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Solitary Plasmacytoma Investigation — MFDS Part 1 MCQ

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HardOral PathologySolitary Plasmacytoma InvestigationMFDS Part 1

A 62-year-old patient has a biopsy-confirmed monoclonal plasma-cell neoplasm of the posterior mandible. There is no previous history of a plasma-cell disorder. Before this can be classified as a solitary bone plasmacytoma, which investigation package is most appropriate to exclude systemic multiple myeloma?

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Correct answer: B — Serum electrophoresis and immunofixation, serum free light chains and urine electrophoresis; FBC, renal function and calcium; bone-marrow aspirate and trephine with flow cytometry; whole-body MRI

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · E = shown as D · C = shown as E

The correct answer is A. A plasma-cell tumour can be called a solitary bone plasmacytoma only after systemic multiple myeloma has been excluded. Assessment therefore combines monoclonal protein studies, tests for myeloma-related organ dysfunction, bone-marrow aspirate and trephine assessment, and sensitive whole-body imaging. Whole-body MRI is preferred in UK guidance; low-dose whole-body CT is an alternative when MRI is unsuitable. Option B reflects an older, incomplete approach: normal serum electrophoresis or urine Bence Jones testing does not exclude myeloma, and a skeletal survey is less sensitive. Option C incorrectly makes marrow examination dependent on finding a serum paraprotein. Options D and E investigate local, metabolic or alternative disease processes but cannot establish that the plasma-cell neoplasm is truly solitary.

Reference: International Myeloma Working Group, International Myeloma Working Group Recommendations for the Diagnosis and Management of Solitary Plasmacytomas, Journal of Clinical Oncology, 2026. https://pubmed.ncbi.nlm.nih.gov/42485589/