Cytological diagnosis of multiple myeloma presenting as a jaw swelling

Fine-needle aspiration cytology for the diagnosis of plasma cell neoplasms in the head and neck region: A systematic analysis of the literature

BACKGROUND

Cytopathologic analysis is feasible and provides detailed morphological characterisation of head and neck lesions.

AIMS

To integrate the available data published on fine-needle aspiration cytology (FNAC) used for the diagnosis of plasma cell neoplasms (PCN) of the head and neck region.

MATERIALS AND METHODS

Searches on PubMed, Web of Science, Embase, and Scopus were performed to compile data from case reports/case series published in English. The Joanna Briggs Institute tool was used for the critical appraisal of studies.

RESULTS

A total of 82 studies comprising 102 patients were included in this review. There was a predilection for men (68.6%) (male/female ratio: 2.1:1). Individuals in their 50s (29.4%), 60s (22.5%), and 70s (22.5%) were more often affected. The thyroid gland (26.2%) was the main anatomical location, followed by scalp (15.5%), neck/cervical region (15.5%), jaws (13.6%), and major salivary glands (13.6%). For FNAC analysis, a smear was employed in 41 (40.6%) cases and a cell block was used in four (3.9%). In 56 (55.4%) reports, no cytological methods were available. Morphologically, 34 (56.7%) cases had a diagnosis of PCN with agreement between cytopathology and histopathology. The rate of wrong diagnoses when using cytology was 27.5%. Immunophenotyping was performed in 49 (48%) of the cases. The 69-month disease-free survival rate was 60.2%, while the 27-month overall survival rate was 64.1%.

CONCLUSION

This study reinforces that FNAC can be an ancillary tool in the first step towards the diagnosis of PCN of the head and neck region, especially when applying a cell block for cytological analysis.

Multiple myeloma involving mandible: In an elderly female

Multiple myeloma (MM) is a malignancy of plasma cell origin. It often has a multicentric origin within the bone. It makes about 1% of all malignancies and 15% of all hematologic malignancies. There is a monoclonal proliferation of abnormal plasma cells in this disease that arise from a single malignant precursor that has undergone uncontrolled mitotic division. These cells in turn produce one type of immunoglobulin light chain, either kappa or lambda. Unifocal, monoclonal proliferation of plasma cells is called plasmacytoma. Hereby, we present a case of a 65-year-old female patient who presented with a swelling of the mandible. The uniform sheets of plasma cells in the histopathology punched out radiolucencies in skull radiograph and the blood picture of anemia and hypercalcemia, confirmed the case as MM.

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.

Fine needle aspiration cytology in lesions of oral and maxillofacial region: Diagnostic pitfalls

Background:

Fine needle aspiration cytology (FNAC) of oral and maxillofacial region has not been widely utilized for diagnosis due to diversity of lesion types, heterogeneity of cell populations and difficulties in reaching and aspirating these lesions.

Aim:

Our aim was to demonstrate the effectiveness of this cheap and simple procedure for the diagnosis of tumor and tumor like lesions of oral and maxillofacial region. In addition, we sought to highlight probable causes of errors in the cases showing lack of correlation between cytological and histological diagnoses.

Materials and Methods:

The study was conducted on 50 patients of all age groups with various palpable lesions in the oromaxillofacial region. A comparison between cytological and histological diagnosis was done wherever biopsy material was available.

Results:

The rate of unsatisfactory FNA was 4%. There were six false negative cases but no false positive case. The sensitivity of our study ranged from 77.7 to 75% including and excluding the suspicious cases, respectively. Specificity and positive predictive value was 100%.

Conclusion:

FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with oromaxillofacial lesions. When applied in a proper manner, FNAC can help avoid a surgical biopsy in many cases.