PMC6248880_01
Initial presentation of patient #1.
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F1
Intra-oral examination revealed a large mass of the left maxilla that involved both the premolars and the first molar extending buccally and palatally (Fig. 1).
Initial panoramic radiograph of the maxilla and mandible.
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F2
A panoramic radiograph showed an ill-defined radiolucency that extended superiorly towards the maxillary sinus involving the roots of teeth #12 and #13 (Fig. 2).
Periapical radiograph revealing the maxillary radiolucency.
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F3
There appeared to be no lamina dura around the first premolar and the lamina dura around the second premolar appeared mottled (Fig. 3).
Magnetic resonance imaging without contrast (pre-treatment) revealing maxillary enhancement.
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F4
Magnetic resonance imaging (MRI) was performed and demonstrated several maxillary lesions including a 1.4-cm lesion on the right anterior region, a 2-cm lesion within the right posterior maxilla, and a 3-cm lesion on the left; also several lesions were noted on the mandible that were not clinically visible (Figs. 4a, 4b).
MRI without contrast post treatment.
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F5
An MRI scan was repeated after radiation therapy and revealed resolution of the lesion within the left maxillary alveolus with stability of the remaining lesions (Figs. 5a, 5b).
PMC6248880_02
Initial presentation of case #2.
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F6
Clinic with oral pathology (Fig. 6a, 6b). Cone-beam computerized tomography (CBCT) was performed and revealed two localized ill-defined radiolucent lesions associated with tooth #19 and #30 (Fig 7).
Initial radiograph showing some localized bone loss associated with #19 and 30.
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F7
Clinic with oral pathology (Fig. 6a, 6b). Cone-beam computerized tomography (CBCT) was performed and revealed two localized ill-defined radiolucent lesions associated with tooth #19 and #30 (Fig 7).
Dense infiltrate composed of plasma cells with enlarged eccentric nuclei, prominent nucleoli, and moderate of cytoplasm
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F8
Biopsy of the lesion revealed a dense infiltrate of plasma cells with enlarged eccentric nuclei, prominent nucleoli, and moderate cytoplasm (Fig. 8).
MRI revealing several buccal maxillary and mandibular lesions; also, a large pharyngeal lesion
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F9
An MRI (Fig. 9) of the head and neck showed extensive myelomatous involvement in the right maxilla with involvement of the right posterior maxillary and buccal gingiva that correlated clinically with the exophytic mass.
Partial resolution of intra-oral lesions.
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F10
After one cycle, he had partial resolution of his intra-oral lesions (Fig. 10a-c).
PMC6248880_03
Initial presentation.
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F11
Upon examination, the patient was found to have a palpable and freely mobile mass in the right gingivobuccal sulcus between the second and first premolars (Fig. 11).
PMC6248880_04
PMC6248880_05