Aim: This study reports a case of oral Multiple Myeloma and explains the methods to diagnose this pathology. Materials and methods: a man 74 years aged were referred to our operative unit, because of a neoplasm in left mandible, accompanied by pain. After the removal of neoplasm, histological and immunophenotypic exams were affected. The patient was therefore sent to the hematology department for inquiries regarding the stage of disease and treatment. Among the diagnostic tests performed PET showed accumulation of relevance marrow infiltrating the adjacent soft tissues at the level of the left jaw, and of the lower third of the sternum and the right iliac wing, confirming the systemic nature of the disease, as magnetic resonance imaging, which showed nodular lesions with intense enhancement, to C2, L5, in the pelvic bone, in the right iliac wing, and in the body of the stern urn. Osteo-medullary biopsy (bone) staging has found a reduced cellularity of 30-35%,however compatible with the advanced age of the patient, but not revealed the presence of malignant plasma cell infiltration. The search for kappa and lambda light chains in urine and serum has also given negative results. Meanwhile, the patient began a transcutaneous cycle of radiotherapy at mandibular/ maxillary left in order to reduce the size of mandibular plasmacytoma, which postoperatively was returning to recur. However, even if the analysis of bone marrow, peripheral blood and urine samples were negative for systemic disease, the presence of these multiple sites of bone disease, as well as the primitive seat extramedullary in mouth, we have put the diagnosis of multiple myeloma, in non-secretor form of the disease. Results: histological and immunophenotypic exams claimed a poorly differentiated neoplasm, compatible with the diagnosis of "extramedullary plasmablastyc/anaplastyc plasmocytoma". Discussions and Conclusion: this clinical case is peculiar because the involvement of soft tissues, in an unusual location of the gingival mucosa, was the primary sign of the disease in act, hence the importance of training of dentists and early diagnosis of this disease. It's, therefore, a form of non-secretor myeloma, with the consequent difficulty in establishing a correct staging and in assessing the response to therapy.
Oral localization of multiple myeloma: a case report
VERZI', Placido
2010-01-01
Abstract
Aim: This study reports a case of oral Multiple Myeloma and explains the methods to diagnose this pathology. Materials and methods: a man 74 years aged were referred to our operative unit, because of a neoplasm in left mandible, accompanied by pain. After the removal of neoplasm, histological and immunophenotypic exams were affected. The patient was therefore sent to the hematology department for inquiries regarding the stage of disease and treatment. Among the diagnostic tests performed PET showed accumulation of relevance marrow infiltrating the adjacent soft tissues at the level of the left jaw, and of the lower third of the sternum and the right iliac wing, confirming the systemic nature of the disease, as magnetic resonance imaging, which showed nodular lesions with intense enhancement, to C2, L5, in the pelvic bone, in the right iliac wing, and in the body of the stern urn. Osteo-medullary biopsy (bone) staging has found a reduced cellularity of 30-35%,however compatible with the advanced age of the patient, but not revealed the presence of malignant plasma cell infiltration. The search for kappa and lambda light chains in urine and serum has also given negative results. Meanwhile, the patient began a transcutaneous cycle of radiotherapy at mandibular/ maxillary left in order to reduce the size of mandibular plasmacytoma, which postoperatively was returning to recur. However, even if the analysis of bone marrow, peripheral blood and urine samples were negative for systemic disease, the presence of these multiple sites of bone disease, as well as the primitive seat extramedullary in mouth, we have put the diagnosis of multiple myeloma, in non-secretor form of the disease. Results: histological and immunophenotypic exams claimed a poorly differentiated neoplasm, compatible with the diagnosis of "extramedullary plasmablastyc/anaplastyc plasmocytoma". Discussions and Conclusion: this clinical case is peculiar because the involvement of soft tissues, in an unusual location of the gingival mucosa, was the primary sign of the disease in act, hence the importance of training of dentists and early diagnosis of this disease. It's, therefore, a form of non-secretor myeloma, with the consequent difficulty in establishing a correct staging and in assessing the response to therapy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
