Medication-related osteonecrosis of the jaw in a patient with multiple myeloma: an unusual case with tumor in the surgical specimen

Ogawa, Ruri; Minami, Yoshiyuki; Ono, Junya; Kanri, Yoriaki; Kobayashi, Eizaburo; Tanaka, Akira; Okada, Yasuo; Ogura, Ichiro

doi:10.1007/s11282-021-00560-4

Cited by 9 publications

(4 citation statements)

References 18 publications

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“…Ogawa and Katkar et al reported cases of MM in bisphosphonate-affected jaws. [12,14] However, unlike in this case, pathological analysis was not performed at the time of MRONJ diagnosis for the 2 reported cases. A retrospective study reported of the 357 sites of BRONJ related with intravenous bisphosphonate medication subjected to microscopic analysis, 19 (5.3%) sites were diagnosed with 20 cancers in 16 patients in a BRONJ specimen, MM and breast cancer were the 2 main pathologies in the osteonecrosis of the jaws specimens.…”

Section: Discussionmentioning

confidence: 98%

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Chen

2023

Medicine

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Rationale: Multiple myeloma (MM) is a malignant disease characterized by abnormal proliferation of plasma cells, which usually occurs in middle-aged and elderly male patients. Bisphosphonates (BP) are commonly used for the treatment of MM bone disease. Long-time use of BP may cause medication-related osteonecrosis of the jaw (MRONJ). MRONJ occurs in jaw exclusively, and Multiple myeloma can also invade the jaw. The 2 diseases have similar clinical manifestations and imaging findings. This report present a case of MM identified in surgical specimen at the site that had been previously pathologically diagnosed as MRONJ in a patient with MM. Patient concerns: A 57-years-old male patient visited our clinic on October 16, 2020 because of gingival swelling and pain in the right mandible for 1 month after extraction of the lower right premolar. The patient had a long-time illness history of multiple myeloma, and received intravenous zoledronic acid treatment. Diagnoses: Based on the clinical characteristics, imaging, and pathological findings of sequestrum formation and high inflammatory cell infiltration, the patient was diagnosed with MRONJ. After 1 year, a mandibular osteotomy was performed and pathological analysis showed the presence of necrotic bone and a large number of abnormal plasma cell infiltration, suggesting the presence of MM in the mandible. Interventions: The patient was treated with a series of conservative treatments including antibiotic treatment, saline irrigation and laser irradiation, as well as superficial sequestration was. One year later, a mandibular osteotomy was performed. Outcomes: For the patient, the symptoms of gingival swelling, pain and discharge disappeared after surgery. Lessons: These findings suggested MRONJ and MM could occur simultaneously at same site, so patients with MM presenting with symptoms of MRONJ should be screened for concurrent or disease relapse of multiple myeloma to prevent misdiagnosis or inadequate management. Meanwhile, this also suggests long-term inflammatory may lead to invasion of multiple myeloma.

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Section: Discussionmentioning

confidence: 98%

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Chen

2023

Medicine

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“…Medication-related osteonecrosis of the jaw (MRONJ) is a complication of treatment with bisphosphonates and denosumab for patients with osteoporosis and bone metastases from cancer [1].…”

Section: Introductionmentioning

confidence: 99%

Maximum and mean standardized uptake values of medication-related osteonecrosis of the jaw with bone SPECT/CT: comparison of mandibular pathologies, control and temporomandibular joints

Tezuka

Ogura

2023

Dentomaxillofacial Radiology

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Objective: Recently, single-photon emission CT/CT (SPECT/CT) plays an important role in assessing patients with medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to investigate maximum and mean standardized uptake values (SUVs) of MRONJ with bone SPECT/CT, especially comparison of mandibular pathologies, control and temporomandibular joints. Methods: 61 mandibular patients with MRONJ who underwent bone SPECT/CT were included in this study. The maximum and mean SUVs of the lesion, right and left sides of the lesion, opposite side of the lesion as control, right and left temporomandibular joints were analyzed using a workstation and software. The SUVs of MRONJ were analyzed using one-way analysis of variance with Tukey’s honestly significant difference test. Patient characteristics with MRONJ and SUVs were analyzed using Mann–Whitney U test. P-values less than 0.05 were considered to indicate statistical significance. Results: The maximum and mean SUVs for opposite side of the lesions (4.4 ± 2.0 and 1.8 ± 0.7) were significantly lower than those for mandibular lesions (18.3 ± 8.1 and 6.3 ± 2.8), right side of the lesions (8.1 ± 3.9 and 2.9 ± 1.3) and left side of the lesions (8.1 ± 3.9 and 2.8 ± 1.4), respectively. The maximum and mean SUVs for right and left sides of the lesions, and opposite side of the lesions, right and left temporomandibular joints were not significant difference. Furthermore, the maximum SUVs of the mandibular lesions were a significant difference for age and staging. Conclusions: The maximum and mean SUVs with SPECT/CT can be useful in the quantitative management of MRONJ patients.

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“…Bisphosphonate (BP) and non-bisphosphonate (other antiresorptive or antiangiogenic medications) are inhibitors of osteoclastic bone resorption, and are useful for the treatment of osteoporosis and bone metastases of cancer. However, medication-related osteonecrosis of the jaw (MRONJ) is one of the major complications of treatment with bisphosphonate and non-bisphosphonate, although the developmental mechanism of MRONJ has not been completely established [14,15].…”

Section: Introductionmentioning

confidence: 99%

Comparison of maximum and mean standardized uptake values of jaw pathologies with bone SPECT/CT: an especial focus on medication-related osteonecrosis of the jaw

Minami

Ogura

2022

Nuclear Medicine Communications

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Objectives To investigate the comparison of maximum and mean standardized uptake values (SUVs) of jaw pathologies with bone Single-photon emission computed tomography/computed tomography (SPECT/CT), and a special focus on medication-related osteonecrosis of the jaw (MRONJ). Methods Eighty-nine patients with jaw pathologies (63 MRONJ, 13 chronic osteomyelitis, 11 osteoradionecrosis and 2 primary intraosseous carcinoma) underwent bone SPECT/CT scans acquisition at 4 h after intravenous injection of Tc-99m hydroxymethylene diphosphonate in this prospective study. The evaluation of mean and maximum SUVs of jaw pathologies were performed using Q. Metrix and Xeleris workstation and defined the data automatically. Statistical analyses were performed by Pearson’s correlation coefficient for comparison of maximum and mean SUVs and Mann-Whitney U-test for SUVs of MRONJ. A P value lower than 0.05 was considered to indicate statistical significance. Results Maximum SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 17.6 ± 8.4, 21.7 ± 7.1, 11.9 ± 4.8 and 26.6 ± 7.0, respectively. Mean SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 10.1 ± 4.9, 11.9 ± 3.3, 7.0 ± 2.8 and 10.1 ± 4.5, respectively. The maximum SUV of jaw pathologies was significantly correlated with the mean SUV (Y = 0.494X + 1.228; R2 = 0.786; P < 0.001). Furthermore, maximum and mean SUVs of MRONJ had significant differences in underlying diseases, medication and staging. Conclusion The maximum and mean SUVs with bone SPECT/CT can be an effective tool for the quantitative evaluation of jaw pathologies, especially MRONJ.

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Medication-related osteonecrosis of the jaw in a patient with multiple myeloma: an unusual case with tumor in the surgical specimen

Cited by 9 publications

References 18 publications

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Multiple myeloma identified within the same site of the mandible with medication-related osteonecrosis of jaw: An unusual case report

Maximum and mean standardized uptake values of medication-related osteonecrosis of the jaw with bone SPECT/CT: comparison of mandibular pathologies, control and temporomandibular joints

Comparison of maximum and mean standardized uptake values of jaw pathologies with bone SPECT/CT: an especial focus on medication-related osteonecrosis of the jaw

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