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