Abstract
A 67-year-old man with periodontitis underwent dental panoramic radiography at a dental clinic. A thumb-sized, punched-out radiolucency was observed in the mandibular left molar region, and the patient was referred to our hospital. Symptoms included mandibular swelling and tenderness. Histological examination of biopsy specimens revealed round or ovoid cells exhibiting abundant eosinophilic cytoplasm with eccentrically placed nuclei, as well as dense infiltration and proliferation of large cells with clear nuclei. Large, prominent nucleoli and signs of mitosis were also observed. Tumor cells were immunohistochemically positive for monoclonal IgA and A chain. A bone marrow smear indicated 31.5% plasma cells. Laboratory examination showed an increased blood IgA level (4, 960mg/dl), decreased IgG (673mg/dl) and IgM levels (42mg/dl), and the presence of urinary Bence-Jones protein. Confocal laser scanning microscopy disclosed enlargement of both the cytoplasm and nuclei of tumor cells with many sponge-like vacuoles, as compared with those of normal plasma cells. As sharply punched-out radiolucencies were also observed in the humerus and the skull, multiple myeloma was diagnosed.
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