Review article multiple myeloma world health organization. Comparison of bone scintigraphy and radiography in. Multiple myeloma is a malignant disease characterized by multifocal proliferation of atypical plasma cells and, in most patients, by the presence of monoclonal gamma. Multiple myeloma, an issue of hematologyoncology clinics. Clonal bone marrow plasma cells 10% or biopsyproven bony or extramedullary plasmacytoma and any one or more of the following calcium, renal failure, anemia, bone lesions crab features and myeloma defining events mdes evidence of end organ damage that can be attributed to the. Ct findings in multiple myeloma consist of punchedout lytic lesions, expansile lesions with soft tissue masses, diffuse osteopenia, fractures, and, rarely. In this challenging context, molecular imaging in multiple myeloma will be of high value for nuclear medicine physicians, radiologists, and hematologists. Mdct seems to be preferable to conventional radiography in evaluating bone destruction in multiple myeloma. There are a number nonodontogenic lesions in the mandible, one of which is myeloma. Patients with multiple myeloma various approaches are used to reduce the impact of common multiple myeloma complications bone damageloss low blood counts anemia infection due to low white blood counts reduced kidney function treatmentrelated side effects partner with your health care team to. For the initial staging in patients with multiple myeloma, mdct in combination with mr imaging seems to be the method of choice. Multiple myeloma is due to malignant clonal proliferation of plasma cells characterized by the production of a monoclonal immunoglobulin. Diagnostic radiation and the risk of multiple myeloma united. There are also lytic lesions in both proximal femora.
International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Oral and maxillofacial lesions in patients with multiple myeloma are not. Multiple myeloma is slightly more common in men than in women and the median age at the time of diagnosis is about 65 years. Multiple myeloma in the mouth can mimic common teeth problems like periapical. Comparison of bone scintigraphy and radiography in multiple myeloma. As the cancer cells grow in the bone marrow, bone or back pain, most often in the ribs or back. Comparison of bone scintigraphy and radiography in multiple. It is responsible for 15%20% of deaths from hematological malignancies and about 2% of all deaths from cancer 35. Level iii evidence pace leonardo, catalano l, del vecchio s, et. Multiple myeloma mm is a hematological malignant neoplasm. Already at diagnosis, approximately eighty percent of patients present with abnormal bone structure 1. Multiple myeloma mm, also known as plasma cell myeloma and simple myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies.
Multiple myeloma and dentistry, multiple myeloma an overview, ajay gupta, intechopen, doi. Role of radiography, mri and fdgpetct in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma. To evaluate the relationship between cumulative lifetime exposure to diagnostic radiation and the risk of multiple myeloma using data from a large, multicenter, populationbased. In the clinical case presented here, we highlight the interdisciplinarity needed to obtain a diagnosis and treatment of multiple myeloma. In cases with continued pain, unexplained by standard radiography, the skeletal survey should be supplemented by tomography and radionuclide imaging. See more ideas about multiple myeloma, cancer and i hate cancer. Long term followup 30years has shown that multiple myeloma develops in up to 16% of patients with mgus. Imaging studies and the development of multiple myeloma. Multiple myeloma with primary manifestation in the mandible. It occurs in more than 70% of patients ultimately diagnosed with the disease. Multiple myeloma mm is the second most common 10%15% of all hematological malignancies and represents 1% of all malignant diseases 1, 2. Oral and maxillofacial lesions in patients with multiple myeloma are not uncommon. Listing a study does not mean it has been evaluated by the u. Although mr imaging has been shown to be superior to plain radiography and ct in the detecting myelomaassociated bone lesions, the mr imaging features have been described as a nonspecific.
Having radiation therapy is much like having a diagnostic xray except that each treatment lasts longer, and the course of treatment can. Level iii evidence pace leonardo, catalano l, del vecchio s, et al. It is more common in men and in african american population. Multiple myeloma is a malignant bone marrow neoplasia in which a monoclonal strain of atypical. Abnormal radiological features in a multiple myeloma. To evaluate the relationship between cumulative lifetime exposure to diagnostic radiation and the risk of multiple myeloma using data from a large, multicenter, populationbased casecontrol study. Study subjects included a total of 540 cases with newly diagnosed multiple myeloma and 1998 frequencymatched population controls living in three areas of the united states.
The skull contains innumerable small lytic lesions of moreorless uniform size. The atlas of oral and maxillofacial radiology presents an extensive case collection of both common and less common conditions of the jaws and teeth. Molecular imaging in multiple myeloma radiology books. Predictive value of technetium99m sestamibi in patients with multiple myeloma and potential role in the followup. Knowledge about the maxillofacial manifestations of multiple myeloma is important for the early diagnosis of the disease, since its primary form can manifest itself in the jaw.
Multiple myeloma commonly referred to as myeloma is defined by the presence of 10% or more clonal plasma cells on bone marrow examination, m protein in serum or urine except in the case of nonsecretory myeloma, and evidence of hypercalcemia, renal insufficiency, anemia, or bone lesions thought to be related to the plasma cell proliferative. Multiple myeloma occurs in older adults, with a median age of onset of. This book provides a comprehensive overview of the importance of molecular imaging in multiple myeloma, with detailed explanation of its clinical impact. Bone xray, normal bone structure scale 0, or solitary bone. Multiple myeloma mm, also known as plasma cell myeloma and simple myeloma, is a cancer. Hematologic malignancies, more frequently multiple myeloma and lymphoma, occur relatively frequently in the sacrum, accounting for 18% of all primary malignant sacral tumors. Maxillofacial presentations in patients with multiple myeloma are not uncommon, but multiple myeloma is often overlooked. Past treatment with radiation therapy raises your risk for this type of cancer. It arises from red marrow due to the monoclonal proliferation of plasma cells and manifests in a wide range of radiographic abnormalities. Multiple myeloma is the secondmost prevalent blood cancer 10% after nonhodgkins lymphoma. It is the most common form of the various plasma cell tumors, which include solitary plasmacytoma and extramedullary plasmacytoma. Clonal bone marrow plasma cells 10% or biopsyproven bony or extramedullary plasmacytoma and.
The radiation is aimed at the cancer from a machine outside the body. It is important to have a complete dental examination before you begin any. The recently updated duriesalmon plus staging system published in 2006 highlights the many advances that have been made in the imaging of multiple myeloma, a common malignancy of plasma. Can dentists detect multiple myeloma through oral manifestations. And on the skull xray as punchedout lesions pepperpot skull. International myeloma working group pmid 12780789 criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders. Abnormal radiological features in a multiple myeloma patient. Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Radiography and bone scintigraphy in multiple myeloma. Panoramic and skull imaging may aid in the identification of multiple. In this cure connections program, moderator, dr philippa cheetham, discusses strategies to monitor and manage oral hygiene with dr charles wakefield, a dentist and.
Jan 28, 2014 these findings suggest that radiography is the method of first choice in obtaining a skeletal survey in patients with multiple myeloma. Complete major dental work before beginning bisphosphonate. During disease progression a large proportion of patients will develop ostelytic lesions. Multiple myeloma without endorgan damage is referred to as smoldering multiple myeloma smm and should be monitored closely, as these patients have a risk of progression of approximately 10% per year for the first 5 years, 3% per year for the next 5 years, and 1% per year thereafter. Sep 22, 2010 multiple myeloma is most common in patients older than 40 years of age with a peak incidence rate at 6070 years. Multiple myeloma with primary manifestation in the. Imaging studies and the development of multiple myeloma the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Diagnostic radiologymusculoskeletal imagingtumors basic. Multiple myeloma affects slightly more men than women.
The pelvis contains numerous lytic lesions without reactive sclerosis which have an almost soapbubbly appearance in the ischia. Bone disease is the most frequent diseasedefining clinical feature of multiple myeloma mm, with 90% of patients developing bone lesions over the course of their disease. Ct is a sensitive imaging modality in detecting the osteolytic effects of multiple myeloma and has a higher sensitivity than plain radiography at detecting small lytic lesions. Patients may present with bone pain or with symptoms that are often nonspecific, such as nausea. 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. Apr 05, 2012 imaging studies and the development of multiple myeloma the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Subjects must have documented multiple myeloma as defined by the criteria below. In this chapter, well define what is meant by multiple myeloma and its underlying disease process. Although conventional radiography has traditionally been the standard of care, its low sensitivity in detecting osteolytic. The patient was diagnosed with multiple myeloma and received. Multiple myeloma occurs in older adults, with a median age of onset of 65 years. Focusing on the essentials of radiologic interpretation, this is a goto companion for clinicians in everyday practice who have radiologically identified a potential abnormality, as well as a comprehensive study guide for students at all levels of.
Swelling and osteolytic lesions represent the most common clinical and radiographic signs of the jaws relating to multiple myeloma, respectively. Denosumab in treating patients with multiple myeloma with. Multiple myeloma with a distinct sunray appearance occurring in. May 29, 2012 multiple myeloma mainly affects older adults. Bone disease is the most frequent diseasedefining clinical feature of multiple myeloma mm. Radiation oncologymultiple myeloma wikibooks, open books. All panoramic radiographs were taken in a dental xray machine pax 400. Diagnostic radiation and the risk of multiple myeloma. The changing paradigm supportive care for patients with multiple myeloma brittany wolfe, pac. Multiple myeloma causes anemia, which makes a person more likely to get infections and have abnormal bleeding. For this reason, imaging plays a major role in the management of disease in patients with mm.
These bone lesions are osteolytic and are best diagnosed with plain radiography. In combination with mr imaging, detailed information for staging these tumors is obtained. The classic radiographic presentation of multiple myeloma is lytic skeletal lesions. Although conventional radiography has traditionally been the standard of care. Aug 08, 2011 ct is a sensitive imaging modality in detecting the osteolytic effects of multiple myeloma and has a higher sensitivity than plain radiography at detecting small lytic lesions. This manuscript presents an unusual radiographic manifestation of multiple. Multiple myeloma a case report indian dentalacademy leader in continuing dental education 2.
International myeloma working group no authors listed, br j haematol. Undiagnosed multiple myeloma causing extensive dental bleeding. Bone disease and renal failure are the main cause of morbidity. Multiple myeloma wikimili, the best wikipedia reader. Multiple myeloma in patients younger than 30 years. Multiple myeloma is the prototype of malignant monoclonal gammopathies.
Feb 28, 2018 the type of radiation therapy most often used to treat multiple myeloma or solitary plasmacytoma is called external beam radiation therapy. The sensitivity of radionuclide imaging for detecting skeletal lesions was compared with that of radiography by evaluating 573 different anatomical sites in 41 patients with multiple myeloma. The most common clinical signs and symptoms of multiple myeloma include bone pain, fatigue, anaemia, infectious diseases and it is characterized by multiple punchedout radiolucent lesions. Ajaz shah, suhail latoo and irshad ahmad january 20th 2012. Multiple myeloma is a relatively uncommon malignancy in the united states, representing approximately 1% of. This issue of hematologyoncology clinics of north america, devoted to multiple myeloma, is edited by dr. Jan 05, 2016 multiple myeloma a case report indian dentalacademy leader in continuing dental education 2. The incidence of the oral lesions in multiple myeloma varies from less than 270% 1, 2. The most common skeletal sites are pelvis, skull, spine, ribs and femoral and humeral shafts. Multiple myeloma is a monoclonal gammopathy and is the most common primary malignant bone neoplasm in adults. Multiple myeloma dental courses linkedin slideshare.