Occurrence of multiple myeloma in the head and neck: a report of two cases
A 61-year-old female patient who had been diagnosed with MM at the skull and rib areas by the Department of Hematology and Oncology in May 2009 received HSCT in January 2010. She was observed to be in a systemically stable state. In December 2010, she complained of edemas and pain in the left mandibular buccal gingiva and the buccal mucosa; thus, she was referred to our department. She had a history of extraction of the left lower first molar tooth due to pain and tooth mobility at the relevant sites 2 months before her visit to the Department of Oral and Maxillofacial Surgery. An edema in the left facial area was found during the first examination, and clinical symptoms such as spontaneous hemorrhage of blue-reddish color tones were observed.() No specific features were noted in the panoramic view. There were no abnormal results except decrease of hemoglobin and hematocrit from the complete blood cell count test.() Monoclonal gammapathy was observed with 5.29 g/dL when the M-protein level increased since June 2010, with the IgA level increasing considerably in the serum immunoglobulin counts (2,314 mg/dL, normal range=70-400 mg/dL). There were no osteolytic lesions in the mandible from the CT scan. Since the patient had a history of existing MM, the test results seemed to be related to hematological diseases, and no changes in bones were observed from the CT scan; our department judged the existing MM to have been manifested into the oral soft tissue area and temporarily diagnosed the patient in detail with extramedullary plasmacytoma. Strong standardized uptake value (SUV) uptake (SUVmax=4.3) was found at the relevant site from a positron emission tomography-CT (PET-CT).()\nThus, our department carried out a biopsy, and tissue specimens were sent to the Department of Pathology at Samsung Medical Center. After the results of the biopsy determined the disease to be plasmacytoma, chemotherapy using lenalidomide, dexamethasone, and radiotherapy (25 Gy) were performed. Healing of the oral lesions was observed later(); some aspects of improvement, including decrease of IgA level, were found from the blood test carried out in March 2011 (740 mg/dL); the M-protein level also shifted to a constant decrease (1.9 g/dL in March 2011), and there was no uptake observed from a follow-up PET-CT scan.()\nDuring the follow-up in August 2011, pain and edemas at the buccal gingiva of the left maxillary posterior teeth and palatal gingiva and pain, edemas, and spontaneous hemorrhage at the left mandibular lingual and buccal sites were found.() Such was considered a recurrence of the existing lesions. In addition, osteolytic lesion with diameter of up to 1 cm and sclerotic rim was found in plain film and CT scans. Consequently, biopsy and radiotherapy were performed again, with the patient hospitalized after consulting the Department of Hematology and Oncology for observation with chemotherapy (dexamethasone, thalidomide, cyclo-pho sphamide, doxorubicin, cisplatin, and etoposide). Note, however, that cytopenia, azotemia, and pleural effusion of the lungs were observed due to development of the lesions; the patient was discharged in September 2011 due to the aggravation of general condition owing to the lesions.