Osteolytic Lesion of the Maxilla in an Undiagnosed Multiple Myeloma Patient Identified Incidentally by Cone Beam Computed Tomography

Abstract

Patient: Female, 65-year-old Final Diagnosis: Multiple myeloma Symptoms: Palatal lesion Medication: — Clinical Procedure: Biopsy and CBCT • laboratory investigations Specialty: Dentistry Objective: Unusual clinical course Background: Multiple myeloma is a hematological malignancy characterized by monoclonal plasma cell proliferation. Jaw lesions are found in nearly 35% of patients with symptomatic myeloma, and lesions occur in the mandible more often than in the maxilla. However, maxillary or mandibular lesions are rarely found as a primary manifestation of the disease. This report describes a case of a 65-year-old Palestinian woman with lytic lesions in the maxilla due to undiagnosed multiple myeloma identified incidentally on cone beam computed tomography (CBCT). Case Report: A 65-year-old Palestinian woman presented to the Oral Maxillofacial Surgery Clinic with an expansion of the maxilla which was initially thought of as an infection. CBCT imaging revealed diffuse osteolytic lesions involving multiple osseous structures. The patient was biopsied. Histopathological examination was suspicious for plasmacytic neoplasm. She was directly referred to the Hematology Department for further laboratory tests. These included complete blood count, liver function test, bone profile, protein electrophoresis, flow cytometry, and bone marrow biopsy, which were performed to confirm the diagnosis of multiple myeloma. The patient was treated with chemotherapy including zoledronic acid, dexamethasone, bortezomib, and cyclophosphamide. She went into remission for a year but unfortunately died 2 years later. Conclusions: Primary myeloma of the maxilla is a rare presentation. The present report illustrates the role of CBCT imaging supported by a multidisciplinary approach to the diagnosis and management of myeloma. Consequently, it is recommended that dental practitioners be aware of radiographic features and possible oral manifestations to avoid any delay in medical intervention.

Plasmacytoma in the Maxillary Jaw: A Diagnostic and Therapeutic Challenge

“…This case study highlights the importance of accurate clinical and radiological examinations, as well as an adequate background in oral medicine and in hematologic diseases with oral manifestation in case of rare manifestations of these diseases. Indeed, dentists can play a key role in the diagnosis of these silent diseases, such as the case of Ali et al [ 13 ]. The authors, in their article, underline the possibility of early diagnosis from dental practitioners in these diseases, which are often asymptomatic in their early stages [ 13 ].…”

“…Indeed, dentists can play a key role in the diagnosis of these silent diseases, such as the case of Ali et al [ 13 ]. The authors, in their article, underline the possibility of early diagnosis from dental practitioners in these diseases, which are often asymptomatic in their early stages [ 13 ].…”

The Bloody Crossroads: Interactions between Periodontitis and Hematologic Diseases

“…Diagnostic criteria for symptomatic MM require the presence of plasmacytoma or clonal plasma cells on bone marrow biopsy, M protein in urine or serum, and evidence of organ or tissue damage associated with plasma cell proliferation [ 82 ]. To ensure prompt and accurate treatment, it is important to maintain a high index of suspicion for MM in patients with such oral symptoms, especially in the context of a known diagnosis of MM [ 83 ].…”

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

“…M proteins consist of either kappa or lambda light chains, with or without associated heavy chains, and can cause damage to various target organs. 2 3 MM represents approximately 10% of all hematological malignancies. 1 In 2020, the global incidence of MM was 1.8 cases per 100,000 people, with a mortality rate of 1.1 deaths per 100,000 individuals.…”

“…This disruption leads to the development of bone erosion areas, which give rise to lytic lesions-a hallmark of MM. 3 9 10 In patients with MM, these changes are frequently observed in skeletal regions including the vertebral column, femur, ribs, humerus, pelvis, and skull. However, jaw lesions have also been documented, and in some cases, these may represent the first detectable sign of the disease.…”