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1. Multiple MyeloMa
– a case report
INDIAN DENTALACADEMY
Leader in continuing Dental Education
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2. About…
 A malignant neoplastic condition
characterized by the proliferation of
a single clone of abnormal plasma
cells
 Old age >40 years
 Peak incidence- 60 to 70 years
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3. Causes
 Genetic
 Environmental or occupational
 Radiation
 MGUS
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4. Characteristics…
 M proteinsM proteins
 Bone lesionsBone lesions
 Kidney diseaseKidney disease
 Hyper viscosityHyper viscosity
 HypercalcaemiaHypercalcaemia
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5. Symptoms…
 Bone pain
 Pathologic fractures
 Weakness
 Frequent infections
 Spinal cord compression
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6. Treatment
 Chemotherapy
 Radiation
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7.  70 yr female
 Swelling on right lower half of face
of 2 months duration
case report…
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8.  A small painless swelling in front of
the right ear 2 months back
 Slowly increasing in size
 Ten days back another painless
swelling -right side of lower jaw
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9. Past history:
 Medical
 Was hospitalized for body pain 1 week
back
 Dental
 Had undergone extraction of multiple
teeth
 Post extraction periods were uneventful
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10. Extra oral examination:
 Oval swelling in the right
parasymphysis of mandible
- 2x2cm
 Diffuse swelling in the
preauricular region - 3x4
cm
 Firm with diffuse margins
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11. Intra oral examination
 Oval swelling in the buccal
sulcus -1.5x1.5cm
 Mucosa - slightly
erythematous
 Firm with diffuse margins
 Buccal expansion present
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12. Provisional diagnosis:
 Odontogenic cyst / neoplasm
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13. Investigations:
 Radiological examination
 Blood picture
 Aspiration
 Immuno-electrophoresis
 Histopathology
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14. Radiological examination
 IOPA
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15.  Panoramic view
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16.  Lateral skull view
 multiple punched out areas of radiolucency
on the skull.
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17.  PA skull view
 multiple punched out areas of radiolucency
on the skull.
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18.  Chest PA
 lytic lesions without sclerotic border on
clavicle
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19. Blood examination
 TC – 8250 cells per mm3
 P-39%, L-53%, E-8%
 ESR 26mm
 Hb- 9gm/dl
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20. Aspiration
 Blood tinged fluid present
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21. Immuno-electrophoresis
 24 hour urine Bence-Jones protein
immuno-electrophoresis was
negative.
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22. Histopathology
 Sheets of mature malignant plasma
cells showing eccentric nuclei and
stippled nuclear chromatin
40 x 100 x
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23. Final Diagnosis:
 Multiple myeloma
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24. To conclude…
 Clinical presentation mimics an
odontogenic lesion.
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