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SHORT COMMUNICATION Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 460-462
Gingival plasma cell granuloma


Department of Periodontics, Government Dental College and Hospital, Aurangabad - 431 001, Maharashtra, India

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Date of Submission24-Jul-2009
Date of Decision04-Aug-2009
Date of Acceptance21-May-2010
Date of Web Publication29-Sep-2010
 

   Abstract 

Plasma cell granuloma is a rare reactive lesion composed of polyclonal plasma cells. It manifests primarily in the lungs, but may occur in various other anatomic locations like the oral cavity. Intraoral plasma cell granulomas involving the tongue, lip, oral mucosa and gingiva have been reported in the past. This case presents a 54-year-old female with chronic periodontitis and mandibular anterior gingival overgrowth treated by Phase I therapy (scaling and root planing) and excisional biopsy. Histological examination revealed inflammatory cell infiltrate containing sheets of plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. This case highlights the need to biopsy for unusual lesions to rule out potential neoplasms.

Keywords: Chronic periodontitis, immunohistochemistry, polyclonal plasma cell granuloma, reactive lesion

How to cite this article:
Phadnaik MB, Attar N. Gingival plasma cell granuloma. Indian J Dent Res 2010;21:460-2

How to cite this URL:
Phadnaik MB, Attar N. Gingival plasma cell granuloma. Indian J Dent Res [serial online] 2010 [cited 2019 Dec 7];21:460-2. Available from: http://www.ijdr.in/text.asp?2010/21/3/460/70788
Plasma cell granulomas are exceedingly rare, non-neoplastic, reactive tumor-like proliferation to idiopathic antigenic cue, composed chiefly of plasmacytic infiltrate. [1]

The lung is the most common site of involvement, but nearly any other organ may be involved, including the head and neck region. [2] Intraoral plasma cell granulomas are even more rare entities. Plasma cell granulomas in the oral and nasopharyngeal region have been reported on the movable tissues of the oral cavity, such as tongue, [3] lip [4] and buccal mucosa. They are even rarer on the gingiva, and very few case reports have been documented. [5],[6],[7],[8],[9]

The plasma cell granuloma is considered a non-neoplastic reactive lesion. It is often singular and is associated with some chronic antigenic exposure. This could be due to periodontitis, periradicular inflammation or foreign bodies. [10]

The present case report describes a rarely reported case of plasma cell granuloma on the gingiva.


   Case Report Top


A 54-year-old female patient reported to the Department of Periodontology, Government Dental College and Hospital, Aurangabad (India), with the chief complaint of swelling in the right mandibular anterior region. On intraoral examination, the lesion was slowly growing in size and was first noticed 3 months prior to the examination. The lesion was asymptomatic but the patient complained it to be interfering with oral hygiene practice. The medical history was non-contributory. Before the onset of the oral lesion, the patient had not experienced any symptoms suggestive of systemic abnormalities. The lesion was a well-circumscribed sessile spherical mass of 2 cm diameter with color same as that of the surrounding oral mucosa [Figure 1].
Figure 1: Presurgical clinical appearance (mirror view)

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Complete hemogram showed all blood counts to be within normal limits. Urine examination was normal. Intraoral periapical radiograph showed generalized horizontal bone loss with no radiographic changes adjacent to the lesional area [Figure 2]. An excisional biopsy was performed and the excised tissue was sent for histopathologic examination.
Figure 2: Intraoral periapical view

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Histopathologic examination showed proliferative parakeratinized stratified squamous epithelium. Connective tissue showed inflammatory cell infiltrate with the predominance of plasma cells and haphazardly arranged collagen fibers. No abnormal or malignant cells were observed [Figure 3] and [Figure 4].
Figure 3: Histological picture under low magnification (10x) showing plasma cell infiltrate

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Figure 4: Histological picture under high magnification (×40) showing dense plasma cell infiltrate

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Immunohistochemical stain for kappa and lambda light chains showed a polyclonal plasma cell population [Figure 5] and [Figure 6].
Figure 5: Immunohistochemistry for kappa chains

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Figure 6: Immunohistochemistry for lambda chains

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On the basis of clinicohistopathologic examination and immunohisotochemistry, a confirmative diagnosis of plasma cell granuloma was made.

Healing was eventful and the patient is presently under follow-up since 8 months. There has been no evidence of recurrence [Figure 7].
Figure 7: Postsurgical clinical appearance of the 6th month (mirror view)

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   Discussion Top


Plasma cell granulomas, which are considered to be highly uncommon, non-neoplastic, reactive lesions, were brought to the attention of health care practitioners during the late 1960s and early 1970s. They are found primarily in the lungs and are found even more frequently intraorally. [11]

Bhaskar, Levin and Firch [5] first reported this pathologic entity on the gingival tissue and only very few case reports have been documented since then. Avecdo and Buchler, [6] Mark and Steven, [1] Karthikeyan and Pradeep [7] and Baltaciaglu et al. [8] have reported this lesion on the gingiva. These cases reported a similar gingival growth with histological and clinical appearance of a well-circumscribed, asymptomatic reactive lesion treated by excisional biopsy, as in the present case.

Kim et al. [9] reported gingival plasma cell granuloma in patients with cyclosporine-induced gingival overgrowth. They suggested that interleukin-6 (IL-6) and phospholipase C-γ1 may induce heavy plasma cell infiltration in cyclosporine-induced gingival overgrowth.

Plasma cell granulomas are benign inflammatory lesions to which biopsy and histopathologic/immunologic studies must be performed to rule out potential plasma cell dyscrasias and neoplasms, including multiple myeloma. It is important to differentiate plasma cell granulomas from extramedullary plasmacytoma and multiple myeloma, considering the poor prognosis of this neoplasm. Extramedullary plasmacytoma are singular lesions like the plasma cell granulomas and may be malignant or a precursor to malignancy. On histopathologic examination, plasmacytoma is composed of a pure culture of plasma cells arranged in relatively broad sheets on a delicate reticular stroma, whereas the plasma cell granuloma consists primarily of a capillary network. The plasmacytomas replace the tissue whereas in the plasma cell granulomas, plasma cell infiltrate on is by its deposition through the tissues. The inflammatory cells are very scarce, with absence of Russell bodies in the plasmacytoma in contrast to the plasma cell granulomas. [11]

Multiple myeloma is a relatively uncommon malignancy of plasma cell origin that appears to have a multicentric origin within the bone. The patients show signs of anemia, hypocalcaemia or renal failure. Histopathologic examination shows diffuse sheets of neoplastic, variably differentiated, plasmacytoid cells that invade and replace the normal tissue. Mitotic activity may be seen with some frequency. Amyloid deposition may be present. [11]

The treatment modality and follow-up of the soft tissue lesions varies. Plasma cell granulomas are usually treated by simple excision and removal of underlying inciting agent whereas neoplasms may require surgical excision, followed by chemotherapy and/or radiotherapy.

The pathogenesis of this lesion remains uncertain. It has been postulated that the presence of a large number of plasma cells may represent an altered antigen-antibody reaction of the host or an alteration of blood flow imposing congestive vasodilation. A parasitic etiology has also been suggested for this type of lesion. [2]

This case highlights the need to perform biopsy in unusual lesions to rule out potential neoplasms and also emphasizes the need to subject all excised tissue for histological examination regardless of clinical impression.

 
   References Top

1.Mark PE, Steven HD, John HW, Robert HW, Scott MA, Donald SK, et al. Gingival plasma cell granulomas. J Periodontol 2001;72:1287-90.  Back to cited text no. 1      
2.Ide F, Shimoyama T, Horie N. Plasma cell granuloma of the oral mucosa with angiokeratomatous features: A possible analogue of cutaneous angioplasmocellular hyperplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:204-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Soares J, Nunes JF, Sacadura J. Plasma cell granuloma of the tongue. Report of a case. Histol Histopathol 1987;2:199-201.   Back to cited text no. 3  [PUBMED]    
4.Ballesteros E, Osborne BM, Matsushima AY. Plasma cell granuloma of the oral cavity: A report of two cases and review of the literature. Mod Pathol 1998;11:60-4.  Back to cited text no. 4  [PUBMED]    
5.Bhaskar SN, Levin MP, Firsch J. Plasma cell granuloma of periodontal tissues. Report of 45 cases. Periodontics 1968;6:272-6.   Back to cited text no. 5      
6.Acevedo A, Bhuler JE. Plasma cell granuloma of the gingiva. Oral Surg Oral Med Oral Pathol 1977;43:196-200.  Back to cited text no. 6      
7.Karthikeyan BV, Pradeep AR. Plasma cell granuloma of gingiva. Int J Dent Res 2004;15:114-6.  Back to cited text no. 7      
8.Baltacioglue E, Akalin FA, Cobanoglu U, Sukuroglue E. Plasma cell granuloma in gingiva. Hacettepe Dis Hekimilgi Fakultesi 2007;31:39-43.  Back to cited text no. 8      
9.Kim SS, Eom D, Huh J, Sung I, Choi I, Sung HR, et al. Plasma cell granulomas in cyclosporine-induced gingival growth; A report of two cases with immunohistochemical positivity of Interleukin-6 and Phospholipase C-g. J Korean Med Sci 2002;17:704-7.  Back to cited text no. 9      
10.Neville BW, Doliglas D, Carl M, Jerry E. Hematologic disorders. In: Neville BW, Doliglas D, Carl M, Jerry E, editors. Oral and Maxillofacial Pathology. 2 nd ed. Philadelphia: Saunders; 2002. p. 526-7.  Back to cited text no. 10      
11.Betram S, Don K. Lymphoreticular disorders. In: Batsakis JG, editor. Tumors of the head, Clinical and Pathologic considerations. 2 nd ed. London: Williams and Willkins; 1980. p. 472-3.  Back to cited text no. 11      

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Correspondence Address:
Nilofar Attar
Department of Periodontics, Government Dental College and Hospital, Aurangabad - 431 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.70788

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]

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