Extramedullary Jaw Masses in Multiple Myeloma: The Critical Impact of Resource Limitations on Diagnostic and Therapeutic Outcomes

Abstract

Non-Hodgkin lymphoma and extramedullary plasmacytoma are some diseases which are known to cause swellings in the head and neck region of the body. Making diagnosis and distinguishing both conditions require biopsy of the tissue for immunohistochemistry, and where immunohistochemistry is unavailable, it presents a diagnostic as well as therapeutic challenge, as treatment for both diseases differ significantly. We report the case of jaw swelling in an elderly man; swelling was thought to be non-Hodgkin lymphoma, but patient subsequently had bone marrow aspiration showing multiple myeloma. This suggested the possibility that the jaw swelling was an extramedullary plasmacytoma. The histologic composition of the swelling was not confirmed due to financial and logistical difficulties to have immunohistochemistry done. Patient’s swelling reduced following treatment with Velcade, Revlimid, and Dexamethasone from 10cm x 16cm x 16cm to 7cm x 5cm. There was also reduction in the κ/λ ratio from 38.36 to 1.9, as well as improvement in his overall clinical state. This report demonstrates the need for a high index of suspicion when approaching elderly patients with head and neck masses. It also emphasizes the central role of immunohistochemistry in diagnosis of tumours, and in their distinction.