A Wolf in Sheep’s clothing: A case report series of oral manifestations of multiple myeloma

Beaumont, Sophie; Koo, Ray Mun; Harrison, Simon

doi:10.1111/adj.12808

Cited by 7 publications

(4 citation statements)

References 17 publications

(25 reference statements)

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“…The main symptoms are pain, swelling, loose teeth, paresthesia, soft tissue mass, bleeding or pathological fracture. [13] The clinical manifestations and radiology of MM in jaw are non-distinct and variable, which is a challenge to its diagnosis, for oral presentation of MM have similar clinical signs and radiology with MRONJ. The gold standard for the diagnosis of MM is pathological analysis of biopsies.…”

Section: Discussionmentioning

confidence: 99%

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Chen

2023

Medicine

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Rationale: Multiple myeloma (MM) is a malignant disease characterized by abnormal proliferation of plasma cells, which usually occurs in middle-aged and elderly male patients. Bisphosphonates (BP) are commonly used for the treatment of MM bone disease. Long-time use of BP may cause medication-related osteonecrosis of the jaw (MRONJ). MRONJ occurs in jaw exclusively, and Multiple myeloma can also invade the jaw. The 2 diseases have similar clinical manifestations and imaging findings. This report present a case of MM identified in surgical specimen at the site that had been previously pathologically diagnosed as MRONJ in a patient with MM. Patient concerns: A 57-years-old male patient visited our clinic on October 16, 2020 because of gingival swelling and pain in the right mandible for 1 month after extraction of the lower right premolar. The patient had a long-time illness history of multiple myeloma, and received intravenous zoledronic acid treatment. Diagnoses: Based on the clinical characteristics, imaging, and pathological findings of sequestrum formation and high inflammatory cell infiltration, the patient was diagnosed with MRONJ. After 1 year, a mandibular osteotomy was performed and pathological analysis showed the presence of necrotic bone and a large number of abnormal plasma cell infiltration, suggesting the presence of MM in the mandible. Interventions: The patient was treated with a series of conservative treatments including antibiotic treatment, saline irrigation and laser irradiation, as well as superficial sequestration was. One year later, a mandibular osteotomy was performed. Outcomes: For the patient, the symptoms of gingival swelling, pain and discharge disappeared after surgery. Lessons: These findings suggested MRONJ and MM could occur simultaneously at same site, so patients with MM presenting with symptoms of MRONJ should be screened for concurrent or disease relapse of multiple myeloma to prevent misdiagnosis or inadequate management. Meanwhile, this also suggests long-term inflammatory may lead to invasion of multiple myeloma.

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Section: Discussionmentioning

confidence: 99%

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Chen

2023

Medicine

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“…In addition, the immunohistochemical assay results for kappa or lambda chains were negative. Treatment approaches for plasmacytoma, whether in its solitary form or associated with multiple myeloma, involve various combinations such as local surgery, local irradiation, or chemotherapy [6]. Sensitive tests (M PROTEIN, free light chain (FLC), imaging, and Positron-Emitting Tomography-Computer Tomography (PET/CT)) are valuable for differentiating between the isolated presence of clonal plasma cells in the bone marrow and systemic manifestations of the disease.…”

Section: The Casementioning

confidence: 99%

Plasmacytoma in the Maxillary Jaw: A Diagnostic and Therapeutic Challenge

Bernardi,

Bianchi,

Lupi

et al. 2024

Hematology Reports

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Plasmacytoma is a neoplastic disorder originating from plasma cells, with bone and soft tissue being common sites of manifestation. This report presents the clinical and radiological findings of a 65-year-old female patient who presented with an exophytic lesion in the upper right lateral incisor region. The lesion appeared as a unilocular radiotransparent area in imaging tests. Following an excisional biopsy, histological and immunohistochemical evaluations confirmed the presence of mature plasmacellular elements and small infiltrates of B and T lymphocytes. The patient did not exhibit systemic manifestations of multiple myeloma. Surgical intervention, in the form of enucleation of the lesion combined with root canal treatment and apicoectomy, was performed. This case underscores the rare occurrence of plasmacytoma in the jaw region and highlights the importance of surgical management in cases where structural damage or functional impairment is present. Further research on novel treatment approaches is also mentioned, including targeted therapies, immunomodulatory agents, and monoclonal antibodies. The patient is currently under the care of a hematologist for further investigation and the choice of the most appropriate therapy.

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“…However, jaw lesions have also been documented, and in some cases, these may represent the first detectable sign of the disease. 3 9 11 12 …”

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confidence: 99%

“… 13 However, the presence of these lesions as an early indicator of the disease is relatively rare and is more often associated with disease progression. 3 12 Reports of NSMM involving the maxillary bones are even scarcer, 6 14 15 16 and to date, no cases have been detailed as originating from mandibular involvement. The present report details a case of NSMM in which the initial findings were identified during dental consultation.…”

mentioning

confidence: 99%

Beyond the mouth: Uncovering non-secretory multiple myeloma through oral symptoms

Isaias,

Costa,

Amorim

et al. 2024

Imaging Sci Dent

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Non-secretory multiple myeloma (NSMM) is a rare cancer of plasma cells characterized by the absence of detectable monoclonal M protein in the blood or urine. A 57-year-old woman presented with mandibular pain but without intraoral swelling. Imaging studies revealed multiple osteolytic lesions in her mandible and pronounced root resorption of the left mandibular second molar. Biopsy results showed atypical plasmacytoid cells positive for anti-kappa, CD138, MUM1, and CD79a antibodies, but negative for anti-lambda and CD20. These results were indicative of a malignant plasma cell neoplasm. No abnormalities were revealed by free light chain assay or by serum or urine protein electrophoresis, leading to a diagnosis of NSMM. The patient began chemotherapy in conjunction with bisphosphonate therapy and achieved remission following treatment. This case underscores the critical role of dentists in the early detection and prevention of NSMM complications, as the disease can initially present in the oral cavity.

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A Wolf in Sheep’s clothing: A case report series of oral manifestations of multiple myeloma

Cited by 7 publications

References 17 publications

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Plasmacytoma in the Maxillary Jaw: A Diagnostic and Therapeutic Challenge

Beyond the mouth: Uncovering non-secretory multiple myeloma through oral symptoms

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