Multiple myeloma and chemical maxillary osteonecrosis. Can both occur simultaneously? - 25/12/19

Doi : 10.1016/j.jormas.2019.12.002

S. Junquera ^a , E. Álvarez-Yagüe ^b , L. Junquera ^b , R. Ugalde ^c , L. Rúa ^d,⁎
^a Department of Radiology, University Hospital of Santiago of Compostela, Santiago de Compostela, Spain
^b Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, Oviedo, Spain
^c Department of Pathological Anatomy, Central University Hospital of Asturias, Oviedo, Spain
^d Department of Oral and Maxillofacial Surgery, University Hospital of Cabueñes, Gijón, Asturias, Spain

^⁎Corresponding author at: Department of Oral and Maxillofacial Surgery. University Hospital of Cabueñes, Los Prados, 395, 33394 Gijón, Asturias, Spain.Department of Oral and Maxillofacial Surgery. University Hospital of CabueñesLos Prados, 395Gijón, Asturias33394Spain

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 25 December 2019
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Introduction

The aim of the present study was to investigate the number of patients with Multiple Myeloma (MM) treated with intravenous Zoledronic Acid who presented an involvement of the jaws by Myeloma that mimicked an osteonecrosis.

Material and methods

A retrospective study was performed in a University Hospital reference for a population of 1.084.000 inhabitants. A ‘case’ Medication-Related Osteonecrosis of the jaw (MRONJ) was considered when the patient met diagnostic criteria established by the American Association of Oral and Maxillofacial Surgeons (AAOMS, 2014). We recorded data on the underlying disease, medications used, mode of Bisphosphonate administration (oral or intravenous), and timing of medication use.

Results

The sample size was 84 cases. 22 patients had MRONJ associated to MM treatment. Histopathological examination of pathological bone was characterized by the presence of necrotic osteitis in 82 patients. Only 2 patients with MRONJ suspicion were finally diagnosed as MM. These cases represented 9.09% of all patients with multiple myeloma initially labeled MRONJ in our hospital.

Conclusion

The present study has shown that MM can be identified in jaw specimens of patients exposed to Bisphosphonates and clinically diagnosed as osteonecrosis. Biopsy examination should be considered in at least selected cases, for example, before surgical treatment in patients with MM and clinical stage 3 osteonecrosis (due to the detection of malignancy would alter the surgical strategy).

Le texte complet de cet article est disponible en PDF.

Keywords : Bisphosphonates, Multiple Myeloma, Osteonecrosis, Osteomyelitis, Metastatic Cancer