An Aggressive Plasmablastic Lymphoma of the Oral Cavity as Primary Manifestation of Acquired Immunodeficiency Syndrome: Case Report and Literature Review

Abstract

Introduction Plasmablastic lymphoma is a rare entity that was first described in the jaws and the oral cavity of patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Plasmablastic lymphoma is considered as a diffuse, large, B-cell lymphoma with a unique phenotype and a predilection for the oral cavity. Objective The authors describe a case of an aggressive plasmablastic lymphoma of the oral cavity as the primary manifestation of AIDS. Resumed Report We report a case of plasmablastic lymphoma involving only the oral cavity as the first manifestation of AIDS. Diagnosis was confirmed by the oral lesion biopsy and the histopathologic examination that showed a dense infiltrate composed of atypical lymphocytes with numerous plasmocytes that expressed the plasma cell markers MUM-1 and CD138 and that were negative for the B-cell markers CD3, CD20, and CD45. Immunohistochemical and in situ hybridization revealed the Epstein-Barr virus genome in the atypical cells. Polymerase chain reaction was also positive for human herpesvirus-8 RNA. Conclusion The HIV serologic status should be evaluated in all patients with plasmablastic lymphoma of the oral cavity or extraoral sites.

Keywords: AIDS; HIV; oral cavity; plasmablastic lymphoma.

Fig. 1

Initial clinical appearance: a large, nonfluctuant, necrotizing, and ulcerated gingival lesion located at the right upper jaw, the gingiva, and the palate.

Fig. 2

The large initial lesion including dental pieces at the right upper jaw, with infiltration of the palate and the gingiva.

Fig. 3

Axial computed tomography scan of the head and face showing a large and heterogeneous mass with areas of necrosis and a partial occupation of the cavum.

Fig. 4

Coronal computed tomography scan of the maxillofacial region revealed a large mass with areas of necrosis involving the upper right gingival and the right hard palate with bone erosion of the upper jaw.

Fig. 5

Oral mucosal lesion biopsy revealed the existence of an atypical and dense infiltrate, relativity uniform, composed of large cells with a moderate cytoplasm, an eccentric nuclei, and one or more large nucleoli. Also, it is possible to see a variable number of small cells with plasmacytic appearance, consistent with the diagnosis of high-grade non-Hodgkin lymphoma. Hematoxylin and eosin, ×200.

Fig. 6

Immunohistochemical phenotype of plasmablastic lymphoma: the majority of cells expressed the B cell antigens CD138 and MUM1.

Fig. 7

In situ hybridization: Epstein-Barr virus-encoded RNA (EBV genome) was expressed with monomorphic cytologic features in the atypical cells.