Diagnosis Of Plasma Cell Granuloma Research Articles

Intra-oral Plasma Cell Granuloma: A Rare Clinico-pathological Entity-Report of Two Cases with Review

Plasma cell granulomas (PCGs) or inflammatory pseudotumors are non-neoplastic lesions that consist of predominantly antibody-producing plasma cells and innate immune cells such as neutrophils, macrophages, and eosinophils. Unlike in multiple myeloma, the plasma cells are polyclonal and proliferate in a fibroblast-rich stromal background. These lesions are predominantly reported in the lungs; however, they may involve other organs too. Very few cases are reported regarding the presence of PCG in the oral cavity and a confirmatory diagnosis is crucial for further management. A critical and careful examination from a pathological point of view is obviously necessary to rule out other plasma cell neoplasms. We present here two cases of intra-oral PCGs; one in the gingiva & another within the jaw; both showing a polyclonal staining pattern in immunohistochemistry confirming a diagnosis of plasma cell granuloma. Keywords: Inflammatory pseudotumor, Plasma cell granuloma, Plasma cells, Polyclonal plasma cells, Lambda and kappa chain

Diagnostic dilemma in a case of gingival lesion plasma cell granuloma versus extramedullary plasmacytoma-resolved by immunohistochemistry: a case study

Plasma cell granuloma is a rare reactive tumor- like lesion composed of polyclonal plasma cells. It primarily affects the lungs but occurs in other anatomic locations such as orbit, paranasal sinuses, larynx, tonsils, ears, tongue, lip, oral cavity and gingiva. A 65- year old female presented with the chief complaint of swelling over the right upper gingiva and mobility of right upper 2nd and 3rd molar teeth since 3-4 months At histopathology due to presence of uniform population of plasma cells a histopathological diagnosis of plasma cell rich lesion was made with a differential diagnosis of extramedullary plasmacytoma and plasma cell granuloma. However, immunohistochemical staining for kappa and lambda chains showed a polyclonal process and antibodies to CD138 were strongly positive, confirming the diagnosis of plasma cell granuloma. The case describes a rare condition of plasma cell granuloma occurring at an unusual site. Authors also emphasize the importance of immunohistochemistry in differential diagnosis of plasma cell rich lesions.

Gingival plasma cell granuloma: A rare case report

Herewith reporting a rare case of gingival plasma cell granuloma in a 50 year old woman who presented with upper gingival polypoidal growth. The histopathological examination revealed a mass composed of parakeratinised thin epithelium with proliferating rete ridges. The connective tissue is hypercellular and shows dense inflammatory infiltrate primarily composed of plasma cells and lymphocytes. Focal budding capillaries are also seen in the stroma confirming a diagnosis of plasma cell granuloma.

Plasma cell granuloma of gingiva

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.

Plasma Cell Granuloma of the Thyroid: A Conservative Approach to a Rare Condition and Review of the Literature

Introduction. We present a case of an 89-year-old female who attended our surgical endocrine clinic with a 3-month history of a left-sided neck lump. There was no past medical history of thyroid disease. Methods. Following examination and further investigation, including core biopsy, a diagnosis of plasma cell granuloma of the thyroid was made. Biochemical testing of thyroid function and Thyroid Peroxidase Antibody was in-keeping with an associated Hashimoto's thyroiditis. Results. The patient was treated conservatively with thyroxine and regularly seen in clinic. TSH levels improved and the lump showed signs of regression. Conclusion. Plasma cell granuloma of the thyroid is rare with only 16 previously reported cases. We present a new approach to management without the use of surgery or steroids. The literature is reviewed comparing clinico-pathological features and management of other reported cases.

Gingival plasma cell granuloma

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.

Plasma cell granuloma of the urinary bladder responsive to corticosteroid therapy

Plasma cell granuloma of the urinary bladder is a rare benign entity of the submucosal stroma that is difficult to distinguish from malignant neoplasm clinically. We report a case of plasma cell granuloma of the urinary bladder treated successfully with corticosteroid. A 78-year-old man was admitted to our hospital complaining of miction pain, pollakisuria and fever for a month. He had undergone surgery for a transverse colon tumor about 4 years previously, but the pathological diagnosis was plasma cell granuloma. Urinalysis showed microscopic hematuria. Urine cytology was class I. The urine culture was negative. Computed tomography (CT) showed diffuse thickness of the bladder wall (Fig. 1a). At this point, we made a diagnosis of invasive bladder cancer. Transurethral resection of bladder tumor (TUR-BT) was carried out. Histopathological examination demonstrated a proliferation of blood vessels and infiltration of many plasma cells. Histologically it was similar to that of the previous colon tumor and no malignant cell was identified. Thus, we made a diagnosis of plasma cell granuloma of the urinary bladder. The lesion occupied a large part of the bladder and it seemed difficult to carry out partial cystectomy. So we decided to carry out corticosteroid therapy according to some reports. We started 30 mg/day of oral prednisolone. The fever and the irritated bladder symptoms were dramatically improved from the next day. Bladder-wall thickening was significantly reduced in a CT after treatment in comparison with that before the treatment (Fig. 1a,b). The dose of prednisolone was gradually tapered down in an ambulatory setting. There has been no evidence of recurrence for 28 months. Many reports have dealt with similar lesions under various names including plasma cell granuloma, inflammatory myofibroblastic tumor, inflammatory pseudotumor, pseudosarcomatous fibromyxoid tumor, etc. The cause is not well resolved , but some reports describe that urinary tract infection, operation, and Crohn’s disease have some relations with the disease. Partial cystectomy is often carried out for treatment. Some cases are overtreated as total cystectomy. Some reports describe that corticosteroid was effective for inflammatory pseudotumor of the kidney and the upper urinary tract. Some reports describe that corticosteroid is effective for plasma cell granuloma of the lung, in which serum IgG4 level is high. Serum IgG4 of this case was within normal levels. This patient had a history of plasma cell granuloma of transverse colon about 4 years ago. The relation between plasma cell granuloma of transverse colon and urinary bladder is unknown but the histological appearance is very similar (Fig. 1c,d). To the best of our knowledge, this is a rare case of plasma cell granuloma of the urinary bladder that was dramatically reactive to corticosteroid. Futoshi Kunieda MD, Koji Inoue MD and Akito Terai MD PhD Department of Urology, Kurashiki Central Hospital, Kurashiki, Oyakama, Japan f kunieda@yahoo.co.jp

A CASE OF PLASMA CELL GRANULOMA OF THE STOMACH

Plasma cell granuloma is a granulomatous disorder of unknown origin that is histologically composed of plasma cell predominant cell infiltrate and fibrous connective tissue. This time we experienced a case of plasma cell granuloma arisen in the stomach. A 45-year-old man was admitted to the hospital because of appetite loss and epigastric pain. Gastric endoscopy revealed ulcerative lesion surrounded with irregular mucosa in the pyloric antrum. Biopsy yielded no definite diagnosis. Non-epithelial malignant tumor was suspected, and a gastrectomy was performed. Histopathologically, the difinite diagnosis of plasma cell granuloma was made. In this case, we were able to observe the morphological changes in ulcerative lesion of plasma cell granuloma with time. Domestic cases of gastric plasma cell granuloma are numbered only ten, and the clinical features of the disorder are still obscure. Some bibliographical comments in terms of the clinical features are also presented here.