Occurrence of multiple myeloma in the head and neck: a report of two cases
A 44-year-old female patient who had been diagnosed with MM at the bilateral humerus bones, bilateral pelvic bones, and bilateral femur bones as observed while receiving chemotherapy using vincristine doxorubicin, dexamethasone, hematopoietic stem cell transplantation (HSCT), etc., was referred to our department after masses were observed over the buccal gingiva on the left side of the maxillary anterior in May 2008.() No specific features were observed from the panoramic view, but osteolytic features were noted at the relevant site based on a computed tomography (CT) scan in May 2008.() M-protein was 1.07 g/dL, and there was an increase in the immunoglobulin G (IgG) count from the serum electrophoresis (2,235 mg/dL, normal range=700-1,600 mg/dL). There were no specific results from other hematological and physico-chemical tests. Reddish swellings were observed from the intraoral environment of the patient, and there were edemas - including teeth #22 and #23 - with smooth surfaces. Thus, based on the fact that the patient had been observed by the Department of Hematology and Oncology due to MM and an increase of M-protein, our department temporarily diagnosed the patient with an expression of MM at the head and neck area and carried out a biopsy of the relevant lesions under local anesthesia. The sample was sent to the Department of Pathology at Samsung Medical Center, and the tissue was reported to have aspects of monotonous plasmacytoid cell infiltration. Consequently, our department confirmed the expression of MM at the head and neck area. Though the aspects of osteolysis were observed to increase based on a follow-up CT scan in July 2008, healing of the gingival wounds at the sites of biopsy were shown, but the M-protein level was 1.6 g/dL, whereas the IgG level was 2,176 mg/dL. The Department of Hematology and Oncology then performed chemotherapy using thalidomide, dexamethasone, velcade, etc. Note, however, that pancytopenia occurred in January 2009, and other malignant aspects had been observed, including plasma cell rate of more than 35% based on the hematological test performed in April 2009. The patient expired in July 2009.