Post on 09-Jan-2017
Multiple Myeloma – A case report
INDIAN DENTALACADEMYLeader in continuing Dental Education
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About…
A malignant neoplastic condition characterized by the proliferation of a single clone of abnormal plasma cells
Old age >40 years Peak incidence- 60 to 70 years
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Causes
Genetic Environmental or occupational Radiation MGUS
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Characteristics…
M proteinsM proteins Bone lesionsBone lesions Kidney diseaseKidney disease Hyper viscosity Hyper viscosity HypercalcaemiaHypercalcaemia
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Symptoms…
Bone pain Pathologic fractures Weakness Frequent infections Spinal cord compression
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Treatment
Chemotherapy
Radiation
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70 yr female Swelling on right lower half of face
of 2 months duration
Case report…
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A small painless swelling in front of the right ear 2 months back
Slowly increasing in size
Ten days back another painless swelling -right side of lower jaw
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Past history:
Medical Was hospitalized for body pain 1 week
back Dental
Had undergone extraction of multiple teeth
Post extraction periods were uneventful
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Extra oral examination:
Oval swelling in the right parasymphysis of mandible - 2x2cm
Diffuse swelling in the preauricular region - 3x4 cm
Firm with diffuse margins
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Intra oral examination Oval swelling in the buccal
sulcus -1.5x1.5cm
Mucosa - slightly erythematous
Firm with diffuse margins
Buccal expansion present
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Provisional diagnosis:
Odontogenic cyst / neoplasm
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Investigations:
Radiological examination Blood picture Aspiration Immuno-electrophoresis Histopathology
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Radiological examination
IOPA
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Panoramic view
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Lateral skull view multiple punched out areas of radiolucency
on the skull.
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PA skull view multiple punched out areas of radiolucency on the skull.
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Chest PA lytic lesions without sclerotic border on
clavicle
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Blood examination
TC – 8250 cells per mm3
P-39%, L-53%, E-8%
ESR 26mm
Hb- 9gm/dl
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Aspiration
Blood tinged fluid present
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Immuno-electrophoresis
24 hour urine Bence-Jones protein immuno-electrophoresis was negative.
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Histopathology
Sheets of mature malignant plasma cells showing eccentric nuclei and stippled nuclear chromatin
40 x 100 x
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Final Diagnosis:
Multiple myeloma
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To conclude…
Clinical presentation mimics an odontogenic lesion.
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