Panoramic and skull imaging may aid in the identification of multiple myeloma lesions

Abstract

BackgroundThe purpose of this study was to investigate the presence of punched-out lesions in craniofacial bones using three different radiographic protocols in a large cohort of patients.Material and MethodsOne hundred fifty-five MM patients were evaluated using panoramic and skull (frontal and lateral) radiographs, which were performed in all patients at the time of MM diagnosis. The diagnostic potential for detecting punched-out lesions was compared among the radiographic techniques.ResultsMM punched-out lesions were identified in 135 (87%) panoramic radiographs, 141 (91%) frontal and 144 (93%) lateral skull radiographs. Punched out-lesions were synchronously present in skull and jawbones in 129 (83.23 %) cases. The lesions were detected exclusively in skull in 18 (11.61%) cases and exclusively in jawbones in 6 (3.87%) cases. Punched out-lesion mainly affected the skull and the jawbones in a synchronous way (p<0.001) rather than separately.ConclusionsAll investigated radiographic techniques (panoramic, frontal and lateral skull approaches) demonstrated high detection rates for MM punched-out lesions in craniofacial bones. Panoramic radiography may aid to the radiographic protocols to identify multiple myeloma bone lesions. Key words:Multiple myeloma, osteolytic lesions, panoramic radiography.

Plasmacytoma and plasma cell myeloma affecting the jaws: A multi‐institutional collaborative study

“…According to the current WHO guidelines, a plasmacytoma is a malignant plasma cell tumour manifesting as an isolated lesion that may affect virtually any bone, although the ribs, vertebrae, axial skeleton and skull are the most common sites 1 . Manifestations in the gnathic bones have also been documented and usually manifest as a single radiolucent image in the posterior region or ascending ramus of the mandible, as demonstrated in our series 10,12 . It is known that approximately 50% of all plasmacytomas will evolve to PCM during the patients’ follow‐up, since this diagnosis must rely not only on the presence of plasma cell microscopic presentation, but also on clinical, radiographic and laboratory findings 1,2 .…”

“…Plasma cell neoplasms account for approximately 10% of all malignant haematolymphoid tumours, representing the second most common intra-osseous malignancy after osteosarcomas. 1,3,4 The gnathic bones can be affected in up to 30% of the cases, usually in the posterior region and ascending ramus of the mandible, 12 and these lesions may be the first finding that leads to the diagnosis of the disease. [10][11][12] In the present series, we described the clinicopathological and radiographic features of a large series of patients affected by plasma cell neoplasms that were diagnosed by microscopic examination, demonstrating the importance of gnathic lesions for the diagnosis of plasma cell neoplasms.…”

“…1 Manifestations in the gnathic bones have also been documented and usually manifest as a single radiolucent image in the posterior region or ascending ramus of the mandible, as demonstrated in our series. 10,12 It is known that approximately 50% of all plasmacytomas will evolve to PCM during Abbreviations: BMT, bone marrow transplantation; CT, chemotherapy; ND, Not described; NOS, Not otherwise specified; RT, radiotherapy.…”

“…The so-called punched-out appearance is highly suggestive of the diagnosis, but not pathognomonic, and other findings such as sun-ray aspect and Codman's triangle can also be described, as also demonstrated in our series. 10,12,15 Microscopic diagnosis of plasma cell neoplasms is usually suggestive due to the plasmacytic differentiation of neoplastic cells and the monoclonality of immunoglobulin light chains. 1,13 However, as shown in two of our cases, plasma cell neoplasms may rarely contain anaplastic plasma cells, with a very high Ki67 proliferative index that greatly impairs their differentiation from plasmablastic lymphomas, so that their diagnosis strongly relies on clinical data and EBV identification.…”

Prevalence of Apical Periodontitis in patients with Multiple Myeloma

“…Manifestations of Multiple Myeloma include osteolytic lesions or punched-out lesions on the jawbones and it may occur with a similar presentation to other cysts and odontogenic lesions. However, the osteolytic lesions are not usually located in periapical regions, but in the posterior teeth region, ramus, and condyle (25). As regards evaluating endodontic variables using panoramic radiographs (PAN), this technique is a simple tool for diagnosing apical periodontitis because of its easy acquisition, low radiation dose, and panoramic views, as mentioned by Nardi et al (26).…”