Multiple myeloma occurring in the jaws: A study of 17 cases

Abstract

The case records and the roentgenograms of the jaws of 59 patients with multiple myeloma were reviewed. Seventeen of these patients exhibited evidence of myeloma in the jaws. Among these 59 patients the ratio of males to females was approximately 2 to 1. However, among the patients with lesions in the jaws more women than men were affected. In all but 1 case of myeloma of the jaws there was general skeletal involvement. One case represented a solitary myeloma of the jaws, and there was no evidence of lesions elsewhere in the skeleton. The mandible was more frequently involved than the maxilla. Lesions occurred more often in the posterior portion of the body, the angle, and the ascending ramus of the mandible than elsewhere in the jaws. More patients exhibited lesions in the skull than in the jaws. Symptoms referable to the jaw, such as pain, pressure sensation, numbness, swelling, expansion of the jaw, mobility of teeth, and epulis formation, were observed. In 7 cases the initial symptoms of myeloma were observed first in the jaws. Usually myelomas of the jaws appear roentgenographically as multiple rounded lesions of various sizes which have little, if any, circumferential osteosclerotic bone reaction. These vacuolated configurations are frequently situated within a larger region of diffuse radiolucency with hazy ill-defined margins. Histopathologic examination of tissue from the jaws in 5 cases disclosed tumor tissue that was composed of closely packed anaplastic cells resembling plasma cells. The supporting stroma was scanty but vascularity was prominent. This study demonstrates the prevalence of myelomas in the jaws and illustrates the contribution that oral evaluation can provide in the diagnosis of generalized disease.