Plasma Cell Gingivitis Mimicking Granulomatous Disease: A Diagnostic Dilemma

Abstract

Introduction:Plasma cell gingivitis is an uncommon benign inflammatory condition of the gingiva which is considered to arise as a hypersensitivity reaction to certain allergens. The distinguishing feature of this condition is massive infiltration of plasma cells into the subepithelial connective tissue. This case report discusses a case of plasma cell gingivitis which produced a diagnostic dilemma due to its unusual histopathologic appearance.Case Presentation: A 13-year-old female patient presented with diffuse gingival enlargement in relationship to upper anterior teeth. The case was managed successfully by gingivectomy following phase I therapy. Histopathological examination showed presence of epithelioid granulomas and foreign body giant cells along with plasma cells which is an uncommon finding in plasma cell gingivitis. Further tests conducted excluded granulomatous disease and the diagnosis was confirmed as plasma cell gingivitis. Conclusion:Plasma cell gingivitis can present a diagnostic dilemma and should be included in the differential diagnosis of patients presenting with non-specific gingival enlargements.

Plasma Cell Gingivitis Treated with Photobiomodulation, with No Recurrence for a Five-Year Follow-Up

“…PCG is an extended form of plasma cell mucositis of unknown etiology. Only in some patients is it possible to recognize a specific irritant cause that could favor the disease, with consequent remission of the disease after removal [1,2,4,6,7]. The role that bacterial plaque plays in the etiology of the disease is not Although the lesions often appear in anatomical areas compatible with plaque-induced gingivitis, patients generally do not have significant indices of periodontal inflammation, but a general condition of periodontitis is associated [1,2,4,12].…”

“…PCG is histologically characterized by a prevalent plasma cell infiltrate near the basement membrane, associated with spongiosis, and marked exocytosis [4,6,7,9,15,[17][18][19][20]. The histopathological examination is fundamental because this pathology must be placed in a differential diagnosis with chronic non-plaque dependent gingivitis, atrophic-erosive gingivitis, bullous gingivitis, and possible plasma cell neoplastic infiltrates [4,6,7,9,15,[17][18][19][20].…”

“…PCG is an extended form of plasma cell mucositis of unknown etiology. Only in some patients is it possible to recognize a specific irritant cause that could favor the disease, with consequent remission of the disease after removal [ 1 , 2 , 4 , 6 , 7 ].…”

“…The clinical-objective features are represented by erythematous mucous membranes with intense red color, velvety, edematous, and delimited by the surrounding mucosa. These lesions are accompanied by painful symptoms, burning, and frequent bleeding [1,[4][5][6][7].…”

“…The diagnosis is fundamentally histopathological. In differential diagnosis, there are chronic gingivitis non-plaque dependent, atrophic erosive, bullous gingivitis, and possible plasma cell neoplastic infiltrates [ 3 , 4 , 6 ]. Furthermore, PCG could mimic a wide range of life-threatening entities, such as squamous cell carcinoma, autoimmune mucocutaneous bullous diseases, and lymphoproliferative disorders [ 1 , 2 , 4 , 8 , 9 ].…”