From the Guidelines
Plasma cell neoplasms of the jaw, including multiple myeloma, typically present with pain, swelling, and loosening of teeth in the affected area, as well as potential systemic symptoms like fatigue and weight loss, as noted in the NCCN guidelines 1. The symptoms of plasma cell neoplasms of the jaw can be quite debilitating and impact the patient's quality of life significantly.
- Pain in the jaw is a common symptom, often persistent and gradually worsening over time.
- Swelling of the jaw can occur, presenting as a firm, non-tender mass that may distort facial appearance.
- Teeth in the affected region may become loose or shift position, and patients might report numbness or tingling in the lips or chin due to nerve compression (paresthesia).
- Pathological fractures of the jawbone can occur even with minimal trauma as the disease progresses.
- Patients may also notice bleeding from the gums, difficulty chewing, and changes in their bite alignment.
- In advanced cases, systemic symptoms like fatigue, weight loss, recurrent infections, and anemia might develop, particularly if the jaw lesion is part of multiple myeloma rather than a solitary plasmacytoma. According to the NCCN guidelines, early diagnosis is crucial and typically involves radiographic imaging showing characteristic "punched-out" lytic lesions in the bone, followed by biopsy confirmation 1. Treatment depends on whether the condition is a solitary plasmacytoma or part of systemic multiple myeloma, with options including radiation therapy, surgery, and systemic treatments like chemotherapy or targeted therapies, as recommended by the NCCN guidelines 1. It is essential to follow the NCCN guidelines for the management of multiple myeloma, including the use of bisphosphonates or denosumab for all patients receiving therapy for symptomatic multiple myeloma, regardless of documented bone disease, to reduce the risk of skeletal-related events and improve quality of life 1.
From the Research
Symptoms of Plasma Cell Neoplasm (Multiple Myeloma) of the jaw
- Pain in the jaw is a common symptom, as reported in a case where a 69-year-old lady presented with a month-long history of unilateral left-sided pain in her jaw 2
- Swelling in the jaw, such as a buccolingual swelling of 2cm diameter in the lower left premolar region, can also be a symptom 2
- Paresthesia (numbness or tingling sensation) in the jaw can occur, with 53.8% of cases reporting pain and/or paresthesia 3
- Radiographic images may show lytic lesions, which are poorly defined osteolytic lesions with unilocular or multilocular images 3
- Systemic symptoms such as bone pain, fatigue, and weight loss may also be present, although they are not exclusive to jaw involvement 4, 5
Clinical and Radiographic Features
- The mandible is the most commonly affected site, with 67.3% of cases occurring in this area 3
- Lesions in the jaw can be single or multiple, and may be associated with other bone lesions 4, 6
- Radiographic images may show multilocular radiolucency with well-defined borders 6
- Histopathological diagnosis is critical, with immunohistochemical markers such as MUM1 and CD138 used to confirm plasma cell neoplasm 6
Prognosis and Treatment
- The prognosis of solitary plasmacytoma of the jaw is generally poor, with a high risk of progression to multiple myeloma 4, 6
- Treatment may involve radiation therapy, surgery, or chemotherapy, although the optimal management strategy is still debated 4, 5
- Factors such as tumor size, anaplasia of tumor cells, and presence of clonal bone marrow plasma cells can affect the prognosis of solitary plasmacytoma of the jaw 6