Plasmacytoma of the mandible: a primary presentation of multiple myeloma

Solitary plasmacytoma of the jaws: therapeutical considerations and prognosis based on a case reports systematic survey

Introduction

Solitary plasmacytoma is a rare malignant tumor of plasma cells with no evidence of systemic proliferation. There are two known subtypes: extramedullary solitary plasmacytoma and solitary bone plasmacytoma. The etiology is still unknown. Both lesions present a risk of progression to multiple myeloma. A number of approaches have been used for treatment of solitary plasmacytoma.

Objective

To carry out a systematic review of the case reports described in the literature, focusing on therapeutic and prognostic aspects.

Methods

A search of clinical case reports was performed in the PubMed database using Mesh Terms related to “plasmacytoma” under the following criteria: type of study (case report), articles in English language, conducted in humans, with no publication date limits.

Results

Of the 216 articles found, only 21 articles met the pre-established inclusion criteria.

Conclusion

The occurrence of solitary bone plasmacytoma in the bones of the face is a rare condition prevalent between the 4th and 6th decades of life, located in the posterior region of the mandible in most cases. Histopathological examination and systemic investigation are mandatory for confirmation of diagnosis.

Can dentists detect multiple myeloma through oral manifestations?

Objective

To review published data on oral manifestations of multiple myeloma.

Methods

An electronic database search was performed of articles published from 1971 to November 2016 in order to identify studies that reported oral manifestations of patients with multiple myeloma. Case reports and case series with oral manifestations of multiple myeloma in English were included in the study. An additional search was performed of the references of the selected articles.

Results

Thirty-seven articles that reported 81 patients with oral manifestations of multiple myeloma were selected: 30 case reports (82%) and seven case series (18%). The most common clinical features in the dental cavity were swelling (65.4%), bone pain (33.3%), paresthesia (27.1%) and amyloidosis lesions (11.1%). Osteolytic lesions detected on imaging exams were reported in the majority of the patients (90.1%) as plasmacytomas or ‘punched-out’ lesions.

Conclusions

Swelling and osteolytic lesions represent the most common clinical and radiographic signs of the jaws relating to multiple myeloma, respectively.

Solitary plasmacytoma of the jaw

BACKGROUND

There is a lack of consensus on the appropriate management of solitary plasmacytoma (SP) of the jaw. The aim of the present investigation was to provide scientific evidence for the optimal management of this disease through a systematic literature review.

METHODS

The included articles are published in English from 1948 to March 2011 and describe the population affected by SP of the jaw with site, clinical and radiographic features, special findings, initial diagnosis, treatment, and follow-up.

RESULTS

Fifty cases of SP of the jaw were identified. It typically presents as a single osteolytic lesion with no plasmocytosis involvement of bone marrow. Long bones and vertebrae are the most common sites of SP. Rarely, it involves the jaw occurring in only 4% of cases, mainly in the bone marrow-rich areas, angulus and ramus. Solitary plasmacytoma of the jaw has a worse prognosis than multiple myeloma (MM), and in half of the cases, it evolves in MM.

CONCLUSIONS

Because SP of bones is an uncommon tumor that rarely involves the jaws, through this article we emphasize early diagnosis and appropriate management to avoid progression to MM.

Plasmacytoma in the temporomandibular joint: a case report

We report a case of a 64-year-old patient in whom limitation of mouth opening was the presenting symptom of plasmacytoma. Intra-oral biopsy confirmed a plasma-cell tumour, with no sign of extension on imaging. He was treated with radiotherapy (4000 cGy) and followed up. The diagnosis of solitary plasmacytoma of bone can be confirmed only when the presence of systemic disease has been excluded by clinical, biological, and radiological investigations. We think that the treatment should consist only of radiotherapy. Long-term follow-up is necessary because of the high risk of development of multiple myeloma, which may be delayed.

Unusual combination of presenting features in multiple myeloma

Initial oral signs of multiple myeloma may involve pain, paraesthesia, swelling, tooth mobility and radiolucency. A 62-year-old female patient presented with the chief complaint of numbness in the right lower jaw. Intraoral examination revealed no abnormalities and her history was non-contributory. A panoramic radiograph revealed an irregular, small radiopacity in the premolar region and small, multiple and diffuse osteolytic alterations in the mandible. Computed tomography revealed maxillary and mandibular cortical destruction. An incisional biopsy was performed. The histopathological diagnosis was plasma cell myeloma and further investigations lead to the diagnosis of multiple myeloma. Dysfunction of a nerve coursing through diseased bone is an ominous sign and may be an indication that a malignant process is present.

Malignant tumors of the mandible and maxilla

Malignant tumors of the mandible and maxilla are grouped into primary tumors that originate within the mandible and secondary lesions, predominantly oral cancers and metastatic lesions, that involve the mandible secondarily. The most common malignant tumors of the mandible represent SCCs of the oral cavity, notably carcinoma of the floor of the mouth and gingiva that invade the mandible secondarily. Metastatic disease, most commonly from the breast and lung, are not an uncommon malignant lesion in the mandible and may be the first manifestation of a malignant lesion outside the head and neck. The osteogenic sarcoma is the most common sarcomatous lesion in the mandible and is suggested when a bone-forming matrix with sclerosis is found within the tumor on CT images. Some benign lesions may mimic a malignant tumor on imaging studies. In such cases, a biopsy is indicated to establish the diagnosis by histopathologic means. CT is indicated for assessment of bone destruction in the mandible before surgery or radiation therapy. MR imaging is the optimal modality for the assessment of marrow involvement and evaluation of the extraosseous soft tissue component. Finally, conventional films, frequently a Panorex view, are the initial radiographic examinations in suspected lesions.

Head and neck manifestations of plasma cell neoplasms

Multiple myeloma, solitary plasmacytoma of bone, and extramedullary plasmacytoma are plasma cell neoplasms. They represent distinct manifestations of a disease continuum, whereby the clinical findings are critical to diagnosis. Plasma cell neoplasms are histologically similar, and distinguishing one from the other has significant implications for treatment and survival. Plasma cell neoplasms are relatively unusual malignancies of the head and neck region. We present a case series of plasma cell neoplasms involving the skull base, paranasal sinus, larynx, and mandible as an introduction to a complete review of the literature on plasma cell neoplasms of the head and neck area.

Radiographic manifestations of multiple myeloma in the mandible: a retrospective study of 77 patients

PURPOSE

This retrospective study was done to determine the frequency and radiographic pattern multiple myeloma in the mandible.

PATIENTS AND METHODS

Seventy-seven patients with multiple myeloma were studied using skull and panoramic radiographs of the jaws made at the time of initial diagnosis.

RESULTS

Skull manifestations were present in 46.7% and jaw manifestations in 15.6% of the cases studied. The pattern of jaw involvement was characterized by osteolytic lesions without other radiographic manifestations of bone involvement. There was no relationship between the pattern of jaw and extragnathic involvement and increased M-component of secreted immune globulin. Jaw involvement was largely unaccompained by oral symptoms.

CONCLUSION

The results suggest that mandibular lesions are a common finding in multiple myeloma.

Gingival mass as the primary manifestation of multiple myeloma: report of two cases

Two cases of multiple myeloma with primary manifestations in the oral cavity are reported, both presenting as a mandibular gingival/alveolar mass with hypermobility of the adjacent teeth. Roentgenographic examination demonstrated concomitant "punched-out" osteolytic jawbone lesions. After biopsy of the gingival mass was performed, multiple myeloma was subsequently diagnosed in both cases. Systemic bone scanning revealed multiple osteolytic bone lesions involving the skull and various skeletal bones. Hematologic screening showed a monoclonal gammopathy in both cases. A bone marrow biopsy confirmed the diagnosis of multiple myeloma. Awareness of the maxillofacial manifestations of multiple myeloma is important for early detection of the disease, especially in patients with initial oral involvement.

Solitary plasmacytoma of the mandible. Case report and review of the literature

A case of solitary plasmacytoma of the mandible is presented. Review of the literature disclosed the following characteristics regarding the clinical course and prognosis. The patients ages ranged from 34 to 76 years, with a mean of 53 years; there was a marked preponderance of males. The site of predilection was the posterior portion of the mandible. The common symptom was a non-painful swelling of the mandible of long duration, and radiological features were non-specific. Monoclonal immunoglobulin was initially detected in 42% of the evaluated patients. The majority of patients were treated with radiation therapy with a mean dose of 48Gy with or without surgery. The period of follow-up ranged from 4 months to 12 years, and 17% of the patients progressed to multiple myeloma within 1 year.