Plasma Cell Granuloma Research Articles

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.

Inflammatory myofibroblastic tumor of the liver: A rare pathological entity

Inflammatory myofibroblastic tumor (IMT) of the liver is a rare tumor like lesion that can mimic malignant liver neoplasm. IMT is a lesion composed of myofibroblastic spindle cells, plasma cells, lymphocytes, and eosinophils. It can occur in soft tissues and viscera. It was previously called plasma cell granuloma, inflammatory myofibrohistiocytic proliferation, and inflammatory pseudo tumor, but IMT is the designation currently used. IMT is more frequently described in the lung and abdomen of young patients, but it can also be found in the central nervous system, salivary glands, larynx, bladder, breast, spleen, skin, and liver. Here, we present a case of IMT of the liver in a 55-year-old female patient which is a rare presentation.

Spontaneous Resolution of an Inflammatory Pseudotumour of the Lung Subsequent to Wedge Biopsy

Spontaneous, complete resolution of inflammatory pseudotumour (IPT) of lungs is exceptionally rare. A 44-year-old male was referred for evaluation for «non resolving pneumonitis». He had cough and minimal expectoration for 5 months, chest pain, haemoptysis and fever for a fortnight. Computed tomography of thorax (CT-thorax) confirmed the presence of a homogenous mass with irregular borders in right middle lobe with areas of breakdown and air bronchogram. Transbronchial lung biopsy was suggestive of «plasma cell granuloma». Thoracotomy disclosed a hard mass in right middle lobe adherent to lower lobe, chest wall and mediastinum which could not be removed. A wedge biopsy confirmed IPT. Chest radiograph after 4 weeks revealed significant resolution. CT-thorax a year later showed fibrotic scar. Till date, there are only five reports documenting 6 patients with spontaneous resolution of IPT of lungs and in 4 this occurred within 3 months of an invasive diagnostic intervention.

Resolución espontánea de un seudotumor inflamatorio del pulmón como consecuencia de una biopsia en cuña

Spontaneous, complete resolution of inflammatory pseudotumour (IPT) of lungs is exceptionally rare. A 44-year-old male was referred for evaluation for «non resolving pneumonitis». He had cough and minimal expectoration for 5 months, chest pain, haemoptysis and fever for a fortnight. Computed tomography of thorax (CT-thorax) confirmed the presence of a homogenous mass with irregular borders in right middle lobe with areas of breakdown and air bronchogram. Transbronchial lung biopsy was suggestive of «plasma cell granuloma». Thoracotomy disclosed a hard mass in right middle lobe adherent to lower lobe, chest wall and mediastinum which could not be removed. A wedge biopsy confirmed IPT. Chest radiograph after 4 weeks revealed significant resolution. CT-thorax a year later showed fibrotic scar. Till date, there are only five reports documenting 6 patients with spontaneous resolution of IPT of lungs and in 4 this occurred within 3 months of an invasive diagnostic intervention.

Intravascular plasma cell granuloma of the pulmonary artery

A 29-year old man presented with chronic cough. A chest X-ray revealed several faint round opacities in the right upper zone (Fig. 1a). Computed tomography showed a mass occluding the right main pulmonary artery (Fig. 1b). Positron emission tomography showed increased activity (Fig. 1c). He underwent median sternotomy and intrapericardial right pneumonectomy. Histopathology revealed an intravascular plasma cell granuloma (Fig. 1d).

A Case of Plasma Cell Granuloma of Unknown Cause

Plasma cell gingivitis (PCG) is a condition in which a hypersensitive reaction is seen to various etiologic causes in the gingival tissue. A rare form of PCG, called plasma cell granuloma may sometimes occur, in which enlargement of a specific area of the mouth is seen. This case report elicits a case of such a rare case of the granuloma in the anterior maxilla of a 25-year-old patient. All the routine blood investigations were performed to rule out any systemic causes of this enlargement. After the etiotropic phase of treatment was complete, excisional biopsy was performed in the area of the interdental papilla between the maxillary right canine and first premolar. A 0.5 × 0.5 × 0.5 cm of tissue was obtained, which was then sent for histopathological investigation. The histopathological report revealed the presence of parakeratinized squamous epithelium with elongated rete ridges. The cells were separated by sheaths of collagen fibers in bundles. Engorged capillaries and small blood vessels were also seen (Fig. 2). The underlying connective tissue showed infiltration of numerous plasma cells, in sheets, with occasional lymphocytes (Fig. 3). DISCUSSION

Inflammatory Myofibroblastic Tumor Mimicking Malignant Meningioma in the Middle Cranial Fossa: a Case Report

INFLAMMATORY myofibroblastic tumor (IMT), also known as inflammatory pseudotumor or plasma cell granulomas, is an uncommon fibro-inflammatory lesion which is composed of inflammatory cells and myofibroblastic spindle cells. Its pathogenesis is still unknown. The tumor commonly occurs in the lung, upper respiratory tract, live, orbit, abdominal membrane, retroperitoneum, and genitourinary tract.It rarely involves the central nerve system, especially the middle cranial fossa. As far as we know, there are no more than 5 reports of IMT that developed in the middle cranial fossa without involving temporal bone. IMT can occur at any age but primarily affects children and young adults. It is difficult to diagnose IMT by clinical and imaging characteristics only. Here we present an 82-year-old female with intracranial IMT arising from the meninges and without involving temporal bone, which was diagnosed as malignant meningioma before operation.

Xanthomatous hypophysitis

Xanthomatous hypophysitis (XH) is the rarely seen primary form of hypophysitis. The histological differential diagnosis includes other causes of hypophysitis, Erdheim–Chester disease (ECD), Langerhans cell histiocytosis, Rosai–Dorfman disease and plasma cell granulomas. We present a 39-year-old woman admitted to our department with headache, menstrual irregularity and galactorrhea. The MRI revealed a lesion with a central cystic/necrotic region and a diameter of almost 1cm. Histologic examination showed an inflammatory infiltrate of numerous foamy histiocytes, surrounding the necrotic tissue. On immunohistochemical sections, infiltrating foamy cells stained strongly positive for CD68, and negative for CD1a and S100. After establishing the diagnosis of XH, the patient underwent glucocorticoid treatment. XH should be considered in the differential diagnosis of pituitary lesions. Since XH is rare, it is difficult to assess the efficacy of medical/surgical treatment of this entity accurately.

Laparoscopic Resection of a Gastric Plasma Cell Granuloma: A Case Report

Plasma cell granuloma, also known as inflammatory myofibroblastic tumour or inflammatory pseudotumour, is a nonneoplastic process characterized by an unregulated growth of inflammatory cells. It most commonly occurs in the lung and upper respiratory tract, and only six other cases of gastric plasma cell granuloma exist. There are no other cases of intragastric laparoscopic resection of this type of lesion. Here, we present a case of a 60-year-old gentleman who had gradual onset epigastric discomfort and was thought to have a gastrointestinal stromal tumour on gastroscopy. Subsequent imaging and laparoscopic transgastric resection of the lesion confirmed the presence of a plasma cell granuloma. We discuss the aetiologies, presentation, investigation, and treatment of this rare disorder and make recommendations on the management.

Presence of Immunoglobulin Heavy Chain Rearrangement in So-Called IgG4-Related Plasma Cell Granuloma of the Eyelid

So-called inflammatory pseudotumor (IPT) affects almost all major organs. The histological appearance of IPT varies from fibrohistiocytic proliferation to plasma cell-dominated lesions. The latter are composed of numerous plasma cells, lymphocytes, and histiocytes as well as mesenchymal cells, that is, plasma cell granuloma (PCG). Recently, Zen et al. demonstrated that some of the pulmonary PCGs represent an immunoglobulin G4 (IgG4)-related sclerosing disease. We report here a unique case of IgG4-related PCG of the eyelid. An 85-year-old man had a history of bronchial asthma for several years. He presented with a right upper eyelid mass, and under a diagnosis of squamous cell papilloma underwent tumor resection in May 2008. The surgical tissue was diagnosed as an inflammatory granulation tissue. Preoperative patient laboratory examination results were within normal limits. Serum IgG4 level was not examined. Two years later, he also presented with a left upper eyelid mass, and mass resection was performed under the diagnosis of chalazion. There was no other evidence of disease and the patient remained free of disease on examination 12 months later. Histologically, initial and recurrent lesions presented similar findings. In a lowpower field, both lesions were characterized by chronic inflammatory processes, and irregular fibrosis and/or sclerosis were not prominent (Fig. 1a). In a highpower field, these lesions demonstrated severe infiltration of mature plasma cells, plasmacytoid cells, and small lymphocytes with scattered eosinophils (Fig. 1b). Scattered Russell bodies (intracytoplasmic inclusions) were present in both lesions (Fig. 1b), but there were no centrocyte-like (CCL) cells, Dutcher bodies (intranuclear inclusions), or amyloid deposition. A few isolated small lymphocytes and mature plasma cells invaded into the Meibomian gland epithelium. However, there was no lymphoepithelial lesion (LEL) (Fig. 1b). Elastica-van Gieson staining demonstrated that there was no obliterative phlebitis or arteritis. Immunohistochemical studies were performed using the antigen retrieval method on the Histofine Histostainer (Nichirei Bioscience Inc., Tokyo, Japan) according to the manufacturer’s instructions. Staining for CD20, CD3, and CD5 showed the mixed nature of the small lymphocytes. There were no CD43 B-cells in either lesion. In situ hybridization (ISH) and immunohistochemical studies of k-chain and l-chain demonstrated polyclonality of the plasma cells and plasmacytoid cells in both lesions (Figs. 1c & 1d). There were numerous IgG-positive plasma cells with scattered IgAor IgM-positive plasma cells. However, IgG4 cells comprised more than 40% of the IgG plasma cells (Figs. 1e & 1f). There were no LELs detected even by immunostaining for cytokeratin in any of the two lesions (Fig. 1g). CD23 immunostain demonstrated no residual follicular dendritic cell network in both lesions. On ISH study, there were no Epstein-Barr virus (EBV)-encoded small RNA (EBER) cells in either lesion. By polymerase chain reaction (PCR) for immunoglobulin heavy chain (IgH) gene, a discrete band of amplified IgH gene was found for the recurrent lesion, while for the initial lesion, only germline bands were detected (Fig. 1h). IgG4 is the least common of the 4 subclasses of IgG4,

Dural lesions mimicking meningiomas: A pictorial essay

The purpose of this essay was to illustrate the radiological and pathological findings in a wide spectrum of dural lesions mimicking meningiomas. Familiarity with and knowledge of these findings will narrow the differential diagnosis and provide guidance for patient management. In this pictorial review, we describe the following entities: Solitary fibrous tumors, hemangiopericytoma, gliosarcoma, leiomyosarcoma, dural metastases, Hodgkin's disease, plasmocytoma, Rosai-Dorfman disease, neurosarcoidosis, melanocytic neoplasms and plasma cell granuloma.

Inflammatory myofibroblastic tumor appendix with concomitant mucosal dysplasia, simulating pseudomyxoma on preoperative aspiration cytology

Inflammatory myofibroblastic tumor (IMT) has been described as a pseudosarcomatous proliferation of spindled myofibroblasts admixed with lymphoplasmacytic cells. The various terminologies like inflammatory pseudotumor, plasma cell granuloma, and inflammatory myofibrohistiocytic proliferation, used to describe this entity, highlight the controversial etiopathogenesis of this relatively indolent neoplasm. IMT has now been described in different anatomic locations. However, cases occurring in the gastrointestinal tract are rare with very few cases described in the appendix. We present a case of inflammatory myofibroblastic tumor appendix with mucosal dysplasia in a 41-year-old male, presenting with abdominal pain and lump in the right iliac fossa. Aspiration cytology yielded few atypical epithelial cells and spindle cells in a mucinous background, suggesting the possibility of pseudomyxoma peritonei. Awareness of IMT appendix with rare presence of mucosal dysplasia may help in preventing overzealous resection, especially in situations that on preoperative evaluation may suggest malignancy.

Plasma cell granuloma of lip

Plasma cells are medium-sized round-to-oval cells with eccentrically placed nuclei, usually found in the red pulp of the spleen, tonsils, medulla of the lymph nodes, nasal mucosa, upper airway, lamina propria of the gastrointestinal tract, and sites of inflammation. Plasma cell granuloma is a rare reactive tumor-like proliferation composed chiefly of plasmacytic infiltrate. Here, we present a case of plasma cell granuloma of lip in a female patient.

Plasma Cell Granuloma of the Thyroid Gland

This study reports a case of plasma cell granuloma of the thyroid gland in a 47-year-old woman, presenting with a right subhyoid mass and a previous diagnosis of Hashimoto thyroiditis dating back to 1988, which was made on a subtotal thyroidectomy. Plasma cell granuloma preferentially involves the lung, with only 18 cases of thyroid gland involvement having been reported to date in the English literature. Thyroid plasma cell granuloma preferentially affects women and classically shows a prominent plasma cell infiltrate embedded in a variable degree of fibrous stroma: only 2 of the reported cases exhibited the morphologic features of inflammatory myofibroblastic tumor. These morphologic features may raise problems in the differential diagnosis with other plasma cell-rich disorders, including infectious diseases and auto(dys)immune conditions, including the recently described "IgG4-related sclerosing disease." In view of these considerations, a contemporary diagnostic approach to thyroid plasma cell granuloma is therefore discussed here.

Primary intracranial plasma cell granulomas presenting as malignant neoplasms

Plasma cell granuloma (PCG) is an uncommon non-neoplastic mass lesion of unknown etiology. It is characterized by a polyclonal proliferation of chronic inflammatory cells, mostly mature plasma and other mononuclear cells. PCGs arising in the central nervous system are particularly rare. We report two additional cases of intracranial PCG exclusively involving the brain parenchyma. A 47 year-old woman, presenting with partial motor seizures and fluent aphasia, underwent complete excision of a well-demarcated, enhancing left parietal mass. The second patient was a 56 year-old man presenting with headaches and right-sided weakness who underwent stereotactic biopsy of an ill-defined, heterogeneously enhancing lesion in the left basal ganglia. Immunohistochemical analysis of surgical specimens showed polyclonal plasma cells and mature lymphocytes but no etiological agent. A histopathologic diagnosis of intracranial PCG was made in both cases. PCG should be part of the differential diagnosis of enhancing mass lesions of the brain. The etiology and natural history of these tumor-like lesions is not fully understood. Complete surgical excision appears to be curative. Lesions where total resection is not possible may benefit from adjuvant treatment including corticosteroids and possibly radiation therapy.

Isolated Sixth Nerve Palsy Due to Plasma Cell Granuloma in the Sphenoid Sinus

Isolated Sixth Nerve Palsy Due to Plasma Cell Granuloma in the Sphenoid Sinus

Inflammatory Pseudotumor of Premaxillary Subcutaneous Tissue

ABSTRACTInflammatory pseudotumor also known as plasma cell granuloma is a space occupying lesion which occurs in wide variety of somatic tissue and visceral organs, including lungs, liver, thyroid and many other organs. Recently, it has been described in the major salivary glands and buccal tissue in children.1 We have described here the clinical, radiological and histological findings of inflammatory pseudotumor in premaxillary subcutaneous tissue in an adult, which is a rare site.

Inflammatory myofibroblastic tumor

Inflammatory myofibroblastic tumor is an uncommon lesion of unknown cause. It encompasses a spectrum of myofibroblastic proliferation along with varying amount of inflammatory infiltrate. A number of terms have been applied to the lesion, namely, inflammatory pseudotumor, fibrous xanthoma, plasma cell granuloma, pseudosarcoma, lymphoid hamartoma, myxoid hamartoma, inflammatory myofibrohistiocytic proliferation, benign myofibroblatoma, and most recently, inflammatory myofibroblastic tumor. The diverse nomenclature is mostly descriptive and reflects the uncertainty regarding true biologic nature of these lesions. Recently, the concept of this lesion being reactive has been challenged based on the clinical demonstration of recurrences and metastasis and cytogenetic evidence of acquired clonal chromosomal abnormalities. We hereby report a case of inflammatory pseudotumor and review its inflammatory versus neoplastic behavior.

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.

Intraventricular inflammatory pseudotumor: Report of two cases and review of the literature

Inflammatory pseudotumors (IP) are non-neoplastic lesions characterized by collagenous stroma and polyclonal mononuclear infiltrates. It is best characterized in the lung, but can occur in the CNS, mimicking a neoplastic process. We discuss the available literature and our cases in order to elucidate best medical practices when confronted with such a lesion. We report on two cases of intraventricular inflammatory pseudotumor in patients who presented with symptoms of CSF obstruction. Both patients were treated surgically with significant clinical improvement. Histopathologically, both specimens revealed a plasma cell granuloma variant of IP. A Medline search for English articles identified 46 cases of CNS IP, only eight of which were located within the ventricle. As with our case, most patients presented due to CSF obstruction or mass effect. Radiographically, the lesions have a variable appearance although most enhanced with gadolinium. Complete resection was achieved in 67% with a 12% rate of recurrence. With incomplete resection or biopsy alone, progression is seen despite steroid or radiation administration. Malignant transformation was only reported once. CNS IP is a rare pathological entity that cannot be diagnosed through clinical presentation or radiographic characteristics, but rather through a careful neuropathological inspection. The available literature suggests that complete resection with close follow-up is necessary.