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Plasma cell neoplasms comprise a group of malignant disorders characterized by the clonal proliferation of plasma cells. The two most clinically relevant entities for dental professionals are solitary plasmacytoma and multiple myeloma (MM). Because these conditions frequently involve the jaw bones, oral cavity findings may represent the earliest sign of disease, placing dentists in a critical diagnostic position.
Classification of Plasma Cell Neoplasms
- Solitary plasmacytoma of bone- Extramedullary plasmacytoma
- Multiple myeloma
Solitary plasmacytoma may progress to multiple myeloma over time.
Epidemiology and Etiology
- Typically affects middle-aged to older adultsPlasmacytoma
Definition
A plasmacytoma is a localized proliferation of monoclonal plasma cells, either:
- Within bone (solitary plasmacytoma of bone)- In soft tissues (extramedullary plasmacytoma)
Common Oral and Maxillofacial Sites
- Mandible (posterior region most common)- Maxilla
- Palate
- Nasal cavity and paranasal sinuses
Clinical Features
- Localized jaw swellingMultiple Myeloma
Definition
Multiple myeloma is a systemic plasma cell malignancy characterized by:
- Multiple osteolytic bone lesions- Bone marrow infiltration
- Monoclonal gammopathy
Systemic Features (CRAB Criteria)
Calcium elevation (hypercalcemia)Renal dysfunction
Anemia
Bone lesions
Oral and Maxillofacial Manifestations
- Jaw pain and swelling- Tooth loosening
- Pathologic fractures
- Paresthesia or anesthesia
- Amyloid deposition causing macroglossia
- Mucosal pallor (anemia)
- Delayed healing after extractions
Radiographic Features
Plasmacytoma
- Solitary, well-defined or ill-defined radiolucent lesion
- Cortical expansion or perforation may be present
Multiple Myeloma
- Multiple “punched-out” radiolucencies
- Lack of reactive bone formation
- Loss of lamina dura
- Pathologic fractures
- Skull may show classic “raindrop” appearance
Panoramic radiography may reveal early jaw involvement.
Pathology
Histopathological Features
- Sheets of plasma cells- Eccentric nuclei with “clock-face” chromatin
- Prominent perinuclear hof
- Variable degrees of atypia in MM
Immunohistochemistry
- CD138 positive
- Monoclonal light chain restriction (kappa or lambda)
- CD38 positive
Differential Diagnosis
- Metastatic carcinoma
- Osteomyelitis
- Lymphoma
- Primary bone sarcomas
- Odontogenic tumors
Diagnostic Workup
Diagnosis requires:
- Biopsy of lesion- Bone marrow examination
- Serum and urine protein electrophoresis
- Detection of monoclonal (M) protein
- Imaging (skeletal survey, CT, MRI, PET)
Management
Plasmacytoma
- Radiotherapy (treatment of choice)- Surgical excision in selected cases
- Long-term follow-up due to risk of progression to MM
Multiple Myeloma
- Systemic chemotherapy
- Immunomodulatory agents
- Proteasome inhibitors
- Stem cell transplantation in eligible patients
- Bisphosphonates to reduce skeletal complications
Prognosis
- Solitary plasmacytoma: better prognosis but risk of progression- Multiple myeloma: chronic, incurable disease with variable survival
- Early diagnosis improves quality of life and survival
Dental Management Considerations
- Thorough oral examination in older patients with jaw pain- Avoid invasive procedures during active disease or chemotherapy
- Assess bisphosphonate-related osteonecrosis risk
- Coordinate care with oncology team
- Emphasize preventive oral care
Conclusion
Plasmacytoma and multiple myeloma are critical plasma cell malignancies with frequent oral and maxillofacial involvement. Dental professionals play a vital role in early detection, diagnosis, and ongoing oral management. Recognition of characteristic clinical, radiographic, and histopathologic features is essential for timely referral and improved patient outcomes.