RADIOLOGY CASE

 

Maxillofacial Radiology 201

 

 

C Smit^I; L Robinson^II

^IBChD, MSc (Maxillofacial and Oral Radiology). Department of Oral Pathology and Oral Biology, University of Pretoria. ORCID: 0000-0003-4047-6356
^IIBChD, PDD (Maxillofacial Radiology), PDD (Forensic Odontology), MChD (Oral Path), FC Path (SA) Oral Path. Department of Oral Pathology and Oral Biology, University of Pretoria. ORCID: 0000-0002-0549-7824

Correspondence

 

 

CASES

Two female patients presented with multiple radiolucent lesions noted on panoramic radiography. Cone-beam computed tomography (CBCT) scans confirmed multiple "punched-out" lesions affecting the skull.

 

Figure 1

 

 

Figure 2

 

INTERPRETATION

Both patients presented with multiple synchronous punched-out radiolucencies affecting multiple skull bones. In both cases, the lesions were biopsied with a confirmed diagnosis of a plasma cell neoplasm in keeping with multiple myeloma.

Multiple myeloma (MM) is a haematolymphoid malignancy of plasma cells that presents with multifocal destructive bony lesions. The focal/singular lesion is referred to as a plasmacytoma. MM represents 0.8% of all cancer diagnoses worldwide and often affects patients over the age of 40 years.¹ Accepted risk factors include advanced age, male gender, black ethnicity and positive family history.¹ The clinical signs and symptoms are related to the uncontrolled growth of the malignant cells and their abnormal secretions.² The overgrowth of malignant cells in the bone marrow results in the underproduction of other cell types, resulting in anaemia, neutropenia, and thrombocytopenia. Therefore, fatigue, immunosuppression paired with frequent opportunistic infections, and petechial haemorrhages, are common presenting signs and symptoms. The extensive amount of bony destruction by the multiple bone lesions results in bone pain, pathological fractures, and increased serum calcium resulting in metastatic calcifications. Abnormally secreted proteins may cause renal damage and can be detected in the urine where they are referred to as Bence-Jones proteins. They may also be deposited in soft tissue as amyloid, which may be seen in the tongue as a cause of macroglossia. Patients with MM are usually treated by multiple cycles of combination chemotherapy followed by stem cell transplant with long-term maintenance therapy to prevent relapse.³ The median duration of survival is 33 months², with early diagnosis and treatment initiation being paramount. This emphasises the need for early detection by dental practitioners during routine radiographic examinations.

 

REFERENCES

1. Alexander DD, Mink PJ, Adami H-O, et al. Multiple myeloma: A review of the epidemiologic literature. Int J Cancer. 2007;120(S12):40-61. doi:10.1002/ijc.22718        [ Links ]

2. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 Patients With Newly Diagnosed Multiple Myeloma. Mayo Clin Proc. 2003;78(1):21-33. doi:10.4065/78.1.21        [ Links ]

3. Rajkumar SV, Kumar S. Multiple Myeloma: Diagnosis and Treatment. Mayo Clin Proc. 2016;91(1):101-119. doi:10.1016/j.mayocp.2015.11.007        [ Links ]

 

 

Correspondence:
Chané Smit
Department of Oral Pathology and Oral Biology, University of Pretoria.
Tel +27 (0)12 319 2311; Email: chane.smit@up.ac.za

 

 

Authors contribution:
Chané Smit: 50%
Liam Robinson: 50%