case_images: PMC11126243_01
case_images: (a) Patient photograph before treatment shows swelling on the left mandible (b) Post-treatment photograph shows reduced size of swelling
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case_images: The swelling was firm and non-tender with no involvement of overlying skin or cervical lymph nodes [Figure 1]. The patient was followed up every six weeks with the oncologist, and in the Oral and Maxillofacial Surgery Clinic, tumour remission was noted [Figures 1, 2 and 7].
case_images: (a) Intraoral photograph before treatment shows diffuse swelling involving buccal mucosa, alveolar ridge and obliterated buccal sulcus (b) Post-treatment photograph shows reduced swelling and a more clearly defined buccal sulcus
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case_images: The overlying and surrounding mucosa were normal [Figure 2]. The patient was followed up every six weeks with the oncologist, and in the Oral and Maxillofacial Surgery Clinic, tumour remission was noted [Figures 1, 2 and 7].
case_images: (a) CT axial section shows a heterogeneous expansile lesion arising from the left mandibular ramus (white arrow) (b) Panoramic view of the mandible shows an ill-defined, unicystic osteolytic lesion on the left mandibular ramus (white arrow)
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case_images: A contrast-enhanced computed tomography (CT) scan of the face revealed a heterogeneous expansile lesion with a soft tissue component arising from the left mandibular ramus and destroying the outer and inner cortices [Figure 3a]. An orthopantomogram was also ordered which revealed an ill-defined, unicystic osteolytic lesion with irregular borders extending from the left sigmoid notch superiorly to the mandibular inferior border, and extending up to the left second mandibular molar anteriorly [Figure 3b].
case_images: Histopathological microphotograph of multiple myeloma showing a diffuse population of atypical plasma cells having prominent nucleoli, eccentric nuclei and abundant cytoplasm (plasmablasts) (H&E stain X 40x)
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case_images: Histopathological analysis revealed the presence of atypical plasma cells showing a high nuclear-cytoplasmic ratio, prominent or eccentric nucleoli and dense cytoplasm, indicating a potential plasma cell malignancy [Figure 4].
case_images: (a) Immunohistochemistry image showing strong lambda cytoplasmic positivity (Lamda X 5x) (b) CD138 membranous positivity (CD138 X 45x)
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case_images: The analysis showed positive for CD 138 (Cluster of Differentiation), lambda light chain, MUM-1 (multiple myeloma oncogene-1) and high Ki 67 (50%) immunostaining suggestive of plasmacytoma [Figure 5].
case_images: (a) Diffusion-weighted sagittal spine MRI shows T12 lytic lesion (white arrow) (b) CT section shows evidence of a lytic lesion in the right acetabulum (white arrow)
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case_images: A whole-body MRI (magnetic resonance imaging) diffusion-weighted sequence with MRI spine screening showed evidence of a lytic lesion in the right acetabulum and T12 vertebral body for which the patient was asymptomatic [Figure 6].
case_images: Post-treatment radiographic imaging (a) CBCT axial slice shows bone healing in the left mandibular ramus region (white arrow) (b) Panoramic view shows bone healing in the left mandibular ramus region (white arrow)
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case_images: The patient was followed up every six weeks with the oncologist, and in the Oral and Maxillofacial Surgery Clinic, tumour remission was noted [Figures 1, 2 and 7].