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

Solitary plasmacytoma of jaw bone: A case report and systematic review of fifty cases from literature

Solitary plasmacytoma of bone (SPB) is a localized form of plasma cell neoplasm where jaw involvement is rare. Distinguishing SPB from other plasma cell neoplasms is critical for treatment and survival. Here, a case of SPB of mandible in an elderly female is reported. Histopathological diagnosis of plasma cell neoplasm was confirmed immunohistochemically with MUM1 and CD138 positivity and multiple myeloma (MM) was ruled out on performing systemic workup. Prognosis of SPB worsens when it transforms into MM. A systematic review was undertaken with the objective to determine the factors affecting conversion of SPB to MM. An electronic search was undertaken with PubMed/MEDLINE, Web of Science and Science Direct. Fifty cases of SPB of jaw from 29 publications were reviewed. SPB commonly presents as a painless swelling. Radiographically, it is commonly seen as multilocular radiolucency with well-defined borders. Follow-up data showed that nine cases turned into MM in a mean duration of 1 year 9 months and 12 patients died after median disease-free survival of 6 years 9 months. Prognosis of SPB is found to be affected by tumor size (≥5 cm), anaplasia of tumor cells, Ki-67 labeling index, vascularity of the tumor, presence of clonal bone marrow plasma cells, serum immune globulin level, dose of radiotherapy and persistence of M protein after treatment. There is a need to identify prognostic subgroups in SPB based on these factors. Furthermore, studies are necessary for standardization of treatment protocol to halt or prolong the progression of SPB to MM.

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.

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: A rare case report

Plasmacytoma is a monoclonal, neoplastic proliferation of plasma cells that usually arises within bone marrow or soft tissue sites. It can involve either a single bone (solitary) or multiple bones. Solitary plasmacytoma has a predisposition for the red marrow-containing axial skeleton and is most frequently seen in the thoracic vertebrae, followed by the ribs, sternum, clavicle, or scapula. Its presence in the jaws is extremely rare. We present a case of a 54-year-old female with a well-defined radiolucency of the body region of the mandible later diagnosed as solitary plasmacytoma.

Plasmocytome solitaire osseux de la mandibule

INTRODUCTION

Solitary plasmocytoma is a rare malignant tumor, belonging to the larger family of plasma cell proliferative diseases observed in bones. The mandible localization reported here is extremely rare.

CASE REPORT

A 57-year-old man consulted for a tumefaction of the right mandible. Physical examination revealed a mandibular tumor with an osseous consistency covered by a healthy mucous. Radiologically, the tissue processed from the mandible, which presented a defect and an eroded cortical. Hemimandibulectomy was performed. Pathologic examination of the operative specimen demonstrated plasmocytoma. Complementary radiotherapy was performed. Outcome at 13 months was favorable, without recurrence of multiple myeloma.

DISCUSSION

Plasma cell tumors are rare, about 10% of them are solitary plasmocytomas observed in intra- or extramedullar sites. Pathology is required for confirmation. An exhaustive assessment is needed to rule out multiple myeloma. Most solitary forms are observed in the spine. Appropriate treatment combines surgery and radiotherapy. Careful surveillance is required because of the frequent progression to multiple myeloma.

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.

Early clinical diagnosis of solitary plasmacytoma of the jaws: a case report with a six year follow-up

The authors reported a case of a solitary mandibular plasmacytoma in a 53-year-old male Caucasian patient. The histological examination of the specimen was positive for a plasmacytoma with anaplastic appearance. Since the patient refused a demolitive surgical treatment, he was treated with a local radiation therapy of 4000 rads over a 20-day period and polychemotherapy with cyclophosphamide, prednisone and melphalan. Six years after starting radiation treatment the patient is free of recurrent primary disease and not affected by multiple localization. In conclusion, the solitary bone plasmacytoma represents an initial stage of the multiple myeloma rather than a distinct clinical pathology. Unfortunately, the diagnosis of the plasmacytoma is only rarely carried out in the early phases of the disease. The importance of the identification of the initial stage without a clear M component, as in the reported case, is self-evident, since the prognosis is related to the mass of plasmacytoma cells that are present at the time of the diagnosis. The purpose of this study is to report an extremely rare case of solitary bone plasmacytoma with a mandibular localization treated with radio- and polychemotherapy.

Solitary plasmocytoma of the mandible--a combined approach for treatment and reconstruction

A 44-year-old man presented with a solitary plasmocytoma in the left mandible. After neoadjuvant radiation therapy and chemotherapy, a bone marrow biopsy was taken for cryopreservation. In simulation surgery, tumour resection and primary reconstruction were planned on an individual stereolithographic 3-D skull model. Radical tumour resection and primary reconstruction using a microvascular iliac crest bone graft was performed. In case of extensive osteolysis and/or mandibular asymmetry due to tumourous bone enlargement, preoperative model planning has proved to be a useful tool for primary reconstruction. In the three-year follow up, the patient showed no recurrence of disease.

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.