Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
Medicine (Baltimore). 2023 Jul 21;102(29):e34260. doi: 10.1097/MD.0000000000034260.
Multiple myeloma (MM) is a malignant disease characterized by abnormal proliferation of plasma cells, which usually occurs in middle-aged and elderly male patients. Bisphosphonates (BP) are commonly used for the treatment of MM bone disease. Long-time use of BP may cause medication-related osteonecrosis of the jaw (MRONJ). MRONJ occurs in jaw exclusively, and Multiple myeloma can also invade the jaw. The 2 diseases have similar clinical manifestations and imaging findings. This report present a case of MM identified in surgical specimen at the site that had been previously pathologically diagnosed as MRONJ in a patient with MM.
A 57-years-old male patient visited our clinic on October 16, 2020 because of gingival swelling and pain in the right mandible for 1 month after extraction of the lower right premolar. The patient had a long-time illness history of multiple myeloma, and received intravenous zoledronic acid treatment.
Based on the clinical characteristics, imaging, and pathological findings of sequestrum formation and high inflammatory cell infiltration, the patient was diagnosed with MRONJ. After 1 year, a mandibular osteotomy was performed and pathological analysis showed the presence of necrotic bone and a large number of abnormal plasma cell infiltration, suggesting the presence of MM in the mandible.
The patient was treated with a series of conservative treatments including antibiotic treatment, saline irrigation and laser irradiation, as well as superficial sequestration was. One year later, a mandibular osteotomy was performed.
For the patient, the symptoms of gingival swelling, pain and discharge disappeared after surgery.
These findings suggested MRONJ and MM could occur simultaneously at same site, so patients with MM presenting with symptoms of MRONJ should be screened for concurrent or disease relapse of multiple myeloma to prevent misdiagnosis or inadequate management. Meanwhile, this also suggests long-term inflammatory may lead to invasion of multiple myeloma.
多发性骨髓瘤（MM）是一种以浆细胞异常增殖为特征的恶性疾病，通常发生于中老年男性患者。双膦酸盐（BP）常用于 MM 骨病的治疗。BP 的长期使用可能导致药物相关性下颌骨坏死（MRONJ）。MRONJ 仅发生在颌骨，而多发性骨髓瘤也可侵犯颌骨。这两种疾病具有相似的临床表现和影像学表现。本报告介绍了一例 MM 患者，其在先前经病理诊断为 MRONJ 的部位的手术标本中得到确诊。
一名 57 岁男性患者因右下前磨牙拔除后 1 个月出现右侧下颌牙龈肿胀和疼痛，于 2020 年 10 月 16 日就诊于我院。该患者患有多发性骨髓瘤，长期接受唑来膦酸静脉治疗。
根据临床特征、影像学和病理表现（骨块形成和高炎症细胞浸润），该患者被诊断为 MRONJ。1 年后，进行了下颌骨切开术，病理分析显示存在坏死骨和大量异常浆细胞浸润，提示下颌骨存在 MM。
患者接受了一系列保守治疗，包括抗生素治疗、盐水冲洗和激光照射，以及表面清创。1 年后，进行了下颌骨切开术。
患者术后牙龈肿胀、疼痛和溢脓症状消失。
这些发现提示 MRONJ 和 MM 可同时发生于同一部位，因此出现 MRONJ 症状的 MM 患者应筛查是否同时存在或疾病复发多发性骨髓瘤，以防止误诊或治疗不足。同时，这也提示长期炎症可能导致多发性骨髓瘤的侵犯。
