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Medication-related osteonecrosis of the jaw in a patient with multiple myeloma: an unusual case with tumor in the surgical specimen

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Abstract

Multiple myeloma is characterized by a neoplastic proliferation of plasma cells primarily in the bone marrow. Neoplastic plasma cells stimulated osteoclasts, and destroy bone tissue, causing bone pain, pathological fractures, paralysis due to spinal cord compression, and hypercalcemia. Bisphosphonates are used as supportive therapy in the management of multiple myeloma. Medication-related osteonecrosis of the jaw (MRONJ) is a well-known complication of treatment with bisphosphonates, denosumab, and other drugs, such as anti-angiogenic agents and novel anti-cancer drugs. We report MRONJ in a patient with multiple myeloma, especially an unusual case with tumor in the surgical specimen. A 73-year-old woman presented with pain on the left side of the mandible within 3 months. On clinical examination, an exposed bone without purulent drainage presented on the left side of the mandible. Before 2 years, she received chemotherapy of zoledronate for multiple myeloma at another hospital. Panoramic imaging showed radiopacities of bone in the left side of the mandibular molar area. Multidetector computed tomography (MDCT) with axial, multiplanar reformation (MPR) and three-dimensional (3D) images showed the sequestrum without periosteal reaction. She was diagnosed as MRONJ, and underwent surgery. Finally, the surgical specimen was diagnosed as multiple myeloma in the sequestrum. This case suggests that the evaluation of the surgical specimen of MRONJ could be essential for detection of primary tumor.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, Niigata, 951-8580, Japan

    Ruri Ogawa, Yoshiyuki Minami & Ichiro Ogura

  2. Department of Pathology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, Niigata, 951-8580, Japan

    Junya Ono, Yoriaki Kanri & Yasuo Okada

  3. Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, Niigata, 951-8580, Japan

    Eizaburo Kobayashi & Akira Tanaka

Authors
  1. Ruri Ogawa
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  2. Yoshiyuki Minami
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  3. Junya Ono
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  4. Yoriaki Kanri
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  5. Eizaburo Kobayashi
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  6. Akira Tanaka
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  7. Yasuo Okada
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  8. Ichiro Ogura
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Correspondence to Ichiro Ogura.

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Ruri Ogawa, Yoshiyuki Minami, Junya Ono, Yoriaki Kanri, Eizaburo Kobayashi, Akira Tanaka, Yasuo Okada, and Ichiro Ogura declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all patients for being included in the study.

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Ogawa, R., Minami, Y., Ono, J. et al. Medication-related osteonecrosis of the jaw in a patient with multiple myeloma: an unusual case with tumor in the surgical specimen. Oral Radiol 38, 288–291 (2022). https://doi.org/10.1007/s11282-021-00560-4

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  • DOI: https://doi.org/10.1007/s11282-021-00560-4

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