Pathology · patient case question
What is the diagnosis?
Patient case: Case: multiple punched-out radiolucencies
Scenario: A radiograph shows numerous well-defined radiolucencies scattered through the jaws, without corticated margins and without any relationship to the teeth. Three linked questions followed.
Show answer and explanation
Correct answer: B. Multiple myeloma
- A. Langerhans cell histiocytosis also causes punched-out lesions and 'floating teeth', but it is a Langerhans (dendritic) cell disorder, not a plasma-cell one, and is far more common in children and young adults.
- B. Correct. Punched-out lytic lesions plus a plasma-cell proliferation is multiple myeloma. Bence Jones protein in urine and a serum M spike complete the picture.
- C. Hyperparathyroidism gives generalised demineralisation, loss of lamina dura, and brown tumours — a granular ground-glass or salt-and-pepper pattern rather than discrete punched-out holes.
- D. Paget disease produces enlargement of the jaw, hypercementosis, and a cotton-wool pattern, typically in older patients with a raised alkaline phosphatase.