Diagnostic value of orthopantomography in detecting multiple myeloma in the absence of overt systemic symptoms: a case report and literature review

Multiple myeloma (MM) is a plasma cell malignancy that typically presents with systemic features such as anemia, bone pain, renal dysfunction, and osteolytic lesions. Occasionally, the maxillofacial region is among the first sites to reveal the disease in patients who lack the overt systemic symptoms that would ordinarily prompt medical evaluation, posing a diagnostic challenge. In such situations, imaging performed during routine dental care may provide the earliest clue to an underlying malignancy. This report illustrates how orthopantomography (OPG) can serve as a valuable first-line screening modality in the dental setting, raising suspicion of MM in a patient without overt systemic symptoms and prompting the systemic workup required to establish the diagnosis. A 50-year-old South Asian female presented with a progressively enlarging swelling over the right lower jaw for two months, without associated systemic symptoms. Clinical examination revealed a hard, non-tender swelling involving the right mandibular body and ramus with tooth mobility. Panoramic radiography demonstrated ill-defined osteolytic lesions in the right mandible along with multiple radiolucencies on the contralateral side and altered trabecular pattern. Hematological investigations revealed anemia and renal dysfunction. FNAC suggested a hematolymphoid neoplasm. Skeletal survey showed multiple punched-out lesions in the skull, clavicle, and pelvis. Serum protein electrophoresis revealed an monoclonal spike (M-spike) with monoclonal gammopathy, and immunofixation confirmed IgG-kappa type. Bone marrow examination demonstrated plasma cell infiltration, establishing the diagnosis of multiple myeloma. This case highlights the value of orthopantomography as a first-line screening modality in the dental setting, capable of raising early suspicion of an underlying systemic malignancy when atypical oral findings are encountered. Although the definitive diagnosis required hematological, biochemical, and bone marrow evaluation, vigilant recognition of suspicious radiographic features by oral medicine specialists can prompt timely systemic workup and referral, which may meaningfully influence patient prognosis.