Oral Lesion as Unusual First Manifestation of Multiple Myeloma: Case Reports and Review of the Literature

Figure 1

Extramedullary plasmacytoma, macroscopic features. (a) The soft mass neoplasm appears pink in colour and has floating consistency with a diameter of about 1.5 cm, occupying the area of dental elements 37 and 38. It has ill-defined contours and is slightly ulcerated on the top for the effects of antagonist dental elements, causing algia and difficulty in chewing for the patient. No sign of bone involvement at the orthopantomography (Case A). (b) The patient presented a relapse of the neoplasm seven days after the biopsy, with the enlargement of the lesion to the entire edentulous left side of the jaw, until the first premolar. The mucosa covering the lesion was of irregular colour and the traumatism due to the antagonist dental elements was accentuated (Case A). (c) The mass presented as a swelling in the left posterior region of the maxilla, with maximum dimensions 25 × 45 mm, involving also palate and gingiva. The mass consistency was hard elastic and normal in colour and covered with intact oral mucosa (Case B). (d) The maxillofacial CT scan showed an important osteolytic involvement of the upper alveolar process and the partial obliteration of the basal portion of the left maxillary sinus. The lesion extended also to the homolateral nasal cavity. Concomitant enlargement of lateral cervical and submandibular lymph nodes, with the biggest having 13 mm diameter (Case B).

(a)

(b)

(c)

(d)