasma cell neoplasm was confirmed immunohistochemically with MUM1 and CD138 positivity and multiple myeloma (MM) was ruled out on performing systemic workup. Prognosis of SPB worsens when it transforms into MM. A systematic review was undertaken with the objective to determine the factors affecting conversion of SPB to MM. An electronic search was undertaken with PubMed/MEDLINE, Web of Science and Science Direct. Fifty cases of SPB of jaw from 29 publications were reviewed. SPB commonly presents as a painless swelling. Radiographically, it is commonly seen as multilocular radiolucency with well-defined borders. Follow-up data showed that nine cases turned into MM in a mean duration of 1 year 9 months and 12 patients died after median disease-free survival of 6 years 9 months. Prognosis of SPB is found to be affected by tumor size (≥5 cm), anaplasia of tumor cells, Ki-67 labeling index, vascularity of the tumor, presence of clonal bone marrow plasma cells, serum immune globulin level, dose of radiotherapy and persistence of M protein after treatment. There is a need to identify prognostic subgroups in SPB based on these factors. Furthermore, studies are necessary for standardization of treatment protocol to halt or prolong the progression of SPB to MM.

Solitary Plasmacytoma of the Mandible: Early Diagnosis and Surgical Management

Solitary plasmacytoma is an abnormal proliferation of B-lymphoid cells that involves a single bone. It mainly affects the axial skeleton; the jaw localization is a rare condition. The authors present a case of a 70-year-old female patient with a radiolucency of the angle of the mandible later diagnosed as solitary plasmacytoma.

Mandibular involvement of plasmacytoma - Uncommon case report of rare entity

Solitary plasmacytoma (SP) is an early-stage plasma cell malignancy that is in between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) along the spectrum of plasma cell disorders. SPs can be divided into 2 groups according to location: solitary bone plasmacytoma (SBP) – these occur most commonly in the vertebrae and secondarily in long bones, and extramedullary plasmacytoma (EMP) – these encompass all nonosseus SPs. The etiology is still unknown, and they generally display a destructive course with preponderance of males. Both lesions present a risk of progression to multiple myelom. Its presence in jaws is extremely rare and when it is seen, angulus and ramus mandible are most common sites of occurrence. Histopathological examination and systemic investigation are mandatory for confirmation but support of immunohistochemistry positivity for CD138 was also done for establishing the final diagnosis.

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Solitary plasmacytoma of the jaw is a rare condition, especially in mandible.

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Symptoms may be underestimated because they are considered nonspecific.

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For jaw lesions it may be difficult, using routine hematoxylin and eosin stains, to determine whether the lesion is a neoplasm of plasma cells or an inflamatory lesion.

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Immunoperoxidase techniques can be helpful in making the distinction between inflammatory and neoplastic lesions.

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Plasma cell neoplasms demonstrate monoclonal light chains within the cytoplasm of plasma cells.

Marginal resection of solitary plasmacytoma in the anterior region of the mandible and dental implant rehabilitation: Report of an unusual case

INTRODUCTION

Plasmacytoma describes a neoplastic proliferation of plasma cells affecting different groups of patients according to location, and may demonstrate heterogeneous tumor progression and survival rate. The present article describes a case of solitary plasmacytoma in the mandible.

PRESENTATION OF CASE

A 57-year-old male smoker was referred to the oral and maxillofacial service with extensive injury, approximately 4-5 cm in size, involving the anterior inferior region of mandible. After confirming diagnosis of plasmacytoma through incisional biopsy, because it was a recurrent lesion, excision of the lesion was performed through marginal resection of the mandible under general anesthesia. During the same surgical procedure, a 2.4-mm system fixation plate was placed to mitigate the risk for pathological fracture of the mandible. In a second surgery, a region in the base of the mandible was rehabilitated using implants and prosthesis.

CONCLUSION

The patient is currently undergoing clinical and radiological follow-up of 2 years with success.

Solitary plasmacytoma of the jaws: therapeutical considerations and prognosis based on a case reports systematic survey

Introduction

Solitary plasmacytoma is a rare malignant tumor of plasma cells with no evidence of systemic proliferation. There are two known subtypes: extramedullary solitary plasmacytoma and solitary bone plasmacytoma. The etiology is still unknown. Both lesions present a risk of progression to multiple myeloma. A number of approaches have been used for treatment of solitary plasmacytoma.

Objective

To carry out a systematic review of the case reports described in the literature, focusing on therapeutic and prognostic aspects.

Methods

A search of clinical case reports was performed in the PubMed database using Mesh Terms related to “plasmacytoma” under the following criteria: type of study (case report), articles in English language, conducted in humans, with no publication date limits.

Results

Of the 216 articles found, only 21 articles met the pre-established inclusion criteria.

Conclusion

The occurrence of solitary bone plasmacytoma in the bones of the face is a rare condition prevalent between the 4th and 6th decades of life, located in the posterior region of the mandible in most cases. Histopathological examination and systemic investigation are mandatory for confirmation of diagnosis.

Malignant Lesions in the Dentomaxillofacial Complex

Malignancies in the maxillofacial region are rare but comprise a broad spectrum of lesions. Given the potential for malignancies to mimic dental/sinus/temporomandibular joint pathology or remain asymptomatic, the judicious radiologist will be familiar with the initial and unique malignant changes affecting the dentition, periodontium, and supporting osseous structures on conventional film, dental, and sinus imaging. This article is meant to serve as a complement to the many excellent texts dedicated to advanced imaging techniques for the staging of known malignancies. The lesions discussed are a representative sample of malignancies involving hard tissues of the maxillofacial complex but are far from complete.

Solitary Osteogenic Sternum Plasmacytoma on Bone Scintigraphy and FDG PET/CT

We reported a rare solitary osteogenic sternum plasmacytoma case. A 49-year-old woman experienced progressing pain in the sternum for 2 years. Abnormal Tc-MDP accumulation and increase in F-FDG uptake (SUVmax, 4.4) were co-localized with the osteogenic lesion in the sternum body detected by diagnostic CT. The lesion was histologically confirmed as plasma cell neoplasm suggestive of plasmacytoma. The patient had good response to radiotherapy.

Relapse of Multiple Myeloma Presenting as Lower Lip Numbness

Multiple myeloma (MM) is an uncommon malignancy characterised by the proliferation of clonal plasma cells. There are few published reports describing the extramedullary presentation of MM manifesting primarily in the head and neck region. In addition, the occurrence of an isolated relapse of MM in these sites is exceedingly rare. We report a 56-year-old female who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2010 with sudden-onset numbness of the lower lip. She had a history of MM in remission following chemotherapy and a bone marrow transplant. Clinical and radiographic examinations were indicative of a possible relapse of MM, which was subsequently confirmed by bone marrow aspiration and histopathological evaluation. This unique case highlights the unusual site of relapse of a haematolymphoid malignancy.

Solitary Plasmacytoma in the Mandible Resembling an Odontogenic Cyst/Tumor

A 46-year-old male patient referred to Department of Oral Medicine, with the primary chief complaint of a painless swelling in the right side of mandibular. A panoramic radiograph revealed a well-defined, multilocular radiolucent bony lesion with thin and straight septa in the right side of mandible extending from distal of canine to mesial of third molar. Histological examination showed a solid proliferation of atypical plasmacytoid cells, which was indicative of plasmacytoma. A systemic workup for the final diagnosis was performed to rule out multiple myeloma.

Mandibular destructive radiolucent lesion: The first sign of multiple myeloma

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.

Solitary plasmacytoma of the mandible: report of two cases

Plasma cell neoplasms (plasmacytoma) are discrete, solitary masses of lymphoid neoplastic proliferations of B cells. Plasmacytomas comprise three groups: multiple myeloma, solitary plasmacytoma (SP) and extramedullary plasmacytoma. SP originates as a clone of transformed malignant plasma cells in the bone marrow. SP of the jaw is a rare condition; therefore diagnosis is quite difficult and often results in misdiagnosis. MM is a lymphoproliferative disease the prognosis of which is worse than SP. SP can progress to MM in a few months to years after diagnosis. In this regard, early diagnosis of the disease is of utmost importance. This article presents two cases of SP diagnosed in the mandible and documented with clinical, radiographic and histological findings.

Osseous plasma cell neoplasm of the mandible for initial diagnosis of multiple myeloma: case report and literature review

PURPOSE

Plasmocytoma of the bone represents a variance of plasma cell neoplasms, which often gives hint for systemic affection. A case of a mandibular tumor as first manifestation of multiple myeloma (MM) is presented and discussed with the literature.

MATERIALS AND METHODS

A 76-year old female with pain and swelling of the right lower jaw was assigned to the hospital. Radiograph showed a lytic tumor at the mandibular condyle and histological analysis gave evidence of a plasma cell tumor with positivity to CD138. In further examinations, elevated immunoglobulin levels in serum and osseous plasma cell infiltration unveiled MM. PubMed-database was searched by "multiple myeloma primary lesion jaw", "multiple myeloma primary manifestation mandible" and "multiple myeloma mandibular lesion" within the last 30 years.

RESULTS

Together with the current case, 11 reports including 13 patients were found describing mandibular plasmocytoma as first sign for MM. Mean age was 59 years with slight female preference. Initial symptoms were mostly swelling episodes with or without pain. The main radiological presentation was a uni- or multilocular radiolucency. After a mean follow up time of 29 months (stated in 8 cases; standard deviation 50, min: 1, max: 151), 3/8 patients died and in 5/8 cases, signs of progress were seen.

CONCLUSION

In rare cases, occurrence of plasmocytoma of the mandible is first sign for MM and should always lead to further investigations regarding systemic disease. Simple examinations such as panoramic X-rays can lead to early detection of MM and thereby better prognosis by earlier treatment.