Imaging Sci Dent.  2016 Dec;46(4):273-278. 10.5624/isd.2016.46.4.273.

Radiographic features of plasma cell leukemia in the maxilla: A case report

• Wong P
• Kashtwari
• Nair MK

• KMID: 2362746
• DOI: http://doi.org/10.5624/isd.2016.46.4.273

Abstract

Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma where there is hematogenous spread of abnormal plasma cells into the periphery. This is opposed to multiple myeloma, where the abnormal plasma cells stay in the bone marrow. PCL is more common in males than females, and is also more common in African-Americans than Caucasians. Signs and symptoms of PCL include, but are not limited to, renal insufficiency, hypercalcemia, anemia, lytic bone lesions, thrombocytopenia, hepatomegaly, and splenomegaly. Here, we discussed a case of a 71-year-old Caucasian female recently diagnosed with primary PCL with radiographic features of this disease throughout the body, with an emphasis on the maxillofacial skeleton and relevance from a dental standpoint.

Keyword

Leukemia, Plasma Cell; Radiology; Pathology

MeSH Terms

Aged
Anemia
Bone Marrow
Female
Hepatomegaly
Humans
Hypercalcemia
Leukemia, Plasma Cell*
Male
Maxilla*
Multiple Myeloma
Pathology
Plasma Cells*
Plasma*
Renal Insufficiency
Skeleton
Splenomegaly
Thrombocytopenia

Figure

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  Fig. 1 Lateral skull radiograph (Aug. 2014) depicting osseous changes in the jaws, degenerative changes in the cervical spine, and a loss of intervertebral disc space between C5 and C6.

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  Fig. 2 Conventional plain film radiographs (Aug. 2014) of the left humerus (A) and left femur (B) depicting osseous changes associated with plasma cell leukemia.

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  Fig. 3 Lateral skull radiograph (Aug. 2014) depicting multiple punched-out radiolucent lesions consistent with a myeloproliferative disorder.

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  Fig. 4 Paraxial slice from a multidetector computed tomography study (Nov. 2014) depicts an intact right maxillary sinus free of gross disease.

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  Fig. 5 Dental panoramic radiograph acquired in April 2016 exhibits a relative radiolucency and loss of trabeculation apical to the maxillary right premolars.

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  Fig. 6 Periapical radiograph (Apr. 2016). Note the characteristic widening of the periodontal ligament spaces and sparse trabeculation in the periapical region surrounding the premolars.

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  Fig. 7 Paraxial slice from a cone beam computed tomography study (Apr. 2016) reveals the loss of the buccal and lingual cortical borders in the region of the premolars.

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  Fig. 8 Parasagittal slice from a cone beam computed tomography study (Apr. 2016) shows the altered trabeculation in the periapical region of the premolars, an oroantral communication, and the reactive mucositis of the right maxillary sinus.

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  Fig. 9 Photomicrographs exhibit a histopathological appearance of the known myeloproliferative disorder. Note the malignant neoplastic proliferation of atypical monomorphic lymphocytes forming cords, sheets, and clusters with normal nuclei and an eosinophilic cytoplasm typical of a myeloproliferative disorder (H&E stain, A. ×10, B. ×20).

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