Spontaneous Regression Of Plasmablastic Lymphoma In An Elderly Human Immunodeficiency Virus (hiv)-negative Patient
Igawa, T., Sato, Y., Kawai, H., Kondo, E., Takeuchi, M., Miyata-Takata, T., Takata, K., & Yoshino, T. (2015). spontaneous regression of plasmablastic lymphoma in an elderly human immunodeficiency virus (HIV)-negative patient. Diagnostic pathology, 10, 183. https://doi.org/10.1186/s13000-015-0421-y
View Original Source →Abstract
Plasmablastic lymphoma (PBL) is an aggressive lymphoma commonly associated with human immunodeficiency virus (HIV) infection. Herein we describe a rare case of PBL that spontaneously regressed. An 80-year-old man was referred to our hospital owing to an exophytic gingival tumor in the right maxillary second molar region. He had no significant past medical history, and a screening test for HIV was negative. Imaging showed that the tumor measured 26 × 23 × 16 mm and was confined in the alveolar bone. The tumor was histologically comprised of highly proliferative immunoblastic cells positive for CD138 and Epstein-Barr virus (EBV)-encoded RNA. Monoclonal IgH chain gene rearrangement was detected via polymerase chain reaction. After biopsy and diagnosis of PBL, the tumor began to decrease in size and had apparently disappeared at the time of surgery. There was no histological evidence of a residual lesion in the surgical specimen. In conclusion, a minority of immunosenescence-associated PBLs in the elderly should be recognized as a unique clinicopathological entity distinct from common aggressive PBL.
Case Details
Disease Location
Gingival tumor in the right maxillary second molar region
Personal Characteristics
80 -year-old male he suffered from repeated gingival swelling of this region for 8 months before visit following a diagnosis of apical periodontitis, his right maxillary second molar was extracted 6 weeks before his visit no significant medical history, no autoimmune diseases and no immunosuppressive medication in the past
Clinical Characteristics
Plasmablastic lymphoma of the elderly (pbl-e) referred due to owing to rapid growth of of a gingival tumor in the right maxillary second molar region after an additional mucosal curettage to treat unsuccessful wound healing, the gingiva at the extraction site began to rapidly grow in size. Physical exam revealed an exophytic gingival tumor in the right maxillary second molar. This soft elastic tumor was well circumscribed and bled easily CT showed the tumor measured 26x23x16mm and was confined in the alveolar bone fdg-PET showed elevated fdg uptake in the right maxilla with a max standardized uptake value of 29.29. Biopsy showed a solid tumor with an ulcerated surface, the tumor was characterized by monomorphic neoplastic proliferation of large plasmacytoid and immunoblastic cells with prominent nucleoli ihc immunophenotyping showed neoplastic cells were positive for lca and CD138. 40% of the tumor cells expressed c-myc, and the ki-67 labeling index was <80% in situ hybridization determined ebv-encoded RNA positive clonal igh chain gene rearrangement was detected via pcr pbl-e was diagnosed and excision was scheduled. Excision occured 40 days after the biopsy the surgical specimen showed infiltration of CD138+ plasma cells and polymorphic inflammatory cells, including numerous foamy macrophages. Plasma cells expressed cytoplasmic immunoglobulin (kappa and lambda light chain) with no light chain restriction serological testing for ebv was performed 4 days after surgery, ebv-DNA was detected in whole blood via real-time pcr
Remission Characteristics
After the biopsy, the tumor began to decrease in size. Excision was performed even though the exophytic tumor had apparently disappeared 102 days after biopsy, fdg-PET showed no abnormal uptake suggesting complete clinical disappearance follow-up for 5 months shows no sign of relapse
Treatment & Mechanisms
Proposed Remission Mechanisms
Possibility of mobilization of the immune system against ebv
Clinical Treatment
Excisional biopsy
Non-Clinical Treatment
None reported