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   Table of Contents    
CASE REPORT
Year : 2011  |  Volume : 15  |  Issue : 1  |  Page : 64-66  

Plasma cell granuloma of gingiva


1 Department of Periodontics, Pacific Dental College and Hospital, Debari, Udaipur, Rajasthan, India
2 Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Debari, Udaipur, Rajasthan, India

Date of Submission09-Jul-2010
Date of Acceptance12-Dec-2010
Date of Web Publication23-Jun-2011

Correspondence Address:
Balaji Manohar
Department of Periodontics, Pacific Dental College and Hospital, Debari, Udaipur - 313 024, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-124X.82275

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   Abstract 

Plasma cell granuloma is a rare benign lesion characterized by the infiltration of plasma cells; primarily occurring in the lungs. It is also seen to occur in the brain, kidney stomach, heart, and so on. In the intraoral region it is seen to involve the tongue, oral mucosa, and gingiva. This case presents a 42-year-old female, with an enlargement in the maxillary anterior region, treated by excisional biopsy. Histological evaluation revealed plasma cell infiltrates in the connective tissue. The immunohistochemistry revealed kappa and lambda light chains with a polyclonal staining pattern, which confirmed the diagnosis of plasma cell granuloma.

Keywords: Inflammatory pseudotumor, plasma cell granuloma, plasma cells, reactive lesions


How to cite this article:
Manohar B, Bhuvaneshwari S. Plasma cell granuloma of gingiva. J Indian Soc Periodontol 2011;15:64-6

How to cite this URL:
Manohar B, Bhuvaneshwari S. Plasma cell granuloma of gingiva. J Indian Soc Periodontol [serial online] 2011 [cited 2018 Oct 15];15:64-6. Available from: http://www.jisponline.com/text.asp?2011/15/1/64/82275


   Introduction Top


Plasma cell granuloma, otherwise known as an inflammatory pseudotumor is an uncommon non-neoplastic lesion considered to be the result of an inflammatory condition. Plasma cell granuloma is very rare in the oral cavity, and more so, on the gingiva. These lesions have no sex predilection and may occur at any age. Plasma cell granuloma has been called by different terms, namely; Inflammatory myofibroblastic tumor, Inflammatory pseudotumor, Inflammatory myofibrohistiocytic proliferation, and Xanthomatous pseudotumor. [1]

Although it is an uncommon lesion, when it occurs it is commonly seen in the lungs [2] and some other anatomic locations such as brain, [3] kidney, [4] stomach, [5] heart, [6] and so on. In the head and neck region it has been reported in the oral mucosa, [7] temporal bone, [8] tonsil, [9] sub-mandibular region, [10] paranasal sinuses, [11] tongue, [12] and on the gingiva [13],[14],[15],[16],[17] .

The exact incidence of plasma cell granuloma is unclear. The lesion's etiopathogenesis, biological behavior, and appropriate treatments are unclear, and little is known about the prognosis. It may arise due to periodontitis, periradicular inflammation due to the presence of a foreign body or may be due to an idiopathic antigenic cue. The most commonly considered treatment for plasma cell granuloma is a complete resection; however, in some cases, total surgical excision is not possible. [1]


   Case Report Top


A 42-year-old Indian female patient reported to the Department of Periodontics, Pacific Dental College and Hospital with a gingival enlargement in the right upper anterior region between the lateral incisor and the canine. The enlargement was oval in shape and measured around 1.5 cm in diameter. It was firm, lobulated, and attached to the gingiva by a narrow stalk [Figure 1]. The patient complained of the enlargement interfering with the oral hygiene procedures and was bleeding on brushing. The patient presented no other relevant medical history.
Figure 1: Gingival enlargement in the right upper anterior region between the lateral incisor and the canine

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A complete hemogram was done and all the values were within normal limits. The radiological examination of the region showed no bony involvement [Figure 2].
Figure 2: Intraoral, periapical radiograph of the region showing no bony involvement

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An excisional biopsy and gingivoplasty was performed under local anesthesia and the specimen was sent for histopathological examination. The healing was uneventful.

The histopathological examination, with Hemotoxylin and Eosin stain, revealed a stratified squamous parakeratinized hyperplastic epithelium, with underlying fibrocellular connective tissue stroma [Figure 3], with fibroblasts, few lymphocytes, and abundant plasma cells [Figure 4]. However, a typical eccentrically placed hyperchromatic, cartwheel-shaped nucleus of the plasma cell was also evident [Figure 5]. The histopathological appearance, when co-related with the clinical features, was suggestive of plasma cell granuloma of the gingiva. Immunohistochemical staining for kappa and lambda light chains was carried out, to check for the presence of plasma cells. A strong positivity for the kappa light chain was seen in the polyclonal plasma cell population [Figure 6], whereas, a weak expression was noted for the lambda light chain [Figure 7], with a ratio of 2:1. A polarized microscopic study was also carried out, but failed to reveal any birefringence.
Figure 3: Micrograph at low magnification showing plasma cell infiltrate and elongated rete ridges

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Figure 4: Low power microscopy showing abundant plasma cells in the connective tissue

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Figure 5: High power microscopy showing plasma cells with eccentrically placed nucleus

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Figure 6: Immunohistochemistry for kappa chains

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Figure 7: Immunohistochemistry for lambda chains

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   Discussion Top


During the late 1960s and early 1970s, cases of plasma cell infiltrates of the lips, gums, and tongue were described primarily in the dental literature under the names of atypical gingivistomatitis, idiopathic gingivistomatits, and allergic gingivostomatitis. The lesions were thought to be a result of a reaction to chewing gum, dentrifices, and other foreign substances, although extensive allergy testing had been inconclusive. [1]

Tumors that are mainly composed of plasma cells may be multiple myeloma, solitary myeloma, soft tissue myeloma (plasmacytoma), or plasma cell granuloma. Multiple myeloma and solitary myeloma are tumors of the bone, whereas, plasmacytoma and plasma cell granuloma are soft tissue tumors. Differentiating the type of soft tissue tumor is mandatory, as plasma cell granuloma may be benign, but plasmacytoma may show early stages of multiple myeloma. [13]

Plasmacytoma is a well-defined locally destructive lesion, located on the mucosa of the oropharyngeal region, which may be singular like plasma cell granuloma. Histologically, they have typical and atypical plasma cells, unlike plasma cell granuloma, which consists of normal plasma cells and small lymphocytes that are surrounded by connective tissue septa, Rusell Fuchs bodies. [8]

The immunohistochemistry determines the clonality of the lesion, where, in a reactive lesion, the kappa to lambda light chain ratio is 2:1, and in the case of malignancy the ratio may be greater than 10:1 or 1:10. [14]

The pathogenesis of the plasma cell granuloma remains unclear. The large number of plasma cells may represent an autoimmune reaction or an alteration of blood flow imposing congestive vasodilation. [7] Lesions occurring due to parasitic infiltration can also not be ruled out. [12]


   Conclusion Top


Plasma cell granuloma is a lesion that is diagnosed primarily based on histological findings. The etiology remains unclear, but it is thought to aris due to a non-specific inflammatory response to an unknown exogenous agent.

This case report reinforces the existence of plasma cell granuloma on the gingiva and the need for submitting all the excised gingival tissue for microscopic examination, irrespective of the clinical features and clinical diagnosis.

 
   References Top

1.Anila Namboodripad PC, Jaganath M, Sunitha B, Sumathi A. Plasma cell granuloma in the oral cavity. Oral Surg 2008;1:206-12.  Back to cited text no. 1
    
2.Urschel JD, Horan TA, Unrach HW. Plasma cell granuloma of the lung. J Thorac Cardiovasc Surg 1992;104:8705.  Back to cited text no. 2
    
3.Tresser N, Rolf C, Cohen M. Plasma cell granulomas of the brain: Pediatric case presentation and review of the literature. Child Nerv Syst 1996;12:527.  Back to cited text no. 3
    
4.Fisch AE, Brodey PA. Plasma cell granuloma of kidney. Urology 1976;8:89-91.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Soga J, Saito K, Suzuki N, Sakai T. Plasma cell granuloma of the stomach. A report of a case and review of the literature. Cancer 1970;25:618-25.   Back to cited text no. 5
[PUBMED]    
6.Chou P, Gonzalez-Crussi F, Cole R, Reddy VB. Plasma cell granuloma of the heart. Cancer 1988;62:1409-13.  Back to cited text no. 6
[PUBMED]    
7.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. 7
    
8.Nam BH, Rha KS, Yoo JY, Park CI. Plasma cell granuloma of the temporal bone: A case report. Head Neck 1994;16:457-9.  Back to cited text no. 8
[PUBMED]    
9.Weilbaecher TG, Sarma DP. Plasma cell granuloma of tonsil. J Surg Oncol 1984;27:228-31.  Back to cited text no. 9
[PUBMED]    
10.Inui M, Tagawa T, Mori A, Yoneda J, Nomura J, Fukumori T. Inflammatory pseudotumor in the submandibular region. Clinicopathologic study and review of the literature. Oral Surg Oral Med Oral Pathol 1993;76:333-7.  Back to cited text no. 10
[PUBMED]    
11.Toriumi DM, Sykes JM, Wolff AP, Goldschmidt RA. Plasma cell granuloma of the paranasal sinuses. Otolaryngol Head Neck Surg 1987;96:562-4.  Back to cited text no. 11
    
12.Soares J, Maura 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. 12
    
13.Acevedo A, Buhler JE. Plasma-cell granuloma of the gingiva. Oral Surg Oral Med Oral Pathol 1977;43:196-200.   Back to cited text no. 13
[PUBMED]    
14.Peacock ME, Hokett SD, Hellstein JW, Herold RW, Matzenbacher SA, Scales DK, et al. Gingival plasma cell granuloma. J Periodontol 2001;72:1287-90.   Back to cited text no. 14
[PUBMED]  [FULLTEXT]  
15.Karthikeyan BV, Pradeep AR. Plasma cell granuloma of gingiva. Indian J Dent Res 2004;15:114-6.  Back to cited text no. 15
[PUBMED]  Medknow Journal  
16.Baltacioglu E, Akalin FA, Cobanoglu U, Sukuroglu E. Plasma cell granuloma in gingival.Hacettepe Diþhekimliði Fakültesi Dergisi. :31, Sayý:3, Sayfa: 39-43,2007.  Back to cited text no. 16
    
17.Phadnaik MB, Attar N. Gingival plasma cell granuloma. Indian J Dent Res 2010;21:460-2.  Back to cited text no. 17
[PUBMED]  Medknow Journal  


    Figures

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


This article has been cited by
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Journal of Maxillofacial and Oral Surgery. 2013;
[Pubmed] | [DOI]



 

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