PMC8387062_01
A - Extraoral examination showing diffuse bilateral swellings over the posterior mandible; B - Intraoral examination showing a proliferative mass extending from tooth number 35 to the retromolar area, and from 45 to 47.
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On the right side, swelling extended from the ala tragus line to the lower border of the mandible and from the corner of the mouth to the ascending ramus (Figure1A). Buccal vestibular obliteration with cortical expansion was observed (Figure 1B).
A - Orthopantomograph showing ill-defined radiolucency with respect to tooth numbers 31 to 38 and 45 to 48; B - CBCT showing the presence of bilateral expansile lytic lesions with irregular borders.
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The right side showed a radiolucent lesion around the periapical area of 46 and the interdental area of 45 and 46 (Figure 2A). Tomography (CBCT) revealed expansile lytic lesions with irregular borders. The periapical area in relation to 41 and 42 was spared (Figure 2B).
Photomicrograph of the tumor showing, A - Low magnification of diffuse sheets of plasma cells with eccentric nuclei (H&E x100); B - High magnification of atypical plasma cells with abnormal mitotic figures and occasional binucleated forms (H&E x400); C - amyloid deposition with in connective tissue stroma (Congo red stain x100); D - High Magnification immunohistochemistry showing strong positivity for CD138 (x400).
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Histopathological examination of the incisional biopsy from both right and left sides showed diffuse sheets of uniformly appearing plasma cells with eccentric nuclei and pale cytoplasm (Figure 3A). Nuclear hyperchromatism and pleomorphism of cells were suggestive of a malignancy (Figure 3B). Connective tissue stroma showed interstitial amorphous eosinophilic amyloid-like material in abundance, which was later confirmed with Congo red staining (Figure 3C). Immunohistochemistry (IHC) was performed, which revealed strong positivity for CD138 and lambda light chain; kappa chain was negative (Figures 3D and 4).
High magnification photomicrograph of the tumor showing lambda light chain positivity. (CD138 x400).
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Immunohistochemistry (IHC) was performed, which revealed strong positivity for CD138 and lambda light chain; kappa chain was negative (Figures 3D and 4).