Solitary plasmacytoma of maxillofacial bones: correlation of CT features with pathological findings

Abstract

Objective: To explore the CT features of solitary plasmacytoma (SP) of maxillofacial bones and correlation with pathological findings. Methods and materials: We retrospectively reviewed the clinical, CT and pathological features of SP in the maxillofacial bones. 16 patients with clinically and histologically proven SP of maxillofacial bones were involved. They were aged from 27 to 79 years old (median 55.5 years old), and included 12 males and 4 females (males vs females: 3:1). All patients performed CT examination, in whom 13 patients underwent enhanced scanning and 3 plain scanning. The CT images were assessed for lesion location, size (maximum diameter), shape (round, oval and irregular), boundary (defined and illdefined), bone changes (bone destruction, residual bone, sclerotic margin and periosteal reaction), density of soft tissue mass and enhancement manifestations, and invasion of adjacent structures. Results: 13 patients suffered from SP in the mandible, 2 in the zygoma, and 1 in the maxilla and hard palate. The maximum diameter of lesions ranged from 2.4 to 8.2 cm (mean 3.93 ± 1.435 cm). Most lesions were founded as a solitary osteolytic lesions (15/16, 93.75%) with round or ovoid shape (13/16, 81.25%), smooth margin (16/16, 100%) and defined boundary (16/16, 100%) in bone marrow. They destroyed bone cortex (15/16, 93.75%) and had residual bone (10/16, 62.5%), without sclerosis margin (15/16, 93.75%) and periosteal reaction (14/16, 87.5%). They easily formed soft tissue masses (16/16, 100%) and invade adjacent anatomical structures (15/16, 93.75%). The density of lesions was usually uniform (12/16, 75%) with strong enhancement. There was a significant difference in CT values between plain and enhanced scanning [50.75 ± 9.140 Hounfield unit (HU) vs 101.0 ± 28.830 HU; p < 0.001), with the mean difference of CT values 50.25 HU. Conclusions: SP is predominant in the mandible of elderly male patients. A solitary, round or ovoid, well-defined, osteolytic, invasive mass in bone marrow, which destroys bone cortex, has residual bone, no sclerosis margin and periosteal reaction, and shows strong enhancement, is suggestive of this diagnosis.

Application Value of the CT Scan 3D Reconstruction Technique in Maxillofacial Fracture Patients

“…Due to the anatomical relationship of maxillofacial bone and the displacement of fracture, the resolution and accuracy of ordinary X-ray films are poor and show compound overlapping images of multiple structures [ 4 ]. Multislice spiral CT (MSCT) is a noninvasive imaging examination technology, and it can display human bones, joints, soft tissues, blood vessels, and other aspects more clearly and effectively prevent the image clarity of motion artifacts owing to its high scanning speed in unit time [ 5 , 6 ]. However, for the complex layer of the maxillofacial region, it is difficult for an ordinary MSCT scan to perform specific display.…”

Plasmacytoma in the Maxillary Jaw: A Diagnostic and Therapeutic Challenge

“…In this case report, the diagnosis of solitary plasmacytoma in the anterior maxilla, which has still to be confirmed through further analysis, at the level of the upper lateral incisor was an example of a rare localization of this type of lesion in the head region [11], showing the challenge in the diagnosis of this pathology; therefore, plasmacytomas are more common in long bones and vertebrae, while they are rare in the jaw [12]. This case study highlights the importance of accurate clinical and radiological examinations, as well as an adequate background in oral medicine and in hematologic diseases with oral manifestation in case of rare manifestations of these diseases.…”

“…In this case report, the diagnosis of solitary plasmacytoma in the anterior maxilla, which has still to be confirmed through further analysis, at the level of the upper lateral incisor was an example of a rare localization of this type of lesion in the head region [ 11 ], showing the challenge in the diagnosis of this pathology; therefore, plasmacytomas are more common in long bones and vertebrae, while they are rare in the jaw [ 12 ].…”

Solitary bone plasmacytoma mimicking a lesion of odontogenic origin: A case report

“…In the maxillofacial region, SBP is relatively common in the mandible, especially in bone marrow-rich areas including the retromolar trigone, angle, and ramus [ 10 ]. Swelling and pain are the primary clinical presentations of SBP in the jaw, occasionally with mobility of the associated teeth and numbness of the lips [ 11 ]. The International Myeloma Working Group recommends the following guidelines to diagnose SBP: normal bone marrow without evidence of clonal plasma cells, a biopsy-proven bone solitary lesion with evidence of clonal plasma cells, magnetic resonance imaging, or CT of the spine and pelvis showing normal skeletal characteristics (except for the primary solitary lesion), and the absence of end-organ damage such as hypercalcemia, renal insufficiency, anemia, or bone lesions [ 12 ].…”