Value of immunohistochemistry in diagnosing a rare case of maxillofacial plasma cell granuloma masquerading as a gingival epulis.
BACKGROUND
Plasma cell granuloma is a non-neoplastic lesion rather uncommonly seen in the maxillofacial region. Its etiology, biological behavior, ideal treatment and prognosis are still unclear and rather controversial.


METHODS
A detailed histopathological examination and immunohistochemical study of the excised specimen was carried out, both for making a confirmatory diagnosis as well as to determine the etiopathology, biological behavior and prognosis of the lesion.


RESULTS
Light microscopy revealed a hyperplastic stratified squamous epithelial lining, overlying a densely fibrocellular granulation tissue containing a rich proliferation of mononuclear inflammatory cells, among which there was a predominance of plasma cells with their typical eccentric, cartwheel shaped, "clock-faced" nuclei. Strong immunohistochemical positivity was observed for CD-138 by numerous cells of the connective tissue of the lesion, thus confirming them to indeed be plasma cells. Further, immunohistochemistry (IH) analysis also demonstrated the expression of both, the lambda and kappa light chain immunoglobulins by the plasma cell population, thus confirming them to be polyclonal and of an inflammatory, non-neoplastic origin.


CONCLUSIONS
As a plasma cell granuloma is rarely encountered in the oral and maxillofacial region, its diagnosis could have been very easily missed, had it not been for the detection of the large numbers of plasma cells by light microscopy, which was further confirmed by IH. IH also helped in establishing the likely etiopathology of the lesion and confirmed it to be of a non-neoplastic reactive/inflammatory origin.
Oral and Maxillofacial Surgery, Command Military Dental Centre (Southern Command), Pune, 411040 India.
Priya
P
Jeyaraj
Oral and Maxillofacial Surgery, Command Military Dental Centre (Southern Command), Pune, 411040 India.
T K
TK
Bandyopadhyay
Department of Oral Pathology, AFMC, Pune, 411040 India.
Nitesh
N
Naresh
Department of Dental Surgery, AFMC, Pune, 411040 India.
N K
NK
Sahoo
CD-138; Immunohistochemistry (IH); Kappa and lambda light chain immunoglobulins; Plasma cell granuloma; Plasma cells