Oral lesions, including gingival swelling, orofacial pain and paraesthesia, osteolytic bone lesions, and fractures of the jawbones, may be a clinical manifestation of multiple myeloma (MM), according to a case reported in Lancet Oncology. The case described a 75-year-old male patient who visited an emergency department in Italy in May 2019 due to a rapidly growing intraoral lesion.

The patient’s oral condition had not improved following an oral hygiene session and 2 weeks of rinsing with antiseptic chlorhexidine. He had a clinical history of MM, diagnosed in 2014 as stage IIIB according to the Durie-Salmon Staging System and stage III according to the International Staging System. He also had a clinical history of respiratory and renal failure and of favism, a condition of hemolytic anemia upon consuming fava beans or inhaling their dust.

Intraoral examination of the patient revealed a painless, purple-red, mucosal mass with multiple lobules located at the left mandibular gingiva and extending to the alveolar fornix. The consistency of the mass was elastic and soft at the top and hard and firm at its base.

Orthopantomography did not indicate dental-associated bone lesions. A multiple incisional biopsy supported differential diagnosis of pyogenic granuloma, hemangioma, hematological neoplasia, Kaposi sarcoma, and mesenchymal neoplasia. Histopathologic diagnosis showed orally localized plasma cell myeloma, and a CT scan of the jaw also supported no bone lesions. Hence, clinicians arrived at their final diagnosis of extramedullary disease of MM.

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The patient was referred to his hematologist for oncologic care, and due to ongoing localized gingival radiotherapy at the time of this report, no follow-up was available.

Although oral manifestations of MM are uncommon, occurring in approximately 8% to 15% of cases, they could be the initial clinical sign of disease. Oral neoplasms of MM can cause orofacial pain and paraesthesia, mandibular fractures, osteolytic bone lesions, and gingival swelling. According to the authors of this case report, both extra- and intraoral examination are critical to detect orally localized MM.

Reference

Lombardi N, Flora A, Franchini R, Sorrentino D, Lodi G, Varoni EM. Gingival localisation of extramedullary multiple myeloma. Lancet Oncol. 2019;20(11):PE653.