Multiple myeloma as a mandibular radiolucency – a difficult diagnostic challenge

A male patient with a non-vital lower left first molar was referred to an oral and maxillofacial department with a large radiolucency associated with the distal root. The tooth was non-vital but had no associated symptoms.

A biopsy of the lesion was undertaken. It was found to extend into soft tissue and was a friable mass of connective tissue, which histologically was confirmed to be a plasma cell tumour.

A 57-year-old male attended his general dental practitioner (GDP) for a routine examination with no presenting complaint. Multiple carious teeth were noted, including a lower left first molar (LL6) which had a full gold crown with deep distal secondary caries present. A periapical radiograph of the tooth revealed a radiolucency associated with the distal root, the extent of which went beyond the borders of the small film. The tooth itself was non-vital but there was no clear history of toothache nor any other painful symptoms. The lower left second molar had been extracted a number of years earlier. A provisional diagnosis of a cyst was made and the GDP referred the patient to the local Oral and Maxillofacial Surgery (OMFS) department for management.