The multiple oral presentations of multiple myeloma

Abstract

Purpose: The purpose of this case series is to show the varied oral presentations of multiple myeloma, illustrating the importance of carefully surveying the oral cavity for suspicious lesions that could be indicative of palpable disease and/or recurrence. The diagnostic criteria and prognostic features for multiple myeloma were also reviewed. Case Series Summary: This report focuses on 5 patients with myeloma manifestations involving the oral cavity, in which the oral presentation of multiple myeloma was an early indication of disease relapse. Although the clinical presentation may be variable, the majority of patients will develop lytic bone lesions and less commonly, extramedullary involvement during the course of their disease. Discussion: The presentation of myeloma can be varied and the oral presentation, although rare, may be the sole manifestation, or part of a group of signs of disease progression. Clinical presentations of patients with myelomatous lesions can mimic common dental pathologies, which then, in turn, can lead to delays in diagnosis and treatment. Conclusion: As members of an interdisciplinary oncology team, it is essential to be familiar with oral manifestations of multiple myeloma and proper diagnostic/biopsy techniques in order to avoid misdiagnosis and treatment delays.

Squamous Odontogenic Tumor: Literature Review Focusing on the Radiographic Features and Differential Diagnosis

“…Multiple myeloma is a hematologic malignancy characterized by proliferation of plasma cells and nonfunctional monoclonal immunoglobulin in which medullary involvement through radiolucent osteolytic lesions is the most frequent presentation [ 56 ]. Nevertheless, a localized ill-defined radiolucency involving roots of teeth with lamina dura loss is also found in solitary plasmacytomas, and these myelomatous lesions could be misdiagnosed as periodontitis [ 56 ].…”

“…Multiple myeloma is a hematologic malignancy characterized by proliferation of plasma cells and nonfunctional monoclonal immunoglobulin in which medullary involvement through radiolucent osteolytic lesions is the most frequent presentation [ 56 ]. Nevertheless, a localized ill-defined radiolucency involving roots of teeth with lamina dura loss is also found in solitary plasmacytomas, and these myelomatous lesions could be misdiagnosed as periodontitis [ 56 ]. Thus, considering that the main radiographic aspect of SOT also mimics severe periodontitis, it should be included as a differential diagnosis of multiple myeloma and solitary plasmacytoma [ 2 , 4 , 7 , 9 , 11 - 16 , 30 , 41 , 42 , 50 , 51 ].…”

Prevalence of Apical Periodontitis in patients with Multiple Myeloma

“…The primary clinical manifestation of the disease will be found in the oral cavity in 14% of myeloma patients (14,15). Maxillofacial manifestations of MM appear more frequently in the mandible than in the maxilla with an incidence of 8-15% (16)(17)(18)(19) and they include soft-tissue amyloid deposits (20), external dental root resorption (21), hypesthetic or anesthetic sensation of the lower lip (Vicent symptom), pain, gingival enlargement, swelling, tooth loosening, osteolytic lesions and amyloidosis with macroglossia (22,23). However, there have been no studies evaluating the association between MM and AP.…”

Oral manifestation of systemic diseases—a perspective from an oral pathology diagnostic service

“…Multiple myeloma is a systemic malignant proliferation of plasma cells that may present with osteolytic lesions of the jaws and/or soft tissue swellings. It has been estimated that 30% of patients with multiple myeloma have oral lesions (Cardoso, Gerngross, Hofstede, Weber, & Chambers, ; Fregnani et al., ; Pisano, Coupland, Chen, & Miller, ). Survey of the OPDS revealed 19 cases with a diagnosis of plasma cell neoplasm or multiple myeloma, including five cases with a clinical history of multiple myeloma and two cases with a history of solitary plasmacytoma.…”