Multiple myeloma: with mandibular mass as predominant presentation

Case contributed by Dr Anil Kumar Singh

Presentation

A 50 year-old male patient presenting with gradually enlarging mass in right jaw region, with mass noted initially five/six months back as mild fullness in right jaw region. Associated complaints of mild to moderate pain, progressive difficulty in mouth opening, fatigue and weight loss.

Patient Data

Age: 50 years
Gender: Male

AP & lateral radiographs of skull showing destruction of right mandibular ramus & posterior body with associated large soft tissue mass lesion. Also noted multiple small discrete punched out lytic lesions in calvarial bones.

AP radiograph of pelvis shows small discrete punched out lytic lesions in bilateral iliac bones & visualized proximal femur. Doubtful lesions in bilateral acetabulum.

Case Discussion

Radiological and histopathological work up suggestive of multiple myeloma. Also positive for M protein.

Multiple myeloma is hematological malignancy, recognized as most common primary malignant tumor of bone (actually arising in bone marrow). Most common age group is sixth to seventh decade. Commonly involved bones are vertebrae, pelvic bones, skull, ribs, clavicles, scapulae & proximal limb bones.  Involvement of jaw bones is seen in approximately 30% of cases, however presentation as predominant jaw mass is rare.

Radiography reveals punched out lytic lesions/bone destruction with or without obvious soft tissue  mass. Poor sensitivity. Sclerotic lesions can be seen in small sub-set of patients.

CT has better sensitivity than conventional radiography. Extent of lytic lesions or bone destruction is better defined. Associated soft tissue mass, if any, is better delineated.

MRI is imaging modality of choice because of its higher sensitivity for marrow infiltrative disorders.  Early disease limited to marrow is usually missed at conventional radiography, may go undetected at CT, but usually detected at MRI. Whole Body MRI is preferred for assessment whole extent of disease. The lesions appear as low signal intensity lesions on T1WI & hyperintense on T2WI, STIR. The lesions are commonly seen as multiple discrete focal lesions, but in vertebrae can be also seen as diffuse infiltrative pattern.

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Case information

rID: 34883
Case created: 12th Mar 2015
Last edited: 20th Mar 2017
Inclusion in quiz mode: Included

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