Multiple myeloma with primary manifestation in mandibular area

Multiple myeloma (MM) is a haematological disease characterised by the multicentric proliferation of plasma cells in the bone marrow. This relatively rare disease develops mainly in men (mean age, 60 years). The occurrence of the disease in jaws is uncommon as a primary manifestation. A 73-year-old man was first seen with a chief complaint of a painful mandibular enlargement persisting for 1 month with an increase in the volume of the gingiva, which bled during oral hygiene. The Xray revealed a ‘punched-out’ lesion with ill-defined margins in the mandibular ramus and body. A computed tomography scan showed a mandibular osteolytic lesion extending to the surrounding soft tissue. The incisional biopsy revealed a monotonous proliferation of plasmacytoid cells strongly immunoreactive to Kappa IgG, which confirmed the diagnosis of MM. After the biopsy, the patient spontaneously fractured his ribs, and the Bence Jones protein test was positive. Conformal radiotherapy followed by bortezomib with melphalan and prednisone was the elected treatment. The patient stopped treatment after two cycles, and progression to death followed after 6 months. This case report reinforces the data on the importance of early diagnosis of MM in the jaw and illustrates the contribution that oral assessment can provide for the diagnosis of this disease.