Plasma Cell Gingivitis Mimicking Granulomatous Disease: A Diagnostic Dilemma

Increased frequency of oral plasma cell mucositis/plasma cell gingivitis after the COVID-19 pandemic: a 23-year retrospective analysis and review of diagnostic challenges relating to this condition

OBJECTIVE

Oral plasma cell mucositis (PCM) or localized plasma cell gingivitis (PCG) is an idiopathic inflammatory condition often associated with hypersensitivity reactions. This study aimed to evaluate the frequency and features of PCM/PCG in a large biopsy service over a time period of more than 20 years.

STUDY DESIGN

The biopsy archives at University of Florida College of Dentistry were searched from 2000 through the first quarter of 2023 for cases of oral PCM or PCG. Case data were aggregated and analyzed.

RESULTS

A total of 107 cases were included. Between 2000 and 2019, PCM/PCG was diagnosed in 0.03% of all biopsy cases. Starting in 2020 through 2023, the percentage of biopsies diagnosed as PCM/PCG increased threefold to 0.10% of all biopsy cases, and the mean patient age increased by 3 years. There were no statistically significant differences between cases diagnosed from 2000 to 2019 and those from 2020 to 2023 regarding age, sex, location, or histology.

CONCLUSIONS

A significant increase in PCM/PCG was identified in this study at one institution coinciding with the start of the COVID-19 pandemic. Further investigation is recommended to determine if this is a widespread phenomenon and identify possible etiologic mechanisms.

Plasma Cell Gingivitis Treated with Photobiomodulation, with No Recurrence for a Five-Year Follow-Up

INTRODUCTION

Plasma cell gingivitis (PCG) is a chronic inflammatory disease usually affecting the vestibular portion of the gingival mucosa. Clinical presentation is marked by erythematous macules of intense red color, confluent, and delimited from the healthy neighboring mucosa. Generally asymptomatic, the gum lesions sometimes are accompanied by burning sensations and a sense of local tension. Recommended treatment is the use of topical steroids, but with apparent initial healing that is not stable over time. The present case report concerns a patient diagnosed with PCG in November 2017, with a five-year follow-up. This is the first patient with PCG successfully treated with non-surgical periodontal therapies associated with photobiomodulation (PBM).

METHODS

A 64-year-old male patient had intense erythema and edema on the vestibular side of the gingival mucosa area from 1.5 to 2.5. The patient's symptomatic subjectivity parameters were evaluated through dedicated questionnaires. Erythema and gingival bleeding were also evaluated. Periodontal charting was not pathological, but intense bleeding was noted. Multiple biopsies were performed, and microscopic findings confirmed the clinical hypothesis of PCG.

RESULTS

The treatment applied was PBM associated with periodontal therapy. The patient demonstrated a progressive improvement in clinical parameters considered and reported symptoms. During the five-year follow-up, no recurrence of the disease was observed.

CONCLUSIONS

The combined PBM and periodontal therapies have proved to be sufficiently effective in the control of PCG, showing reduction of the intense inflammatory, erythematous component, and gingival bleeding, and are a valid treatment alternative to topical steroids.

Clinicopathological and immunohistochemical analysis of plasma cell gingivitis- A retrospective study

Background:

This study aims to describe the demographics and clinicopathological characteristics of the cases of plasma cell gingivitis (PCG) reported in our institute, supported by a review of pertinent literature. Further, we investigated the role of the cluster of differentiation CD138, Ki67, CD56, and CD117 immunoexpression in the differential diagnosis of PCG from plasma cell dyscrasias.

Materials and Methods:

All histopathologically confirmed cases of PCG, whose relevant details could be obtained, were included in this study. They were subjected to panel of immunohistochemical markers to exclude plasma cell malignancies. Further, published English literature for PCG since 1970–2020 was reviewed.

Results:

Nine histopathologically confirmed cases of PCG, were retrieved from the archives of our department. The cases comprised 3 males and 6 females with their ages ranging between 14 and 82 years. The plasma cells exhibited equivocal reactivity for kappa and lambda; and immunonegativity for CD56, CD117 with low Ki67 proliferation index. Published literature in English showed 43 cases of PCG were predominantly female; the diffuse involvement of maxilla and mandible was a common finding.

Conclusion:

In addition to kappa lambda reactivity, an immunoprofile of CD138, Ki67, CD56, and CD117 may be used as a diagnostic adjunct to exclude malignant plasma cell lesions in confusing cases.