Disparities and diagnostic delays: multiple myeloma

Abstract

Clinical Presentation

Multiple myeloma is an uncommon yet well-known hematological malignancy. The present case reports highlight the diagnostic delay encountered in 2 female patients aged 76 and 70 years. The first patient had pain in the right mandible for several months; however, the source of pain could not be established and was referred to a physician. Physical therapy was recommended, which aggravated her pain. Cone beam computed tomography images revealed a large, fairly well-defined, irregular radiolucency in right posterior mandible with effacement of cortices and a pathological fracture. Multiple, discrete, well-defined radiolucencies also were noted in other anatomical regions. The second patient noticed numbness of lower left jaw whenever she applied a gel on her knees for arthritic pain. The source of the pain could not be established for several months. Cone beam computed tomography images revealed multiple, well-defined radiolucencies distributed in entire mandible with 2 large lesions with effacement of the lingual cortex on left posterior region. Both the patients had paresthesia of the lower lip.

Differential Diagnosis

A radiographic diagnosis of multiple myeloma with plasmacytoma was made in both cases.

Diagnosis and Management

Histopathologic evaluation confirmed multiple myeloma. Positron emission tomography imaging and other investigations in the first patient showed metabolically active soft-tissue lesion with presence of 80% kappa restricted, predominantly CD27 plasma cells with monosomy 13 and t(11; 14). Patients were referred for appropriate management.

Conclusions

Multiple myeloma remains to be a diagnostic challenge owing to its diverse clinical presentations. Patients with multiple myeloma often experience long diagnostic delay, with 50% of the patients’ experience delay longer than 3 months. Prompt establishment of the source of pain and paresthesia is crucial. Early diagnosis and management limit the disease process, help to reduce the associated morbidities, improve prognosis and subsequent survival and quality of life.