Oral Cavity: an Inception to Diagnose Plasma Cell Myeloma. Case Report and Literature Review
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MEDICINE
Oral Cavity: an Inception to Diagnose Plasma Cell Myeloma. Case Report and Literature Review Harpreet Kaur 1 & Suchitra Gosavi 2 & Abhay Datarkar 3 & Vandana Gupta 4 Accepted: 30 September 2020 # Springer Nature Switzerland AG 2020
Abstract Plasma cell myeloma (PCM) is a malignant disease of monoclonal plasma cells which is multicentric in origin. The accurate diagnosis demands contemplation of conventional histopathology with meticulous correlation of medical history, clinical and imaging details; and adjunctive investigations. We report a case of 50 year old female who presented with chief complaint of diffuse swelling of jaw and close observation revealed walking difficulty attributed to bone pain. Imaging showed ill-defined punched out lesions in left mandible. Biopsy with adjuvant immunohistochemistry revealed features suggestive of plasmacytoma and work up for plasma cell myeloma was advised. Further investigations showed features of end organ damage (hypercalcemia, increase serum creatinine, anemia, and > 1 osteolytic lesions). Serum electrophoresis and bone marrow aspiration confirmed the diagnosis of plasma cell myeloma. Patient was referred to oncology department where thalidomide was prescribed and patient showed drastic improvement in symptoms within a month. However demise of patient occurred after 7 months which might be attributed to delay in diagnosis by the clinician. Thus, this case report highlights the need of awareness and knowledge on the part of dental professionals for even rare systemic diseases to emphasize early diagnosis and treatment. Keywords Plasma cell myeloma . Plasmacytoma . Punched out . Mandible . Multicentric . Monoclonal plasma cells
Abbreviations PCM PBL OPG SPB Non-IgM MGUS
Introduction Plasma cell myeloma Plasmablastic lymphoma Orthopantomogram Solitary plasmacytoma of bone Non-IgM monoclonal gammapathy of undetermined significance
This article is part of the Topical Collection on Medicine * Harpreet Kaur [email protected] 1
Division of Oral Pathology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
2
Department of Oral Pathology, Government Dental College & Hospital, Nagpur, India
3
Department of Oral and maxillofacial surgery, Government Dental College & Hospital, Nagpur, India
4
Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
Plasma cell dyscrasias are derived from post germinal center B cells with somatic hypermutation and immunoglobulin heavy chain class switching which secrete monoclonal “M protein.” The most common symptomatic intrabony plasma cell dyscrasias include solitary plasmacytoma of bone (SPB) and multifocal plasma cell myeloma (PCM). Non-IgM monoclonal gammapathy of undetermined significance (non-IgM MGUS) is also included under plasma cell dyscrasias; however it is usually asymptomatic and stable in course but has propensity to transform into myeloma. Jaw lesion can be a manifestation of solitary plasmacy
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