Imaging Sci Dent.  2015 Mar;45(1):55-60. 10.5624/isd.2015.45.1.55.

Multiple myeloma presenting with a maxillary lesion as the first sign

• Ramaiah KK
• Joshi V
• Thayi SR
• Sathyanarayana P
• Patil P
• Ahmed Z

• KMID: 2116792
• DOI: http://doi.org/10.5624/isd.2015.45.1.55

Abstract

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.

Keyword

Multiple Myeloma; Maxilla; Plasma Cells; Plasmacytoma

MeSH Terms

B-Lymphocytes
Bone Marrow
Cytochrome P-450 CYP1A1
Humans
Immunohistochemistry
Mandible
Maxilla
Maxillary Sinus
Middle Aged
Multiple Myeloma*
Oral Manifestations
Pelvis
Plasma Cells
Plasmacytoma
Skull
Tooth
Tooth Mobility
Cytochrome P-450 CYP1A1

Figure

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  Fig. 1 An extraoral photograph shows diffuse swelling in the left middle third of the face.

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  Fig. 2 An intraoral photograph shows a sessile mass in the left maxillary alveolus.

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  Fig. 3 A panoramic radiograph shows an osteolytic lesion in the left posterior maxilla, with resorption of the hard palate and the floor of the maxillary sinus.

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  Fig. 4 An antero-posterior pelvic radiograph shows multiple punchedout radiolucent lesions.

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  Fig. 5 A. A coronal computed tomography image of the skull shows punched-out radiolucent lesions. B. An axial computed tomography image shows a soft tissue density mass in the left maxilla, eroding the medial and lateral walls. C. A coronal computed tomography image shows erosion of the left maxillary sinus floor and the maxillary alveolus. D. A sagittal computed tomography image shows erosion of the anterior wall of the maxillary sinus with involvement of the premaxillary tissues.

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  Fig. 6 Photomicrographs show the proliferating sheets of atypical plasma cells (A, H&E stain, 200×) and the immunohistochemically positive cells for CD138 (B, 200×).

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