Mucous membrane plasmacytosis of the upper aerodigestive tract. A case report with effective treatment

An Uncommon Case of Plasma Cell Mucositis of the Tongue in a Young Man

Plasma cell mucositis (PCM) is an unusual plasma cell proliferative disorder of the upper aerodigestive tract. It is a rare disease, and its etiology is not yet known with variable clinical features. Symptoms include dysphagia, oral pain, and swelling. We described a case of PCM involving the tongue of a 14-year-old man. In the first place, several diagnostic hypotheses were proposed, most of them discarded for incompatibility with blood and laboratory tests. This disease rarely manifests itself on the tongue, especially in young patients with no comorbidities. The management of PCM is mainly aimed at reducing the symptoms, and in our report, the treatment involved the use of systemic prednisone with an improvement of the quality of life. At 1-year follow-up, there was no recurrence of the disease. Many therapeutic treatments are able to stabilize but not able to induce a complete remission. PCM is considered an uncommon benign disorder with a favorable prognosis and should be considered in the differential diagnosis with other inflammatory or neoplastic conditions.

Laryngeal mucous membrane plasmacytosis with 15 year follow-up: Case report and literature review

Mucous membrane plasmacytosis (MMP) is an uncommon variant of mucositis represented by a polyclonal plasma cell infiltration of mucosal tissue. Various clinical presentations in the upper airway have been reported ranging from erythematous mucosa to fungating masses. Histologic features include mucosal epithelial hyperplasia or psoriasiform changes with a dense submucosal infiltrate of polytypic plasma cells. Molecular studies for immunoglobulin gene rearrangement should be performed in all cases of MMP to rule out clonal neoplastic expansion of plasma cells. We present a case of MMP with over 15 years of clinical follow-up, emphasizing the relatively benign clinical course of this disorder.

Circumorificial plasmacytosis/plasma cell orificial mucositis: a case series and a review of the literature

Circumorificial plasmacytosis is a rare plasma cell proliferative disorder of the orificial mucous membranes. The etiology is unknown, and there are no reported effective treatments to date. We report three cases of idiopathic circumorificial plasmacytosis with varying clinical presentations and responses to treatment, including a first reported case of resolution with adalimumab therapy.

Are plasma cell-rich inflammatory conditions of the oral mucosa manifestations of IgG4-related disease?

Aim

The aim of this study was to characterise plasma cell infiltrates, in terms of IgG4 positivity, in specific and non-specific plasma cell-rich chronic inflammatory conditions of the oral mucosa. Exploring the possibility that specific plasma cell-rich oral inflammatory conditions have association with or represent an oral manifestation of immunoglobulin G4-related disease (IgG4-RD).

Methods

Ten patients with plasma cell-rich chronic inflammatory conditions of the oral mucosa were identified (seven—plasma cell mucositis and three—non-specific diffuse oral mucosal inflammation with ulceration). For each patient, the clinical record and H&E-stained sections were reviewed. Immunohistochemistry for IgG and IgG4 antibodies was performed on sections from the corresponding paraffin block, permitting calculation of the mean number of IgG4+ plasma cells per high-power field (HPF) and the IgG4+/IgG+ plasma cell ratio.

Results

In all the cases, only one histological hallmark of IgG4-RD—a dense lymphoplasmacytic infiltrate—was seen. Review of the medical histories did not reveal any features representing other manifestations of IgG4-RD. The number of IgG4+ plasma cells exceeded 100 per HPF in half of the cases. Only two cases had an IgG4+/IgG+ plasma cell ratio of >40%; both of which were in the non-specific oral inflammatory group.

Conclusions

Our study suggests that plasma cell mucositis does not meet microscopic criteria for IgG4-RD. It importantly reinforces the opinion that IgG4+ plasma cells are major components of chronic inflammation in the oral cavity and the pertinence of correct contextual interpretation of histopathological features with clinical findings.

Plasma cell mucositis with gingival enlargement and severe periodontitis

Plasma cell mucositis (PCM) is a very rare, chronic, multifocal, idiopathic, non-neoplastic plasma cell proliferative disorder of the upper aerodigestive tract. The classic clinical presentation is an intensely erythematous mucosa with surface changes described variously as papillomatous, cobblestone, nodular or velvety. It is a very rare condition <50 cases reported in literature. A 72-year-old male patient complained of sore throat, stomatodynia, dysphagia, multiple oral ulcers, enlarged swollen bleeding gums and mobile teeth. There was chronic inflammatory enlargement of the gingiva and palate with severe periodontitis. Histopathological examination revealed a hyperplastic epithelium with a dense infiltrate of mature polyclonal plasma cells in the superficial layer of the lamina propria. PCM is a diagnosis of exclusion, to be differentiated from other infective, reactive, autoimmune, allergic and neoplastic disorders with plasma cell infiltrates. Management with surgical and immunosuppressive therapy is mostly ineffective with short remissions and frequent relapses.

Balloon dilatation to treat plasmacytosis of the supraglottic larynx

OBJECTIVE

We discuss the use of balloon dilatation to relieve supraglottic stenosis caused by mucous membrane plasmacytosis.

CASE REPORT

A 54-year-old man with a known diagnosis of mucous membrane plasmacytosis presented with dysphonia and worsening airway obstruction which required a tracheostomy. He underwent balloon dilatation of the supraglottic larynx using an angioplasty balloon within sequentially sized endotracheal tubes. This enabled successful decannulation, with minimal re-stenosis at eight-month follow up.

CONCLUSION

To our knowledge, this is the first reported case of supraglottic stenosis caused by plasmacytosis to be successfully treated using this method. We have shown that this minimally invasive technique deals effectively with a complex airway and minimises re-stenosis.

Mucous membrane plasmacytosis of the nose in a patient affected by B-cell chronic lymphocytic leukemia

Mucous membrane plasmacytosis (MMP) is a rare idiopathic condition characterized by infiltration of the mucosa by non neoplastic plasma cells. In this report we describe a case of mucous membrane plasmacytosis of the nose in a 72-year-old woman patient affected by B-cell chronic lymphocytic leukemia (B-CLL). Two different biopsies of the lesion showed diffuse plasma cell, lymphocyte and granulocyte infiltration compatible with granulation tissue. A complete exeresis of the neoplasm was performed endoscopically without complications, allowing the diagnosis of MMP; a monthly follow up was performed with no signs of local relapse 15 months after surgery. Topical steroid therapy with budesonide nasal spray was administered. There is no standardized treatment for MMP: we have reported good result of surgical approach in a unique case of nasal MMP in a patient with B-CLL; the relation between these two diseases deserves more studies.

Plasma cell mucositis of the oral cavity: report of a case and review of the literature

Plasma cell mucositis (PCM) is a rare plasma cell proliferative disorder of the upper aerodigestive tract with an unknown etiology. Including the present case, only 22 cases have been reported in the English-language literature. PCM affects adult patients at an average age of 56.6 years. Clinical features are an intensely erythematous mucosa with papillomatous, cobblestone, nodular, or velvety surface changes. Symptoms include oral pain of long duration, dysphagia, persistent hoarseness, and pharyngitis. The majority of cases have a history of autoimmune or immunologically mediated disease. The histopathologic features of a dense, submucosal plasma cell infiltrate are not specific and must be differentiated from other reactive and neoplastic conditions. Diagnosis of PCM depends on clinical pathologic correlations. The present case was complicated by evidence of a monoclonal plasma cell population. The significance of this case is the differentiation of a benign disease from one that is potentially life threatening.

Plasma cell granuloma of the oral mucosa with angiokeratomatous features: a possible analogue of cutaneous angioplasmocellular hyperplasia

We report a plasma cell granuloma arising in the movable mucosa of the oral cavity of a 50-year-old man. Histologically, the lesion was characterized by a dense nodular infiltrate of mature plasma cells. Immunostaining for kappa and lambda light chains confirmed a polyclonal plasma cell population. Elongated rete ridges of the overlying epithelium formed collarettes around dilated blood and lymph vessels in focal areas. Based on the overall histologic architecture, we hypothesize that these peculiar changes are secondary to local blood flow alteration with congestive vasodilation caused by a dense plasma cell infiltrate. We believe that the plasma cell population may represent the oral counterpart of the cutaneous angioplasmocellular hyperplasia.

Plasma cell mucositis: a review and case report

The simultaneous involvement of the mucous membranes of the oral cavity and upper aerodigestive tract by lesions characterised clinically by an intensely erythematous, lobulated surface and histologically by a dense connective tissue infiltrate composed of non-neoplastic plasma cells may be called plasma cell mucositis. We present a review of the literature, consisting of 14 cases, outlining the multifocal site distribution, chronicity and systemic background that distinguish this entity and report a single case with confirmation of the polyclonal nature of the plasma cell infiltrate using gene rearrangement studies.