Interdisciplinary assessment and management of a patient with a fibrous gingival enlargement of unknown origin: A case report

Clinicopathological and immunohistochemical analysis of plasma cell gingivitis- A retrospective study

Background:

This study aims to describe the demographics and clinicopathological characteristics of the cases of plasma cell gingivitis (PCG) reported in our institute, supported by a review of pertinent literature. Further, we investigated the role of the cluster of differentiation CD138, Ki67, CD56, and CD117 immunoexpression in the differential diagnosis of PCG from plasma cell dyscrasias.

Materials and Methods:

All histopathologically confirmed cases of PCG, whose relevant details could be obtained, were included in this study. They were subjected to panel of immunohistochemical markers to exclude plasma cell malignancies. Further, published English literature for PCG since 1970–2020 was reviewed.

Results:

Nine histopathologically confirmed cases of PCG, were retrieved from the archives of our department. The cases comprised 3 males and 6 females with their ages ranging between 14 and 82 years. The plasma cells exhibited equivocal reactivity for kappa and lambda; and immunonegativity for CD56, CD117 with low Ki67 proliferation index. Published literature in English showed 43 cases of PCG were predominantly female; the diffuse involvement of maxilla and mandible was a common finding.

Conclusion:

In addition to kappa lambda reactivity, an immunoprofile of CD138, Ki67, CD56, and CD117 may be used as a diagnostic adjunct to exclude malignant plasma cell lesions in confusing cases.

Idiopathic Gingival Enlargement Causing Social Stigma

Gingival enlargement can be multifactorial; it can be due to nutritional deficiency or can be because of several drugs. Poor oral hygiene may further worsen the gingival hyperplasia, because of which the patient may have difficulty in chewing the food, and the speech may get affected. It may end up in psychosocial stigma for the patient as the patient is even neglected by friends or relatives due to poor oral hygiene and horrifying look of gingival overgrowth. Here, we report a case of gingival enlargement in a 22-year-old married female. The enlargement was massive, such that the teeth were barely visible in the anterior mandible. Based on history and histological findings, the case was diagnosed as idiopathic gingival enlargement. Conventional gingivectomy was planned. The patient was kept on the maintenance phase, and no recurrence was recorded. During the whole treatment phase, there was a notable change in the behavior of the patient. Surgical correction and subsequent maintenance of good oral hygiene may improve the disease condition, which in turn helps the patient in not only improving the aesthetics but also results in better social acceptance.