Plasmacytoma in the temporomandibular joint: a case report

Solitary plasmacytoma of mandible: A case report

Solitary plasmacytoma is a rare malignant tumor, presenting less than 5% of all plasma cell proliferation. Bone forms are the most frequent, affecting particularly the axial bone skeleton, mandibular localization is extremely rare. Diagnosis is based on the presence of a localized plasma cell tumor without signs of a disseminated form. We report a case of 65 years old female patient with solitary bone plasmacytoma of mandible, who has undergone surgical treatment without adjuvant therapy, with a good clinical and radiological outcomes at 12 months follow-up.

Solitary plasmacytoma of mandible: an unusual bilateral presentation

Plasmacytoma is a neoplastic proliferation of monoclonal plasma cells, which can present clinically as solitary bone neoplasm, extramedullary plasmacytoma, and multiple myeloma. The biological behavior of these tumors is variable from periods of clinical latency to rapid growth and progression from localized forms to more disseminated multiple myeloma. We present the case of solitary plasmacytoma of the mandible with rare bilateral involvement in a 65-year-old female patient. This paper highlights the importance of understanding the maxillofacial manifestations of the disease by the dentist for early diagnosis and thus better prognosis.

Solitary Plasmacytoma of the Mandible: Early Diagnosis and Surgical Management

Solitary plasmacytoma is an abnormal proliferation of B-lymphoid cells that involves a single bone. It mainly affects the axial skeleton; the jaw localization is a rare condition. The authors present a case of a 70-year-old female patient with a radiolucency of the angle of the mandible later diagnosed as solitary plasmacytoma.

Marginal resection of solitary plasmacytoma in the anterior region of the mandible and dental implant rehabilitation: Report of an unusual case

INTRODUCTION

Plasmacytoma describes a neoplastic proliferation of plasma cells affecting different groups of patients according to location, and may demonstrate heterogeneous tumor progression and survival rate. The present article describes a case of solitary plasmacytoma in the mandible.

PRESENTATION OF CASE

A 57-year-old male smoker was referred to the oral and maxillofacial service with extensive injury, approximately 4-5 cm in size, involving the anterior inferior region of mandible. After confirming diagnosis of plasmacytoma through incisional biopsy, because it was a recurrent lesion, excision of the lesion was performed through marginal resection of the mandible under general anesthesia. During the same surgical procedure, a 2.4-mm system fixation plate was placed to mitigate the risk for pathological fracture of the mandible. In a second surgery, a region in the base of the mandible was rehabilitated using implants and prosthesis.

CONCLUSION

The patient is currently undergoing clinical and radiological follow-up of 2 years with success.

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.

Solitary Plasmacytoma of the Mandible: An Uncommon Entity

INTRODUCTION

Plasma cell dyscrasias are characterized by a monoclonal neoplastic proliferation of plasma cells. Solitary bone plasmacytoma (SBP) is a local form of the disease with the vertebrae and long bones being the most frequently encountered sites. Its prevalence in the maxillofacial area is extremely rare.

CASE PRESENTATION

A 70-year-old Caucasian male patient was referred for the extraction of his mobile premolar tooth with a poorly-defined radiolucent lesion. Histopathological analysis revealed an SBP and no distant lesion or serum M protein was noted on radiological and hematological examinations. The patient was under follow-up care with no recurrence at 2 years of follow up.

CONCLUSIONS

Diagnosis of an SBP is based on local radiological and neurological symptoms and similar systemic manifestations of multiple myeloma that are also distinctive for SBP. Skeletal radiological analysis including CT and PET-CT, bone marrow biopsy, and serum protein electrophoresis are essential for confirmation of the diagnosis. Although surgery, chemotherapy, and radiation, or a combination of these modalities, have been successfully used in the treatment of SBP, it should be managed in relation to its possible long-term evolution.

Facial Swelling as a Primary Manifestation of Multiple Myeloma

Facial swellings are commonly encountered in the dental office, the cause of which could range from a congenital etiology to an acquired one or it may even be a manifestation of an underlying systemic disease. The clinician must have a thorough knowledge of the various clinical and imaging manifestations and the sites of occurrence of the various conditions to arrive at the appropriate diagnosis. Facial swellings can be classified into different groups which include acute swellings with inflammation, nonprogressive swellings, and slowly or rapidly progressive swellings. The various imaging modalities like CT and MRI are useful for assessing the extent of the swelling as well as evaluating the soft tissue and osseous involvement of the swelling. Multiple myeloma represents clonal proliferation of plasma cells and is a condition in which a facial swelling might be present, though not common. This paper reports a case of a patient with a unilateral facial swelling, which on investigation led to a diagnosis of multiple myeloma.

Multiple myeloma presenting with a maxillary lesion as the first sign

Multiple myeloma is a clonal neoplastic proliferation of terminally differentiated B-lymphocytes involving the skeletal system in a multifocal fashion. Its oral manifestations are less common in the maxilla than in the mandible due to the lower amount of hemopoietic bone marrow in the maxilla. We report the case of a 50-year-old man who presented with a mass in the left maxillary alveolar region with tooth mobility. The mass had become enlarged after the teeth were extracted 15 days previously. Radiographs demonstrated multiple punched-out radiolucent lesions in the skull and pelvic region. Computed tomography images showed a soft tissue density mass in the left maxilla, eroding the floor and walls of the maxillary sinus. Although several analytical techniques were used to characterize the lesion, it was finally confirmed as multiple myeloma through immunohistochemistry.

Oral lesion as unusual first manifestation of multiple myeloma: case reports and review of the literature

Extramedullary plasmacytoma (EMP) and solitary bone plasmacytoma (SBP) represent a disease continuum through a multistage process of cell differentiation, survival, proliferation, and dissemination, strictly related to multiple myeloma (MM), the second most common hematological malignancy. Herein, we report two cases of recurrent oral plasmacytoma progressed to MM, in which the first clinical sign of a more widespread disease was limited to the mouth. Based on our experience, we recommend a strict workup for the differential diagnosis between EMP, SBP, and MM for patients with oral plasmacytoma, including radiological exam of the skeleton, magnetic resonance imaging (MRI) of the bone, and positive emission tomography (FDG-PET). MRI and possibly PET can all be used to more sensitively detect EM plasmacytoma sites.

Multiple myeloma presenting as gingival hyperplasia

Multiple myeloma is a malignant neoplasm that is characterized by a monoclonal proliferation of plasma cells. Oral and maxillofacial manifestations as an initial sign or symptom of multiple myeloma are rare. A 58-year-old male patient presented with generalized gingival enlargement for last 6 months. Based on clinical presentation, a diagnosis of gingival hyperplasia was made. After Phase I therapy, excisional biopsy was taken in anterior mandibular region and excised tissue was sent for histopathological examination. The histopathology report revealed a lining of stratified squamous epithelium with foci of ulceration. The subepithelial zone showed infiltration by sheets of mainly binucleate and multinucleate plasma cells, few cells being less differentiated. Rounded cytoplasmic inclusion bodies were identified in many of these cells. After a series of clinical investigations, a case of “multiple myeloma” was diagnosed. Patient presenting with generalized gingival hyperplasia should be worked up for systemic disease like multiple myeloma.