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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
CASE REPORT Table of Contents   
Year : 2004  |  Volume : 8  |  Issue : 2  |  Page : 91-93
 

Plasmacytoma of the oral cavity associated with HIV infection - Causal or casual coincidence?


Department of Oral Pathology, Government Dental College, Calicut, India

Correspondence Address:
Resmi G Nair
Department of Oral Pathology Government Dental College, Calicut 673008
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

The incidence of plasma cell neoplasms is increasing nowadays in HIV positive patients. But plasmacytoma presenting as an oral manilestation of HIV infection has not yet been reported in the literature. Here, we report an HIV positive patient with an extramedullary plasmacytoma in the oral cavity. Chronic antigenic stimulation is probably the reason for the development or a malignant B cell clone. which can be implicated in its pathogenesis. Futher studies are required to elucidate the exact pathology of this condition.


Keywords: HIV, plasma cell, plasmacytoma, neoplasia.


How to cite this article:
Nair RG, Sudha S, Shameena P M, Ipe VV. Plasmacytoma of the oral cavity associated with HIV infection - Causal or casual coincidence?. J Oral Maxillofac Pathol 2004;8:91-3

How to cite this URL:
Nair RG, Sudha S, Shameena P M, Ipe VV. Plasmacytoma of the oral cavity associated with HIV infection - Causal or casual coincidence?. J Oral Maxillofac Pathol [serial online] 2004 [cited 2020 Feb 18];8:91-3. Available from: http://www.jomfp.in/text.asp?2004/8/2/91/40974



   Introduction Top


AIDS is a retroviral disease characterized by profound immunosuppression that leads to opportunistic infections, secondary neoplasnn. and neurologic manifestations.

The common malignancies associated with HIV infection are kaposi sarcoma, Non Hodgkin's lymphoma and Squamous cell carcinoma. Plasma cell neoplasms are increasingly reported in association with HIV infection [1],[2],[3] . But plasmacytoma of the oral cavity associated with HIV infection has not been reported so far. We report a case of an extramedullary plas,acytoma of the oral cavity occurring in a young HIV positive individual


   Case Report Top


A 36 year old male patient reported to the Department of Oral Pathology and Microbiology with a complaint of growth in the palate in 17, 18 region of 2weeks duration..

Intraoral examination revealed a firm non-tender;:rowth of size 1.5x I sq. cm in palate in 17.18 region 17& 18 showed grade Ill mobility. Mucosa overlying the growth was normal [Figure 1]. Radiographic findings were normal.

A provisional diagnosis of pyogenic granulona was made and patient was advised for at , excisional biopsy and extraction of 17& 18.

Macroscopically, the growth appeared to be attached to the tooth extending full length from cervical region to the tool apex. [Figure 2] .

Since the patient complained of progressive weight loss and Iethargy since I month and on interrogation gave the history of receiving a blood transfusion 5 years back, he was advised an HIV screening. He was diagnosed to be HIV positive.

Routine blood Investigations were normal.


   Histopathology Top


Microscopically the honour is compused of sheets of densely packed round and oval cells in a relatively sparse stroma. The neoplastic cells have large, single eccentric nucleus, resembling a typical plasma cell. Cells with double nuclei and abnormal mitotic figures were also seen [Figure 3],[Figure 4],[Figure 5].

Peripheral Smear

RRCs were normochromic and normocytic, WBC normal with increased polyalorphs and Platelets were normal. No abnormal cells were seen.

Skeletal survey showed no lytic lesions. Urine was negative for Bence Jones Protein. Bone marrow study and serum protein electrophoresis continued the diagnosis as plasmacytoma.


   Discussion Top


The increased risk of developing a plasma cell neoplasm in HIV infected individuals is multifactorial. It mav be related to their immune dysregulation, chronic antigenic stimulation from HIV and other infections, raised interleuk in 6 levels, and disorganization of the bone marrow micro-environment [3],[3] . HIV infected persons presenting with a plasma cell malignancy tend to be younger(approximately 33 years) than their non-HIV counterparts (50-75yrs) [13] they also have a propensity to develop more atypical and aggressive tumours. The afflicted patients may develop a hyperviscosity syndrome [5],[14] , intractable hypercalcemia [6] . present with Multiple extramadullary plasmacytomas in unusual locations like breast. liver & testis [10],[12] and may marilest with large malignant effusions containing atypical plasma cells [9] or plasma cell leukaemia [7] .

Some HIV related plasma cell malignancies appear to exhibit anaplastic cytomorphology [I5] and may resemble plasmablastic lymphoma. a newly described HIV related NHL. [1],[2],[4] . Here we report a case of plasmacytoma occurring in the oral cavity. But whether it is caused by HIV infection or it is only a casual coincidence cannot be documented. There are reports in literature about plasma cell neoplasins in HIV positive patients [5],[1] : none of which have mentioned about oral plasmacytoma. It is clear from literature that most of the case, of plasma cell neoplasms are reported in young patients and the present case correlates with them. So in our case it may be presumably caused by HIV rather than a casual coincidence.

It could be speculatcd that such unusual presentation of plasmacytoma may be caused by chronic antigenic stimulation.

This is probably the first case report of unusual presentation ofplasmacytuma in HIV positive patient in the oral cavity.


   Summary and Conclusion Top


Plasma cell neoplasia appears to have an increased incidence in patients infected with HIV. The etiology of HIV related plasma cell ueoplasia appears to be chronic antigenic stimulation. However, additional studies are required to elucidate the exact pathology of these plasma cell disorder. A rare case report of plasmacytoma in the oral cavity in an HIV patient has been presented. Clinical, histopathologic, radiographic, bone marrow studies, and serum protein electrophoresis are considered collectively in establishing the diagnosis. To conclude we recommend that voting patients presenting with extramedullary plasmacytoma even of the oral cavity, should undergo testing for HIV infection.[15]

 
   References Top

1.Brown RS,Campbell C,Lishman SC, Spittle MF,Miller RF, Plasmablastic lymphoma: a new subcategory of human immunodeficiency virus related non-Hodgins lymphoma.Clin Oncol( Rcoll Radiol),1988;10:327-329.  Back to cited text no. 1    
2.Carbone A,Gaidone G,Gloghini A,Ferlito A,Rinaldo A,Stein H,AIDS related plasmablastic lymphomas of the oral cavity and jaws; a diagnostic dilemma.Ann Otol Rhinol Laryngol,1999;108;95-99.  Back to cited text no. 2    
3.Carraway H,Ambinder RF.Plasma cell dyscrasia,Hodgkin lymphoma,HIV, and Kaposi sarcoma-associated herpesvirus. Curr Opin Oncol,2002,14:543-545.  Back to cited text no. 3    
4.Chetty R,Hlatswayo N,Muc R,Sabaratnam R,Gatter K, Plasmablastic lymphoma in HIV+patients: an expanding spectrum.Histopathology,2003;42;605-609.  Back to cited text no. 4    
5.Gold JE,Schwam L,Castella A,Pike SB,Opfell R,Zalusky R. Malignant plasma cell tumors in human immunodeficiency virus infected patientCancer 1990;66;363-368.  Back to cited text no. 5    
6.Herranz S,Sala M,Cervantes M,Sasal M,Soler A,Segura F.Neoplasia of plasma cells with a typical presentation and infection by the human immunodeficiency virus.A presentation of two cases.Am J Hematol,2000;65:239-242.  Back to cited text no. 6    
7.Heuberger L,Costello RT,Petit N,Fripiat F,Gastaut JA,First case of plasma cell leukaemia co-existing with human immunodefiency virus infection Leukemia,1998;12;103-104.  Back to cited text no. 7    
8.Jin DK Nowakowski M,Kramer M,Essex DW.Hyperviscosity syndrome secondary to a myeloma associated IgG(1)kappa paraprotein strongly reactive against the HIV-1 p24 gag antigen. Am J Hematol,2000;64:210-213.  Back to cited text no. 8    
9.Kumar S,Kumar D, Schnadig VJ,Selvanayagam P,Slaughter DP. Plasma cell myeloma in patients who are HIV-Positive. Am J Clin Pathol,1994;102:633-639.  Back to cited text no. 9    
10.Lallemand F,Fritsch L,Cywiner-Golenzer C,Rozenbaum W.Multiple myeloma in an HIV positive man presenting with primary cutaneous plasmacytomas and spinal cord compression. J Am Acad Dermatol,1998;39;506-508.  Back to cited text no. 10    
11.Liron pantanowitz, Bruce Beckwith, Bruce J Dezube HIV associated plasma cell neoplasia HIV AIDS Rev,2004;3(1);47-50.  Back to cited text no. 11    
12.Miranda EG,Iravani S,Doll DC.Unusual presentations of malignancy. Case 2.Breast Plasmacytoma in a patient with uman immunodeficiency virus J Clin Oncol,2001;19;3290-3291.  Back to cited text no. 12    
13.Pantanowitz L,Dezube BJ,Multiple myeloma and HIV infection casual or casual coincidence?AIDS Read,2003;13:386-387.  Back to cited text no. 13    
14.Paul B,Houston S,Latif AS,HIV infection associated with the plasma hyperviscosity syndrome: a report of two fatal cases.AIDS,1990;4;1302-1304.  Back to cited text no. 14    
15.Stewart JM,Krishnamurthy S,Fine-needle aspiration cytology of a case of HIV associated anaplastic myeloma.Diagn Cytopathol 2002;27;218-22.  Back to cited text no. 15    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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    Abstract
    Introduction
    Case Report
    Histopathology
    Discussion
    Summary and Conc...
    References
    Article Figures

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