Plasmablastic lymphoma of gingiva mimicking a reactive lesion: a case report

Analysis of Discrepancy Index between Clinical and Histopathological Diagnosis of Oral Lesions

OBJECTIVE

To analyze the discrepancy index between the clinical and histological diagnosis of oral lesions.

MATERIALS AND METHOD

A sample of 910 cases from year 2013-2021 were analyzed using non probability convenience sampling technique. This included patient records and histopathological reports of patients treated at IIDC & H and FUCD & H. Clinical presentations were classified under five categories; growth/swelling, vesico-ulcerative, white, red/pigmented, and cystic lesions. To evaluate the details of diagnostic discrepancies, the data was categorized into 4 major groups: 1) Neoplastic-Neoplastic,2) Non-Neoplastic-Non-Neoplastic ,3) Neoplastic-Non-Neoplastic and 4) Non-Neoplastic-Neoplastic. The association between clinical diagnosis and histopathological diagnosis was calculated by using pearson chi square test and statistical significance was considered with the p value less than (0.05).

RESULTS

Most common clinical presentation was swelling/growth; 601 (66%), followed by ulceration; 223 (24.5%). There were 528 (58%) incisional and 382 (42%) excisional biopsies. The definitive diagnosis based on histopathological findings showed malignant neoplasms as the commonest category; 287 (31.5%) followed by inflammatory/reactive lesions 271 (29.8%). A consensus was noted between the clinical and histologic diagnosis in 74.8% cases, while a discrepancy index of 25.1 % was calculated. Regarding diagnostic discrepancy among four major categories of our research, maximum discrepancy was noted in neoplastic-nonneoplastic category (29.6%) and minimum discrepancy was noted in malignant - benign category (2.7%).  Statistically significant difference between the clinical and histopathological diagnosis was observed with a p value of 0.000.

CONCLUSION

Considerable amount of diagnostic discordance was observed in all types of pathologies analyzed in the study.

Top Ten Lymphoproliferative Lesions Not to Miss When Evaluating Oral Ulcer Biopsies

BACKGROUND

Oral ulcers represent a full thickness loss of the mucosal epithelium leading to exposure of the submucosal connective tissue. These are common and usually self-limited lesions, although they may sometimes result from neoplasms, most commonly squamous cell carcinoma. Lymphoproliferative disorders may be difficult to diagnose in apthous ulcers since they mimic reactive inflammation.

METHODS

This review presents ten rare oral lymphoid proliferations which should not be missed when assessing oral ulcer biopsies.

RESULTS

The ten lesions include several with diagnostic cells which look similar to the histiocytes of a reactive inflammatory ulcer, including Rosai-Dorfman disease, reticulohistiocytoma, Langerhans cell histiocytosis, and traumatic ulcerative granuloma. Other lesions, such as EBV-positive mucocutaneous ulcer, extranodal marginal zone lymphoma of mucosal-associated lymphoid tissue, and plasmablastic lymphoma have lymphoid and/or plasma cell differentiation that mimic the reactive lymphocytes and plasma cells found in reactive ulcers. Two dendritic cell lesions, follicular dendritic cell sarcoma and blastic plasmacytoid dendritic cell neoplasm, both have distinct phenotypes which are required to make an accurate diagnosis.

CONCLUSION

Each of these lesions are diagnosed by evaluating their histology, along with their phenotypic profile, which is sometimes enhanced by pertinent molecular findings.

Therapy related complications in plasmablastic lymphoma in immunocompetent individual

BACKGROUND

Plasmablastic lymphoma (PBL) is a rare and aggressive subtype of diffuse large B-cell lymphoma seen in immunocompromised individuals. It has a diffuse growth pattern, with no standard therapy and a poor survival rate. Due to overlap in presenting features with lymphoma and myeloma, PBL is often a diagnostic dilemma. We present a case of PBL in a young immunocompetent female who developed treatment associated complications.

CASE REPORT

A 36-year-old presented with a lesion extending from the oral cavity to the pharynx and involving the angle of the mandible. Radiology and laryngoscopy described a growth pattern that was diagnosed to be PBL on histopathology. The patient underwent chemotherapy using level II DA-EPOCH (dose-adjusted-etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) and prophylactic granulocyte-colony stimulating factor along with radiotherapy and ultimately, achieved metabolic response. However, she developed several episodes of paralytic ileus, cytopenia, oral ulcers, dermatitis and long-standing hypothyroidism as therapy-related complications and has been on treatment for the same ever since.

CONCLUSIONS

Thus, a high index of suspicion is necessary for early diagnosis and rapid initiation of therapy. Further, there is a need to detect and address therapy related complications early to prevent long-standing, therapy-related side effects from developing and deteriorating the patient's quality of life.

A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses

INTRODUCTION

The jaw can be affected by several lesions that manifest in the oral cavity, but little is known about their distribution patterns in various populations.

AIMS AND OBJECTIVES

This study presents the frequency and distribution of biopsied jaw lesions recorded in Faculty of Dentistry and gathers the information including provisional and final diagnosis of the lesions.

MATERIAL AND METHODS

Biopsy of 1938 lesions (2008-2013) was reviewed and 1473 lesions were included in this study. The provisional diagnosis and histopathological validations of lesions were compared. Data on the location of the lesion, as well as patient demographics, were also evaluated. The lesions were divided into three major groups as 1 - developmental/reactive and inflammatory lesions of the jaw, 2 - cystic lesion and 3 - tumor and tumor-like lesions.

STATISTICAL ANALYSIS

The variables were recorded and analysed using descriptive statistics.

RESULTS AND OBSERVATIONS

Three hundred and ninety-six lesions were in Group 1 and periapical granuloma was the most frequent diagnosis. Seven hundred and eighty-nine lesions were in Group 2 and the radicular cyst was the most frequent diagnosis. Two hundred and eighty-eight lesions were in Group 3 and the keratocystic odontogenic tumor was the most frequent. Two hundred and ninety-one biopsied lesions were in disagreement with respect to the diagnoses on clinical and histopathological examination.

CONCLUSION

Consequently, a provisional diagnosis of some of the malignant lesions was reactive, inflammatory, cystic or benign lesions, therefore the importance of evaluation of the specimen is emphasized.

Gingival Anaplastic Large-Cell Lymphoma Mimicking Hyperplastic Benignancy as the First Clinical Manifestation of AIDS: A Case Report and Review of the Literature

This paper presents an unusual case of gingival ALCL, which mimicked a benign hyperplastic lesion that occurred in a 57-year-old white man representing the first clinical manifestation of acquired immunodeficiency syndrome (AIDS). The patient was referred to the Dental Clinic of PUCPR complaining of a lobulated nodule on the gingiva of his upper central incisors. The presence of advanced chronic periodontitis and dental plaque raised suspicion for a benignancy. An excisional biopsy was performed, and large pleomorphic cells with an abundant cytoplasm, sometimes containing prominent nucleoli and “Hallmark” cells, were observed through hematoxylin and eosin staining. The tumor cells showed strong CD30 expression, EMA, Ki-67, and LCA, and negative stain for p80^NPM/ALK, CKAE1/AE3, CD20, CD3, CD56, and CD15. The final diagnosis was ALCL (ALK-negative). Further laboratory tests revealed positivity for human immunodeficiency virus (HIV). The patient was submitted to chemotherapy, but four months after diagnosis, the patient died due to pneumonia and respiratory failure. Oral anaplastic large-cell lymphoma (ALCL) is a rare disorder. Only 5 cases involving the gingiva have been reported, and to our knowledge, this is the first case reported of the ALCL, which mimicked a hyperplastic benignancy as the first clinical manifestation of AIDS.