Fig 1 - uploaded by Peer W Kaemmerer
Content may be subject to copyright.
Source publication
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...
Context in source publication
Context 1
... June 2011, a 76-year-old female consulted the Depart- ment of Oral, Maxillofacial and Plastic Surgery, University Medical Center Mainz, Germany, with a painful swelling of the right lower jaw in the pre-auricular region ( Fig. 1) associated with impaired mouth-opening and laterotrusion. The patient stated that she noticed the first signs 3 months ago. A prior fine needle aspiration of the tumor, which was conducted elsewhere, did not reveal a diagnosis. The patient's medical history contained coronary heart disease with an electronic ablation because of ectopic atrial arrhythmia and prior removal of uterus and ovaries. In clinical examination, a tumor (about 8 9 7 cm) that was adjacent to the bone and covered with skin was seen. There was no secretion or mucosal change. Suspect lymphatic nodes were not found. Panoramic radiography showed a radiolucent mass in the region of the ascending ramus and temporo-mandibular joint. The lesion was unilocular with ill-defined and lytic edges and a complete erosion of the condylar process; a cortical reaction was absent (Fig. 2). Computed tomography showed a tissue-dense tumor with total erosion of the condylar process without visible invasion of the surrounding soft tissue (Fig. 3a, b). A biopsy was initiated via pre-auricular approach. Intraoperatively, the lesion presented as a dark-red and compact mass. Immediate histological examination revealed a plasma cell tumor (Fig. 4a, b). Further histological processing included a microscopical stain for plasma cell marker CD138 (Fig. 5) and slight detection of ...
Citations
... However, some published reports have identified oral manifestations as initial clinical signs of the condition. This includes intraoral swelling with osteolytic lesions in the jaws, 3,9,11,23,[25][26][27] jawbone lesions without swelling, 28 involvement of the mandibular condyle, 29,30 and even soft tissue lesions without maxillary involvement. 31 In the early diagnostic stages of the present case, the first lesions observed were in the mandibular bone and were associated with pain and reduced sensitivity, but with no swelling or changes in the oral mucosa. ...
... 3,12 Although late oral maxillofacial involvement is common in cases of MM, 6,11 primary manifestations in this region are rare, and correspond to only 12-15% of the cases. 2,5,7,11,[13][14][15] Given the lack of published studies, we considered it important to perform an integrative review of MM cases in which the diagnosis was based exclusively on oral features. Moreover, we also wanted to emphasize to healthcare professionals, the importance of paying attention to the first signs and symptoms of MM in the maxillofacial region. ...
... unilaterally, 1,2,6,8,14,15,17,18,[20][21][22][23]25,28,30,32 or bilaterally. 16,17,24,26 The maxilla was also a common site, not only in isolation 11,13,18,19,29 but also concomitantly with the mandible. 27 These findings highlight the importance of a thorough and detailed physical examination. ...
... The most common clinical manifestation noted via an extraoral physical examination was facial edema. 1,2,6,7,11,13,17,18,[20][21][22]24,25,26,28,[30][31][32] Other findings included trismus, 11,13,17,28 facial asymmetry, 17,32 temporomandibular joint clicking 17 and pallor. 29 The most frequent manifestations observed on intraoral physical examination were the appearance of a mass or soft lesion in the oral cavity, 1,2,6,11,15,18,23,25,29,32 edema, 6,8,13,16,18,[20][21][22]24,30,31 dental mobility, 2,14,15,19,24,26,31 ulceration, 1,11,18,22,25 bleeding, 6,11,14,20 non-vital teeth 21,26,31 and gingival enlargement. ...
... Selon la revue de littérature d'Epstein et Voss, les signes cliniques buccaux les plus fréquents et par ordre décroissant sont :La panoramique, technique de radiographie la plus commune pour observer les mâchoires, permet la mise en évidence de lésions osseuses de type ostéolytique, qui peuvent être accompagnées de résorptions radiculaires 7 . Les lésions osseuses sont plus fréquemment retrouvées à la mandibule qu'au maxillaire, avec des localisations impliquant préférentiellement et par ordre décroissant le corps mandibulaire (54 %), l'angle de la mandibule (34 %) et le ramus (23 %)8 . Une amylose est également associée au MM dans 5-10 % des cas 9, 10 et peut être le premier signe11 . ...
... In the present case, the lesions had damaged the mandible and the skull. Some patients experience pathologic fractures caused by tumor destruction of bone (10). In this case, our young patient had a typical clinical presentation and fracture of humerus bone about 2 months ago. ...
... Deposition of amyloid appears homogeneous, eosinophilic, and relatively acellular and may be observed in association with the neoplastic cells. It stains metachromatically with crystal violet and shows an affinity for Congo red, demonstrating apple-green birefringence on viewing with polarized light (10). Literature review suggests that factors such as aging, male sex, race, thrombocytopenia, plasma cell leukemia and Bence Jones proteinuria may indicate a worse prognosis for the patient (8). ...
Multiple myeloma (MM) is a relatively rare malignant hematological disease, which is characterized by multicentric proliferation of plasma cells in the bone marrow. It is typically a disease of adults, with men being affected slightly more often than women. The median age at diagnosis is between 60 and 70 years, and it is rarely diagnosed before the age of 40. Although any bone may be affected, the jaws have been reported to be involved in about 30% of cases while its occurrence in the maxilla is very common. We present a case of MM in the mandible of a 30-year-old female patient.
... SP of the jaws is a rare condition; therefore diagnosis is quite difficult and often results in misdiagnosis. 6 It is reported that plasmacytomas are seen in the nasal cavity and sinus in 40% of cases, in the nasopharynx in 20% and in the oropharynx in 18% of cases, within the maxillofacial region. 5 The rate of incidence of plasmacytoma on the mandible has been reported as 4.4%. ...
Plasma cell neoplasms (plasmacytoma) are discrete, solitary maes 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 progre 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.
... El diagnóstico del mieloma múltiple a partir de una lesión osteolítica mandibular es raro 2 . Según la revisión sistemática hecha por Goetze et al. 3 de los últimos 30 años, solo han sido publicados 13 casos. ...
Objetivo: El mieloma múltiple es una neoplasia de células plasmáticas con repercusión sistémica y lesiones osteolíticas. Su diagnóstico a raíz de una lesión mandibular es bastante infrecuente. Por ello presentamos un caso de mieloma múltiple diagnosticado a partir de sintomatología dolorosa e inflamatoria por una lesión osteolítica en la rama mandibular y revisamos la literatura para establecer el perfil clínico e imagen radiológica típica que nos faciliten sospechar el diagnóstico con más certeza.
Material y métodos: Mujer de 46 años acude al servicio de Urgencias por inflamación y dolor preauricular. La ortopantomografía muestra una imagen radiolúcida multilobulada a lo largo de la rama y cóndilo mandibulares. El estudio anatomopatológico y de extensión desenmascaran un mieloma múltiple. Se hace además una revisión de la base de datos Pubmed para casos de diagnóstico de mieloma múltiple a partir de una lesión mandibular en los últimos 5 años.
Resultados: Se encontraron 13 casos incluyendo el presente. La edad media era de 61 años con ligero predominio del sexo masculino; la clínica más frecuenta era inflamación indurada de la región mandibular afectada con o sin ulceración mucosa, y la imagen radiológica característica osteólisis uni o multilocular, en un caso con reacción perióstica.
Conclusiones: La presentación inicial del mieloma múltiple mediante una lesión mandibular es poco frecuente. Sin embargo, el cirujano maxilofacial debe sospechar una neoplasia de células plasmáticas ante imágenes radiolúcidas mandibulares y no demorar un estudio más exhaustivo.
Multiple myeloma (MM) is a disease characterized by a plasmocytic monoclonal proliferation and an increase in the serum and/or urine of monoclonal immunoglobulin (M-protein) produced. Therefore, it presents various clinical symptoms. We report a case of an MM patient who presented a primary symptom in the mandible, leading to acute kidney injury (AKI). A 75-year-old man was referred to our department as mandibular malignancy was suspected in another hospital. We performed a biopsy to make a definitive diagnosis. Ten days after the biopsy, he was referred for emergency treatment due to fatigue and oral feeding difficulty. A blood examination showed AKI of Cr 13.92 mg/dL. The biopsy result was undetermined, and when checked with a pathologist, a plasma cell tumor was suspected. First, we consulted a nephrologist and he started emergency hemodialysis under hospitalization. Since AKI due to MM was suspected, we then consulted a hematologist and performed additional examinations. The results led to a definitive diagnosis of symptomatic MM (IgG-λ). High-dose dexamethasone therapy was commenced immediately. The treatment was very effective, and hemodialysis was stopped. Nineteen months after the primary therapy, he has been continuing chemotherapy in another hospital, with good ADL.
