[Two cases of post-inflammatory pseudotumors--plasma cell granuloma and histiocytoma].
Michio KatayamaHironobu SugitaJunichi MoriAkira KoyamaShinji ShishidoKazuro IwaiAkitsugu MasudaYukiko InoueYukimasa Hirata
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Plasma cell granuloma
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The first case of plasma cell granuloma (PCG) of the breast is presented. The lesion was seen as a circumscribed firm mass in the right breast of a 29-year-old woman. Histologically, a prominent plasma cell infiltrate was seen in a fibrous hyalinized stroma that contained spindle- and large stellateshaped stromal cells with bizarre nuclei. Immunohistochemical study demonstrated the polyclonal nature of the plasma cells and characterized the stromal cells as myofibroblasts. The nature of these cells was confirmed ultrastructurally. PCG of the breast should be considered analogous to inflammatory pseudotumors of the lung and extrapulmonary sites.
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Plasma cell granulomas (pseudotumors) are rare benign, tumor‐like proliferations composed chiefly of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. We report this case of a 54‐year‐old male who presented with an unusual maxillary anterior gingival overgrowth treated by excisional biopsy. Histological examination revealed a dense inflammatory cell infiltrate containing mainly plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. Intraoral plasma cell granuloma is exceedingly rare, although case reports documenting such lesions have been reported. This case highlights the need to biopsy unusual lesions to rule out potential neoplasms. J Periodontol 2001;72:1287‐1290.
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Plasma cell granuloma, also known as inflammatory pseudotumor is a tumor-like lesion that manifests primarily in the lungs. But it may occur in various other anatomic locations like orbit, head and neck, liver and rarely in the oral cavity. We here report an exceedingly rare case of gingival plasma cell granuloma in a 58 year old woman who presented with upper gingival polypoidal growth. The histopathological examination revealed a mass composed of proliferation of benign spindle mesenchymal cells in a loose myxoid and fibrocollagenous stroma along with dense infiltrate of chronic inflammatory cells predominantly containing plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma.
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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
Infiltration (HVAC)
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Plasma cell granulomas (inflammatory pseudotumors) frequently appear as localized benign tumors of the lung in patients under 30 years of age. We describe the case of a 54-year-old woman with a plasma cell granuloma originating in the left lower lobe of lung and extending into the posterior mediastinum with destruction of the T8 vertebral body and pedicle. Distinctive histologic features included granulomatous aggregation of mature plasma cells around small blood vessels and direct invasion of the posterior mediastinum with subsequent dense fibrosis and bony destruction. Immunohistochemical studies revealed polyclonal kappa- and lambda-light chains in the proliferation of plasma cells.
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Abstract: Plasma cell granuloma (PCG) is an uncommon benign tumor of unknown etiology, primarily located in the lungs. We report a case of PCG on the gingiva mimicking benign and malignant tumors in a 56-year-old woman. Histopathological examination revealed a relatively sharp circumscribed inflammatory cell infiltration under the mucosa-containing plasma cells, predominantly those including Russell bodies. Plasma cells are stained by CD138 immunohistochemistry. Polyclonal status of the lesion was confirmed by kappa and lambda light chaining. The typical histopathological and immunohistochemical findings in combination with the clinical features were consistent with PCG, about which the literature reports very few cases.
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Infiltration (HVAC)
Histopathological examination
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To the Editor.— In the X-RAY SEMINAR case, Osteoblastic Lesions of Unusual Nature (219:377, 1972) several findings cast some doubt on the diagnosis of multiple myeloma, osteosclerotic variant. The presence of multiple, discrete, purely osteosclerotic lesions, absence of dysproteinemia despite extensive disease, and the histopathologic finding of a mixture of plasma cells and lymphoid elements which Vickery noted as being an atypical picture for multiple myeloma seem to point to another diagnosis—plasma cell granuloma.1,2 There are few unequivocal cases of untreated myeloma with sclerotic bone lesions, unless complicated by fracture or amyloidosis. The histological features of plasma cell granuloma are the infiltrates of uniformly mature plasma cells with occasional Russell bodies; intermingling of other chronically inflammatory cells, mainly lymphocytes, which tend to occur in aggregates and may be missed in small biopsy specimens; and a background of fibrous tissue. Plasma cell granuloma will not recur if completely excised,
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Plasma Cell Myeloma
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The first case of an intracranial plasma cell granuloma is presented. An associated polyclonal gammopathy was another remarkable feature. Routine and special stains of histologic sections as well as electron microscopy characterized such lesions. Immunofluorescent studies revealed a heterogeneous population of plasma cells. When the granuloma was removed, the polyclonal gammopathy resolved, and neither have recurred with eight months of follow-up. It is suggested that prior reports of meningiomas with conspicuous plasma cell-lymphocytic components may in reality be plasma cell granulomas and could be differentiated by electron microscopy.
Plasma cell granuloma
Polyclonal antibodies
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Plasma cell granuloma
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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 but its intraoral occurrence is a rarity. This case report represents one of the uncommon locations in the oral cavity affected by plasma cell granuloma, its clinical and histological features, and establishes the differential diagnosis with other malignant or benign disease entities and planning the treatment accordingly. This report discusses the diagnostic enigma and the associated terminology of plasma cell granulomas and reinforces the need for performing biopsy and a histopathological or immune histochemical study, irrespective of the clinical features and clinical diagnosis of the lesion. In this case a 52-year-old female, presented with gingival enlargement in the mandibular anterior region, treated by excisional biopsy. Histological evaluation revealed plasma cell infiltrates in the connective tissue. The immune-histochemistry revealed kappa and lambda light chains with a polyclonal staining pattern, which confirmed the diagnosis of plasma cell granuloma.
Plasma cell granuloma
Pyogenic granuloma
Gingival enlargement
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