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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 30  |  Issue : 1  |  Page : 82-84

Plasma cell granuloma of gingiva: A rare entity


1 Department of Oral Medicine and Radiology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
2 Department of Periodontology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India

Date of Submission20-Nov-2017
Date of Acceptance17-Feb-2018
Date of Web Publication23-Apr-2018

Correspondence Address:
Dr. B Sharanamma
Department of Periodontology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_104_17

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   Abstract 


The term “plasma cell granuloma (PCG)” is used to describe a localized benign proliferation of mature plasma cells. Intraoral PCGs involving the tongue, lip, oral mucosa, and gingiva have been reported in the past. This case presents a 16-year-old female with maxillary anterior gingival overgrowth. Histological examination revealed inflammatory cell infiltrate containing sheets of plasma cells. This case highlights the need that tend to locate in the oral cavity, primarily on the periodontal tissue. It reinforces the existence of PCG on the gingiva that it is extremely uncommon.

Keywords: Gingiva, inflammatory pseudotumor, oral cavity, plasma cell, plasma cell granuloma


How to cite this article:
Bhagawati BT, Sharanamma B, Kanwar D. Plasma cell granuloma of gingiva: A rare entity. J Indian Acad Oral Med Radiol 2018;30:82-4

How to cite this URL:
Bhagawati BT, Sharanamma B, Kanwar D. Plasma cell granuloma of gingiva: A rare entity. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2022 Jun 26];30:82-4. Available from: https://www.jiaomr.in/text.asp?2018/30/1/82/230880




   Introduction Top


Plasma cell granuloma (PCG) is a rare form of idiopathic inflammatory pseudotumor, characterized by a benign proliferation consisting predominantly of plasma cells and reticuloendothelial element.[1] Very few cases of primary PCG of the central nervous system are reported.[1] These lesions have no sex predilection and may occur at any age. It manifests primarily in the lungs, but may occur in various other anatomic locations like the oral cavity which is very rare on the gingiva. Intraorally, involves most commonly the tongue, lip, oral mucosa and least commonly on the gingiva.[2] The exact incidence and etiopathogenesis is unclear and may arise due to periodontitis, periradicular inflammation due to the presence of a foreign body or may be due to an idiopathic antigen. The lesion's etiopathogenesis, biological behavior, and appropriate treatments are unclear and little is known about the prognosis. The most commonly considered treatment for PCG is a complete resection; however, in some cases, total surgical excision is not possible.[3] We present such a rare case of PCG of gingiva in the oral cavity.


   Case Report Top


A 16-year-old female patient reported to the Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana with the chief complaint of growth in upper right front region of jaw for 20 days. The history of present illness revealed that this growth was initially small and was present one and half months back. Initially, the growth was small in size and bleeding was present on touching. The patient had got the growth excised from a local hospital in Saharanpur 1 month back and then 20 days back, the growth had reappeared, it grew in size and attained the present size. The lesion was painless but the patient complained of bleeding on touching and interference with oral hygiene practice. The medical history was nonsignificant.

On intraoral examination, a single growth was present between 11, 12 on buccal and palatal attached gingiva. The growth was well-circumscribed, oval, and sessile. The approximating size of growth was 3 cm × 2 cm diameter. The color of the growth was erythematous to that of surrounding mucosa [Figure 1]. On palpation, the inspectory findings were confirmed. It was firm in consistency, fixed to underlying structures. It was nontender, nonpulsatile, nonfluctuant, and noncompressible in nature. Bleeding was elicited on palpation.
Figure 1: A single growth was present between 11, 12 on buccal and palatal attached gingiva

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A working diagnosis of pyogenic granuloma was made and radiographic investigations were done. Radiographic examination revealed no significant bony changes. There was no bony invasion and no bony destruction; no osseous changes seen [Figure 2]. A provisional radiographic diagnosis of pyogenic granuloma was made and the patient was sent for the excision of the mass to the Department of Oral Maxillofacial Surgery.
Figure 2: Radiographic examination revealed no significant bony changes. No osseous changes seen

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Before surgery, complete hemogram was done. The patient was uncooperative, so it was decided to excise the growth under general anesthesia. Pre-anesthetic check-up was done in which chest X-ray and ECG revealed no significant features.

The lesions were excised under general anesthetic [Figure 3] and sent for histopathological examination. Due to the presence of redundant skin and tissue in this region, the defect was primarily closed without the need for skin grafting or reconstructive surgery. Histopathological examination revealed parakeratinized stratified squamous epithelium with long and thin rete pegs and underlying connective tissue. The connective tissue was fibrocellular with numerous proliferating endothelium lined blood vessels. The connective tissue showed the presence of plasma cells in clusters surrounding the blood vessels. The plasma cells were variable in size and shape, with very few large cells and numerous binucleated plasma cells [Figure 3]. The patient was sent for urine analysis for Bence Jones proteins to rule out multiple myeloma. So, final diagnosis of PCG was made based on clinical and histopathological findings. The follow-up was done and revealed nothing significant findings.
Figure 3: Histopathological examination revealed parakeratinized stratified squamous epithelium with long and thin rete pegs and underlying connective tissue. The plasma cells were variable in size and shape, with very few large cells and numerous binucleated plasma cells

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   Discussion Top


PCG is a highly, uncommon, reactive tumor-like lesion whose etiology remains uncertain. Although, some authors suggest that it has a parasitic etiology.[3],[4] It has been called by different terms, namely; inflammatory myofibroblastic tumor, inflammatory pseudotumor, inflammatory myofibrohistiocytic proliferation, and xanthomatous pseudotumor.[5] In the head and neck region it has been reported in the oral mucosa, temporal bone, tonsil, submandibular region, paranasal sinuses, tongue, and on the gingiva.[3]

It is formed by aggregates of mature plasma cells intermixed with mesenchymal cells mostly of the fibroblast and histiocyte-type and arranged in a granulomatous pattern. Plasma cells are terminally differentiated B lymphocytes which are typically found in the red pulp of the spleen, medulla of the lymph nodes, tonsils, lamina propria of the entire gastrointestinal tract, mucosa of the nose and upper airway, and sites of inflammation. These are characterized by basophilic cytoplasm with an eccentrically placed nucleus.[4] They range in size from 14 μm to 20 μm. A plasma cell's main function is to produce immunoglobulins or antibodies. PCG is a plasma cell lesion which merits discussion because it is typically found in the oral cavity. This lesion is not a neoplastic process, nor is it associated with a monoclonal expansion of a single plasma cell; instead, this is a reactive, inflammatory lesion which usually involves the gingival tissue.

PCG has been found in several sites in the body. The lungs and the stomach are the commonest sites; the tonsil and bladder are rarely affected.[6],[7] It is rarely found in oral cavity. Kim et al. also reported gingival PCG in patients with cyclosporine-induced gingival overgrowth which was not true in our case.

In our case, the young age of the patient suggested it to be a reactive lesion. 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.[3] The PCG should be differentiated from plasmacytoma and multiple myeloma. Multiple myeloma is the tumor of the bone, whereas, plasmacytoma and PCG are soft tissue tumors. Differentiating the type of soft tissue tumor is mandatory, as PCG may be benign, but plasmacytoma may show early stages of multiple myeloma.[3]

In our case, the growth was differentiated from multiple myeloma on the basis of negative Bence-Jones protein and from plasmacytoma on basis of histopathological findings. It is suggested that biopsy is mandatory to rule out other differentiating lesions.

The treatment modality and follow-up of the soft tissue lesions varies. PCGs are usually treated by simple excision and removal of underlying inciting agent whereas neoplasms may require surgical excision, followed by chemotherapy and/or radiotherapy.[7] In our case, simple excision, followed by regular check-up sufficed.

With respect to prognosis, PCG seems to be a generally benign, nonrecurring condition; nevertheless, local aggressiveness and recurrences may complicate the outcome of the disease.[5]


   Conclusion Top


PCG is a reactive lesion that is diagnosed primarily based on histopathological findings. The etiology remains unclear, but it is thought to arising due to a nonspecific inflammatory response to an unknown exogenous agent. PCGs tend to locate in the oral cavity, primarily on the periodontal tissue and exact incidence of these cases have not been reported in literature. This case report reinforces the existence of PCG on the gingiva that it is extremely uncommon. So, there is a need for submitting all the excised gingival tissue for histopathological examination, irrespective of the clinical features and clinical diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shenoy SN, Raja A. Intracranial plasma cell granuloma. Neurol India 2004;52:262-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Phadnaik MB, Attar N. Gingival plasma cell granuloma. Indian J Dent Res 2010;21:460-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Manohar B, Bhuvaneshwari S. Plasma cell granuloma of gingiva. Indian Soc Periodontol 2011;15:64-6.  Back to cited text no. 3
    
4.
P.C. Anila Namboodiripad Malathi Jaganath. Plasma cell granuloma in the oral cavity. J Oral Surg 2008;1:206-12.  Back to cited text no. 4
    
5.
Buccoliero AM, Caldarella A, Santucci M, Ammannati F, Mennonna P, Taddei A, et al. Plasma cell granuloma--an enigmatic lesion: Description of an extensive intracranial case and review of the literature. Arch Pathol Lab Med 2003;127:e220-3.  Back to cited text no. 5
[PUBMED]    
6.
Soares J, Nunes JF, Sacadura J. Plasma cell granuloma of the tongue. Report of a case. Histol Histopath 1987;2:199-201.  Back to cited text no. 6
    
7.
Chan KW, Poon GP, Choi CH. Plasma cell granuloma of the thyroid. J Clin Pathol 1986;39:1105-7.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
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INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH. 2021; : 9
[Pubmed] | [DOI]



 

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