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The multiple oral presentations of multiple myeloma

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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 five 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.

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References

  1. Neville BW (2009) Hematologic disorders. In: Neville BW, Damm DD, Allen CM, Bouquot JE (eds) Oral and maxillofacial pathology, 3rd edn. Saunders-Elsevier, Philadelphia, pp 526–528

    Google Scholar 

  2. Rajkumar SV (2011) Multiple myeloma: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol 86:57–65. doi:10.1002/ajh.21913

    Article  PubMed  Google Scholar 

  3. Nofsinger YC, Mirza N, Rowan PT, Lanza D, Weinstein G (1997) Head and neck manifestations of plasma cell neoplasms. Laryngoscope 107:741–746

    Article  PubMed  CAS  Google Scholar 

  4. Weber DM (2005) Solitary bone and extramedullary plasmacytoma. Hematol Am Soc Hematol Educ Prog. doi:10.1182/asheducation-2005.1.373

    Google Scholar 

  5. Reed V, Shah J, Medeiros LJ, Ha CS, Mazloom A, Weber DM, Arzu IY, Orlowski RZ, Thomas SK, Shihadeh F, Alexanian R, Dabaja BS (2011) Solitary plasmacytomas: outcome and prognostic factors after definitive radiation therapy. Cancer 117:4468–4474. doi:10.1002/cncr.26031

    Article  PubMed  Google Scholar 

  6. International Myeloma Working Group (2003) Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 121:749–757

    Article  Google Scholar 

  7. Epstein JB, Voss NJS, Stevenson-Moore P (1984) Maxillofacial manifestations of multiple myeloma. An unusual case and review of the literature. Oral Surg Oral Med Oral Pathol 57:267–271

    Article  PubMed  CAS  Google Scholar 

  8. Greipp PR, San Miguel J, Durie BG, Crowley JJ et al (2005) International staging system for multiple myeloma. J Clin Oncol 23:3412–3420

    Article  PubMed  Google Scholar 

  9. Herve AL, Florence M, Philippe M, Michel A et al (2011) Molecular heterogeneity of multiple myeloma: pathogenesis, prognosis, and therapeutic implications. J Clin Oncol 29:1893–1897. doi:10.1200/JCO.2010.32.8435

    Article  PubMed  Google Scholar 

  10. Mhaskar R, Redzepovic J, Wheatley K, Clark OA, Miladinovic B, Glasmacher A, Kumar A, Djulbegovic B (2010) Bisphosphonates in multiple myeloma (review). Cochrane Database Syst Rev. doi:10.1002/14651858.CD003188

    PubMed  Google Scholar 

  11. Morgan GJ, Davies FE, Gregory WM, Cocks K et al (2010) First-line treatment with zoledronic acid as compared with clodronic acid in multiple (MRC Myeloma IX): a randomised controlled trial. Lancet 376:1989–1999. doi:10.1016/S0140-6736(10)62051-X

    Article  PubMed  CAS  Google Scholar 

  12. Otto S, Schereyer C, Hafner S, Mast G, Ehrefeld M, Sturzenbaum S, Pautke C (2012) Bisphosphonate-related osteonecrosis of the jaws—characteristics, risk factors, clinical features, localization and impact on oncological treatment. J Craniomaxillofac Surg 40:303–309. doi:10.1016/j.jcms.2011.05.003

    Article  PubMed  Google Scholar 

  13. Lambertenghi-Deliliers G, Bruno E, Cortelezzi A, Fumagalli L, Morosini A (1988) Incidence of jaw lesions in 193 patients with multiple myeloma. Oral Surg Oral Med Oral Pathol 65:533–537

    Article  PubMed  CAS  Google Scholar 

  14. Furutani M, Ohnishi M, Tanaka Y (1994) Mandibular involvement in patients with multiple myeloma. J Oral Maxillofac Surg 53:23–25

    Article  Google Scholar 

  15. Pisano JJ, Coupland R, Chen SY, Miller AS (1997) Plasmacytoma of the oral cavity and jaws. A clinicopathologic study of 13 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:265–271

    Article  PubMed  CAS  Google Scholar 

  16. Daneshbod Y, Arabi MA, Ramzi M, Daneshbod K (2008) Jaw lesion as the first presentation of multiple myeloma diagnosed by fine needle aspiration. Acta Cytol 52:268–270

    Article  PubMed  Google Scholar 

  17. August M, Faquin WC, Ferraro NF, Kaban LB (1999) Fine-needle aspiration biopsy of intraosseous jaw lesion. J Oral Maxillofac Surg 57:1282–1286

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

None of the authors has any financial and personal relationships with other people or organizations that could inappropriately influence their work.

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Correspondence to Mark S. Chambers.

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Cardoso, R.C., Gerngross, P.J., Hofstede, T.M. et al. The multiple oral presentations of multiple myeloma. Support Care Cancer 22, 259–267 (2014). https://doi.org/10.1007/s00520-013-1960-y

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  • DOI: https://doi.org/10.1007/s00520-013-1960-y

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