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MULTIPLE MYELOMA PRESENTING AS ORAL CAVITY LESION

Poster · December 2018

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 MULTIPLE MYELOMA PRESENTING AS ORAL CAVITY LESION
Dr. Sweta Sinha, Dr. Satyasri K, Dr. S Krishna Kumari
RIMS Hospital , Srikakulam and HCG cancer center, Visakhapatnam

Introduction Histopathology Effect of treatment

• Revealed ulceration, mild inflammation and at places with sheets of plasma cells.
• Plasmacytoma
• Multiple myeloma is aggressive multifocal plasma cell proliferation in the
bone marrow in which neoplastic cells replace marrow cells1

• If these neoplastic plasma cells are localized within bone it is known as

solitary bone plasmacytoma (SBP).

• Or, outside bone involving only soft tissue- extra medullary plasmacytoma
(EMP).

Photomicrograph showing sheets of plasma cells. H&E. 25x

Clinical history
IHC Post RT Post chemotherapy
• A 69 Y/M. Chronic smoker and alcoholic. CD138 + Kappa + Mum1 +

• Provisional diagnosis- SCC/ NHL Discussion

• C/F- Soft tissue swelling of buccal mucosa/ gingiva with ulceration since
6 months. • Multiple myeloma is one of the most aggressive and most common
primary malignancy of bone .
Gross and microscopic findings Ck -
Lambda + Photomicrograph (25x) showing
• GROSS FINDINGS: Single, soft ulcerated mass measuring • Incidence of primary manifestations of multiple myeloma in the jaws
CD 138 +
approximately 3.5x3.0 cms arising from left buccal mucosa/ gingiva. Kappa + varies from 8% to 15%.2
Lambda +
• FNAC- Sheets of plasma cells with few binucleate and multinucleate • Males are more affected than females2 .
Mum1 + and
plasma cells.
Ck - • The most common bone involved is mandible (30% cases) 1,3.
• HPE- Revealed ulceration, mild inflammation and at places with sheets
of plasma cells.

Conclusion

Before treatment • Awareness of this initial presentation of multiple myeloma is important.

‘M’ spike in β2 region Serum free light chain assay

• Any soft tissue mass in jaw in an elderly male. Should be investigatedtorule out
multiplemyeloma/ solitary bone plasmacytoma/extramedullary plasmacytoma.
• Peripheral smear- Normocytic hypochromic anaemia
Mass oral cavity Mass oral cavity • SBP and SEP can evolve to MM
• BMA/BMB- Plasma cell dyscrasia (< 30%of plasma cells)
Laboratory and radiological findings • CT SCAN- Ill-defined lytic lesion in mandible.

• SERUM PROTEIN ELECTROPHORESIS- ‘M’ spike in the β2 region. References

• SERUM FREE LIGHT CHAIN ASSAY- Increased κappa free light chains (13,200mg/L). 1. Romano A et al. Oral Lesion as Unusual First Manifestation of Multiple
Myeloma: Case Reports and Review of the Literature. Case Reports in
Treatment Hematology, 2014,

2. Alim N, Eltohami Y, Abuaffan A, Elkhatim G. Oral Manifestations of Multiple

• Radiotherapy- Palliative RT. Dose- 30G for 10 fractions Myeloma Case Report. Journal of Dental and Craniofacial Research.
2017;02(01).
• Chemotherapy- [Link] 2mg s/c weekly
3. Raghavan S, Nagaraj P, Ramaswamy B, Nayak D. Multiple myeloma of the
Tab Lenalidomide 25 mg D1- D21
jaw: A case report. Journal of Indian Academy of Oral Medicine and Radiology.
Tab Dexa 20mg D1 D8 D15 D22 2014;26(4):454.

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