Radiological and histopathological work up suggestive of multiple myeloma. Also positive for M protein.

Multiple myeloma is hematological malignancy, recognized as most common primary malignant tumor of bone (actually arising in bone marrow). Most common age group is sixth to seventh decade. Commonly involved bones are vertebrae, pelvic bones, skull, ribs, clavicles, scapulae & proximal limb bones.  Involvement of jaw bones is seen in approximately 30% of cases, however presentation as predominant jaw mass is rare.

Radiography reveals punched out lytic lesions/bone destruction with or without obvious soft tissue  mass. Poor sensitivity. Sclerotic lesions can be seen in small sub-set of patients.

CT has better sensitivity than conventional radiography. Extent of lytic lesions or bone destruction is better defined. Associated soft tissue mass, if any, is better delineated.

MRI is imaging modality of choice because of its higher sensitivity for marrow infiltrative disorders.  Early disease limited to marrow is usually missed at conventional radiography, may go undetected at CT, but usually detected at MRI. Whole Body MRI is preferred for assessment whole extent of disease. The lesions appear as low signal intensity lesions on T1WI & hyperintense on T2WI, STIR. The lesions are commonly seen as multiple discrete focal lesions, but in vertebrae can be also seen as diffuse infiltrative pattern.