Oral plasma cell granuloma
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0975-2870.202100
Plasma cell granuloma is rare, nonneoplastic lesion of the oral cavity, consisting of the proliferation of mature plasma cells. In this case, asymptomatic gingival overgrowth was observed. The lesion was surgically removed and send for histopathological and immunohistochemical examination which showed abundant of plasma cells and high expression of kappa light chain and low expression of lambda chain. Keywords: Peripheral giant cell granuloma, plasma cell granuloma, pyogenic granuloma
Oral plasma cell granuloma (PCG) is Benign, idiopathic inflammatory lesion, characterized by proliferation of plasma cells and reticuloendothelial cells in ground substance of vascular connective tissue.[1] It was first described by Bahadori and Liebow in the year 1973.[2] PCG most commonly affects the lung, stomach, and rarely presents on tonsil, bladder. Finding of this lesion in the oral cavity is extremely rare. It mostly affects the tongue, lips, oral mucosa, and least commonly the gingiva.[3] The etiology of this lesion is unclear.[4] It may occur at any age and has no sex predilection.[5] Histopathologically, it is characterized by abundant of plasma cells with eccentrically placed cartwheel nucleus, which are arranged in shell and islands.[6] Immunol histochemical it revealed high expression of kappa light chain and low expression of lambda chain.
A 45-year-old male reported to the Department of Periodontology with a chief complaint of painless growth in the anterior region of lower jaw since last 8–9 months [Figure 1] and [Figure 2]. Initially, lesion was small and increased in size with time. On intraoral examination, a well-defined nodular, sessile, solitary growth of size 2.0 cm × 1.5 cm was observed in lower anterior region on the buccal side. Lesion was oval shaped and firm in consistency.
In this report, patient medical history was noncontributory, and his routine blood and urine examination showed all parameters within normal limits. Based on clinical examination, differential diagnosis of pyogenic granuloma, peripheral giant cell granuloma, and fibrous epulis was made. Excisional biopsy was done under local anesthesia and send for histopathological and immunohistochemical analysis [Figure 3].
Histopathological examination of this case showed abundant of mixed inflammatory cells infiltrate which composed of plasma cells characterized by eccentrically placed cartwheel nucleus [Figure 4]. Immunohistochemical examination showed increased expression of kappa light chain and lower expression of lambda light chain [Figure 5] and [Figure 6]. Based on these histopathological and immunohistochemical examination, final diagnosis of PCG was confirmed. Postoperative 1 year recurrence was not observed.
It is rare, reactive, benign tumor-like lesion. Etiology of this lesion is unclear but according to some authors, it may be due to parasitic infection, antigen-antibody reaction or results from inflammation which occurred after minor trauma or surgery.[4] PCG of gingiva may be given similar clinical features related to other gingival lesions such as pyogenic granuloma, peripheral giant cell granuloma, fibrous epulis, and fibroma.[5] PCG is differentiated from above-mentioned gingival lesions based on clinical and histopathological examination. In this case, histopathological examination showed abundant of mixed inflammatory cells infiltrate which composed of plasma cells characterized by eccentrically placed cartwheel nucleus, which is a classical histopathological feature of PCG. Microscopically PCG may be related to various other plasma cell neoplasms such as multiple myeloma, plasmacytoma, and plasma cell gingivitis.[3] Multiple myeloma is bone tumor whereas PCG, plasmacytoma, and plasma cell gingivitis is soft tissue tumors. In this case, multiple myeloma rules out due to the absence of Bence-Jones proteins on urine analysis. It may be differentiate from plasmacytoma based on nature of lesion and their immunohistochemical examination. In normal reactive proliferation the ratio of kappa light chain: lambda light chain 2:1, but when their ratio is >10:1 or 1:10, the nature of lesion change from nonneoplastic reactive lesion into neoplastic lesion.[7] In this case, the ratio of kappa light chain:lambda light chain 2:1 and they showed the nonneoplastic reactive nature of lesion and confirmed the diagnosis of PCG. Plasma cell gingivitis is considered as a hypersensitive allergic lesion and gives the clinical features of generalized edematous and erythematous swelling of gingiva. In this case, nodular localized gingival swelling was observed, and the patient was not given any history related to use of chewing gums and dentifrices. It is formed by the accumulation of mature plasma cells intermixed with mesenchymal cells.[8] In treatment modality, they are usually treated by simple surgical excision and removal of underlying causing agent.[9] In this case, simple excision and regular follow-up done and no any recurrence observed after 1 year follow-up. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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