Oral plasmablastic lymphoma: A case report

Abstract

Introduction: Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency viruses -positive patients. Oral cavity is the most commonly PBL affected site. Most oral PBLs presented as asymptomatic swellings, frequently associated with ulcerations and bleeding. Most cases lacked B-symptoms, suggesting a more local involvement of the disease. No standard treatment is yet for oral PBL. Five-year survival rate recorded no more than 33.5%.

Patient concerns: A 39-year-old male presented to Dental Clinic with 1 month swelling of the oral cavity, in absence of any other symptoms or signs. He followed antibiotic therapy just on suspicion of an oral abscess and later oral surgical treatment on suspicion of bone neoplasm.

Diagnosis: Surgical specimen analysis highlighted a diffuse infiltrate of large-sized atypical cells with plasmablastic appearance and plasma cell phenotype. Oral cavity PBL was diagnosed. Blood tests recorded mild lymphopenia and positive human immunodeficiency viruses serology.

Interventions: Patient underwent chemotherapy including intrathecal methotrexate prophylaxis, in addition to a highly active antiretroviral therapy.

Outcomes: At 12 months from diagnosis, patient recorded complete hematological remission.

Conclusions: Oral PBL diagnosis requires a high level of suspicion and awareness both by physicians and pathologists. They should be aware of the extent of such disease which is often mistaken as oral abscess or infected tooth, thus leading to delay the most appropriate diagnostic evaluation. As PBL is an aggressive non-Hodgkin lymphoma, a delayed diagnosis might negatively impact on both treatment and survival.

Figure 1

Clinical image at diagnosis highlights the lesion of the oral cavity.

Figure 2

A dental panoramic radiography revealed a lesion of the upper left dental arch.

Figure 3

Clinical image at follow-up highlights the outcome of oral surgical treatment.

Figure 4

Histology highlights a diffuse infiltrate of large-sized atypical cells with a plasmablastic appearance.

Figure 5

Left The neoplastic cells expressed a plasma cell phenotype, being positive for CD138. Right In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNA (EBER) yielded a positive result in the neoplastic cells.