Cutaneous Plasmacytosis

Primary cutaneous plasmacytosis successfully treated with topical corticosteroids and psoralen plus ultraviolet A: A case report

We present a case of primary cutaneous plasmacytosis without systemic involvement. The patient received topical corticosteroids and psoralen plus ultraviolet A therapy, showing significant improvement. Continuous monitoring is underway despite the rarity of systemic manifestations.

Cutaneous plasmacytosis Characterized by Head Plaques: An Unusual Case Report of a 57-Year-Old Male

Cutaneous plasmacytosis (CP) is a rare disorder of uncertain etiology. We report an unusual and rare case of CP in a 57‑year‑old male who presented with popular nodules all over the body, accompanied by head plaques. Pathological biopsy of the skin revealed large infiltration of mature plasma cells within the dermis. Elevated serum IgG4 concentrations were found. Immunohistochemical analysis confirmed the polyclonal nature of the plasma cells. The diagnosis of CP was established. Steroid therapy was administered at a dose of 20 mg/day. After 1 month of treatment, the patient's eruption showed regression. These findings remind dermatologists to include CP in their clinical differential diagnosis of patients with head plaques. Meanwhile, clinicians should carefully that individuals diagnosed with CP at risk for malignant transformation.

Pitfalls and Challenges in Oral Plasma Cell Mucositis: A Systematic Review

Plasma cell mucositis (PCM) is an unusual idiopathic disorder characterized by dense infiltrates of plasma cells in submucosa. Clinical phenotypes of oral plasma cell mucositis (o-PMC) are heterogenous. A systematic review has been conducted, aiming to synthesize the available evidence on o-PCM. Literature search, study design, and data analysis were performed following PRISMA guidelines. The SPIDER and the PICO tools were used to structure the research question. In all, 79 case reports and 19 case series on a total of 158 patients (85 females and 73 males; average age: 44.1 years) were identified. Among oral sites involved, gingiva (65.82%) was the most frequent site. The main clinical phenotype was erythema (99.37%). In relation to symptoms, pain (60.76%) was the most reported. On histological examination, all samples showed a dense inflammatory infiltration with predominant plasma cells. The treatment regimens of o-PCM were summarized in six groups: irritant removal; topical/systemic corticosteroids; topical/systemic immunosuppressants/immunomodulators; surgery and similar treatments; radiotherapy and chemotherapy; other therapies, such as antifungals, antibiotics, and antivirals drugs. This is the first systematic review aimed to synthesize the findings of studies on o-PCM. The lack of universally shared information on etiological factors and the absence of international consensus of pharmacological protocols make o-PCM a diagnostic and therapeutic challenge.

Cutaneous Reactive B-cell Lymphoid Proliferations

Cutaneous lymphoid hyperplasia (CLH), also known as cutaneous pseudolymphoma, is a spectrum of benign conditions characterized by reactive B- and T-cell cutaneous lymphocytic infiltrates. B-cell lymphoid proliferations are a heterogenous group of non-neoplastic cutaneous diseases that must be histopathologically distinguished from cutaneous B-cell lymphomas. These proliferations can be observed as reactive phenomena to infections, medications, allergens, neoplasms, and more. Further, there are many inflammatory conditions that present with reactive B-cell infiltrates, including actinic prurigo, Zoon balanitis, Rosai-Dorfman, and cutaneous plasmacytosis. This review summarizes multiple cutaneous B-cell lymphoid proliferations within the major categories of reactive and disease-associated CLH. Further we discuss major discriminating features of atypical CLH and malignancy. Understanding the specific patterns of B-cell CLH is essential for the proper diagnosis and treatment of patients presenting with such lesions.

Unusual presentation of maxillary plasma cell gingivitis mistakenly treated as aggressive periodontitis. (A case report)

Introduction

A rare benign inflammatory condition of gingiva of unknown etiology, characterized by diffuse and massive infiltration of plasma cells into the sub-epithelial gingival tissue. Plasma Cell Gingivitis (PCG) is characterized by macular lesions that are bright red, velvety, sharply circumscribed, and flat to slightly elevated.

Presentation of case

Female patient 38 years old, complain of mobility of upper right 7 with dull pain and swelling related to it. She also mentioned that the upper wisdom molar at the same side was extracted a year before due to the same reason. Extraction of upper right 7 and excisional biopsy of surrounding soft tissue swelling and by laboratory investigation and analysis to the biopsy we found that the lesion is gingival plasmacytosis. Microscopic examination revealed marked squamous hyperplasia with focal ulceration and diffuse dense subepithelial plasmacytic infiltrate consistent with PCG. At higher magnification, plasma cells were seen without cellular atypia. The individual plasma cells had eccentric round nuclei with cartwheel chromatin patterns and abundant cytoplasm.

Discussion

In the current report, the surgical team performed complete scaling and root planning to remove the associated plaque to decrease any chance of recurrence or plaque induced exacerbation. The patient was instructed to change her habits to avoid the possibility of exacerbation by unknown allergen. The lesion was excised by enblock removal to decrease recurrence possibility.

Conclusion

Plasma cell gingivitis needs radical management and a thorough diagnosis should be done to rule out and differentiate it from the malignant type of plasma cell tumors like multiple myeloma.

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The abnormal presentation of the lesion

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The management of plasma cell gingivitis

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The discussion of different treatment objectives

Clinico-Pathological Profile and Outcomes of 45 Cases of Plasma Cell Gingivitis

Plasma cell gingivitis (PCG) is an infrequent inflammatory disease of the gingiva of unknown etiology, characterized by a dense polyclonal proliferation of plasma cells in the connective tissue. The aim of this study was to present a case series of patients affected by PCG, analyzing demographic, clinical, histopathological, and therapeutic data. A group of 36 females and 9 males with a mean age of 60.3 years was evaluated. Clinically, 25 cases were bullous, a clinical phenotype never reported to date, 4 erythematous, 4 keratotic, 4 verruciform, and 3 ulcerative. On histological examination, pure polyclonal plasma cell infiltrate was detected in 20 specimens, while in 25 specimens it was associated with a mixed infiltrate. The first-line therapy consisted of oral hygiene and topical corticosteroids in all patients. In 25 patients, doxycycline and sulfasalazine were added; in 10 of these patients, the disease persisted, and it was necessary to resort to systemic steroids. This study presented the clinico-pathological profile and outcomes of a case series of PCG. This could be an aid for clinicians to be aware of the heterogeneous clinical phenotype and of the possible pure bullous phenotype of PCG. Further studies are needed to improve the knowledge about this disorder.

Kappa and lambda immunohistochemistry and in situ hybridization in the evaluation of atypical cutaneous lymphoid infiltrates

BACKGROUND

Atypical cutaneous lymphoid infiltrates are challenging lesions in dermatopathology. We present a summary of the literature regarding kappa and lambda immunohistochemistry (IHC) and in situ hybridization (ISH) in the evaluation of atypical cutaneous or mucosal lymphoid infiltrates.

METHODS

Relevant articles from 1967 to 2018 in the English language were identified and summarized. In the absence of larger studies, case series of n ≥ 3 were included.

RESULTS

Sixty-three articles assessing kappa and lambda IHC and/or ISH were identified. Most focused on marginal zone lymphomas. Other lymphomas included follicle center lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle cell lymphoma, lymphoplasmacytic lymphoma, plasmablastic lymphoma, multiple myeloma, monoclonal gammopathy of undetermined significance, and polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS). Non-neoplastic lesions included reactive lymphoid hyperplasia, cutaneous plasmacytosis, connective tissue disease, IgG4-related disease, acrodermatitis chronic atrophicans, Zoon balanitis, dermatitides, and infiltrates around epithelial dysplasias/neoplasias.

CONCLUSION

Kappa and lambda IHC and ISH are useful tools in the evaluation of cutaneous B-cell lymphomas and plasma cell neoplasms. The literature supports that the detection of light-chain restriction by IHC and ISH is one of the most useful findings in the differential diagnosis of reactive lymphoid hyperplasia vs B-cell lymphoma with plasmacytic differentiation.

A Rare Case of Cutaneous Plasmacytosis in a Korean Male

Cutaneous and systemic plasmacytosis are reactive disease processes that occur in middle-aged Japanese and Chinese men. Systemic plasmacytosis, defined by plasmacytic infiltration of two organ systems, might rarely progress to lymphoma. Cutaneous plasmacytosis, however, is chronic and benign and is characterized by the development of multiple plasma cell-rich infiltrates in the skin. We present a case of cutaneous plasmacytosis in a 46-year-old Korean male. The patient demonstrated classic features of the disease entity, including disseminated red-brown plaques, differentiated plasmacytoid infiltrates on biopsy, hypergammaglobulinemia, and the absence of systemic disease.

Cutaneous and systemic plasmacytosis on the face: Effective treatment of a case using thalidomide

Cutaneous and systemic plasmacytosis is an exceedingly rare condition that is identified in Japanese individuals in particular. The present study describes the case of a patient of mainland Chinese origin who manifested with red-brown macules, papules and plaques limited to the face. Identifying a therapy for cutaneous and systemic plasmacytosis is quite difficult, however, the present patient showed a good response to low-dose thalidomide. The exact mechanism of action is not yet clear, however, we hypothesize that thalidomide may function through decreasing the secretion of interleukin-6 and affecting the growth of plasma cells.

Primary Cutaneous B-Cell Lymphomas

B-cell lymphomas occurring in the skin often tend to be of systemic origin with secondary cutaneous involvement. Primary cutaneous B-cell lymphomas tend to be indolent disorders, with the exception of primary cutaneous diffuse large B-cell lymphoma-leg type (PCDLBCL-LT). In indolent conditions, the distinction between cutaneous lymphoma and cutaneous lymphoid hyperplasia can be difficult. Integration of all available information, including the clinical setting, is crucial to arriving at the appropriate diagnosis. In this review, we cover the diagnostic approaches to primary cutaneous marginal zone lymphoma, primary cutaneous follicle center lymphoma, and PCDLBCL-LT, and discuss their differential diagnosis.

Cutaneous and systemic plasmocytosis

Cutaneous and systemic plasmacytosis is a rare disorder observed mainly in Japanese that features an infiltration of mature plasma cells in various organ systems. In addition to the skin, lymph nodes and bone marrow are regularly affected. Laboratory tests show a polyclonal hypergammaglobulinemia. The cutaneous morphology is characterized by red to dark brown macules, papules and plaques a few centimeters in diameter, usually distributed symmetrically on the face, neck and back. Etiology and pathogenesis are not known. It is speculated that a reactive dysfunction of plasma cells may be triggered by various stimuli, such as interleukin 6. Treatment of cutaneous and systemic plasmacytosis is difficult. A standardized treatment concept does not yet exist. Topical corticosteroids and calcineurin inhibitors are mainly used.

A case of cutaneous plasmacytosis

The present study reports a case of cutaneous plasmacytosis in a 51-year-old patient suffering from infiltrated erythema of the right lower lateral femur for 4–5 years and perioral and abdominal erythema for 1 year. Histopathological examination showed that dense mature plasma cell-dominant inflammatory cell infiltration appeared in the deep dermis and between part of the subcutaneous tissues and that there were small numbers of lymphocytes and polykaryocytes. Immunopathogenetic analysis showed that the infiltrating plasma cells were positive for CD79a and CD138. The patient was diagnosed with cutaneous plasmacytosis.

Cutaneous plasmacytosis: a case report and review of pulmonary findings

Primary cutaneous plasmacytosis is an uncommon cutaneous disorder with multiple cutaneous nodules and plaques mainly on face and trunk. This entity is thought to be a reactive process with unknown etiology. Pulmonary involvement could be found as a part of systemic plasmacytosis whereas cutaneous plasmacytosis was also reported with other pulmonary disorders. This report presents the case of cutaneous plasmacytosis and the review of pulmonary findings reported in plasmacytosis.

Cutaneous and systemic plasmacytosis vs. cutaneous plasmacytic castleman disease: review and speculations about pathogenesis

Cutaneous and systemic plasmacytosis (C/SP), human herpes virus-8 (HHV8), negative multicentric plasmacytic Castleman disease (MPCD), and idiopathic plasmacytic lymphadenopathy are polyclonal plasma cell proliferations of unknown etiology that predominantly affect Asian individuals. Herein, we present our experience with a Vietnamese man with typical C/SP limited to the skin but, after 10 years, may have developed perirenal involvement, and with a white man with human immunodeficiency virus and HHV8 negative MPCD with involvement of skin, lymph nodes, and kidneys at presentation, and who later succumbed to gastric carcinoma. Based on a review of the literature, we suggest that C/SP, cutaneous MPCD, and idiopathic plasmacytic lymphadenopathy with skin involvement are part of a continuum rather than distinct entities and, as such, may be regarded as variants of HHV8-negative MPCD. Although the majority of patients with C/SP run a chronic benign course, special attention should be given to monitoring for pulmonary and renal involvement. We hypothesize that long-lived plasma cells originate and survive in the environment of the skin akin to other stromal "survival" niches due to the local production of interleukin 6 and that such patients might respond to agents that interfere with interleukin-6 activity.

High ratio of IgG4-positive plasma cell infiltration in cutaneous plasmacytosis--is this a cutaneous manifestation of IgG4-related disease?

Cutaneous plasmacytosis is a rare condition affecting middle-aged individuals, characterized by multiple red-brown papules and plaques over the trunk. It has been reported mainly in Japan. The condition is accompanied by polyclonal hypergammaglobulinemia and superficial lymphadenopathy. Lung or retroperitoneal involvement occurs rarely. In the present study, 3 consecutive cases of cutaneous plasmacytosis were observed histologically to have abundant infiltration of IgG4-bearing plasma cells. All 3 were associated with superficial lymphadenopathy, one with interstitial lung involvement showing ground-glass opacity on computed tomography and the others with bone marrow plasmacytosis, showing histologic evidence of more IgG4-positive plasma cells. All 3 had polyclonal hypergammaglobulinemia, one had high serum concentration of IgG4, and all had elevated serum IL-6. The ratios of IgG4+ to IgG+ plasma cells were assessed using skin biopsy specimens with pemphigus (n = 7), discoid lupus erythematosus (n = 5), and morphea (n = 2) (mean ratios, 19%, 0%, and 0%, respectively); we noted the proportion of IgG4-positive plasma cells in cutaneous plasmacytosis (mean, 48%). IgG4-related sclerosing disease is a newly recognized systemic disorder characterized by lymphoplasmacytic infiltration and fibrosis and by a high serum IgG4 level and increased IgG4-positive plasma cells in the tissues. Skin manifestations of this disorder have not been described. Although cutaneous plasmacytosis could be a chronic allergic hypersensitivity reaction, our findings raise the possibility of a relationship in pathogenesis between cutaneous plasmacytosis and IgG4-related sclerosing disease.

Isolated benign primary cutaneous plasmacytosis in children: two illustrative cases

BACKGROUND

Plasma cells are normally found in bone marrow and the intestinal tract. They appear in the skin in malignant conditions, autoimmune diseases, infection, and idiopathic and poorly understood disorders such as primary nodular amyloidosis. It is uncommon to find collections of plasma cells in the skin in the absence of these conditions.

OBSERVATIONS

We present 2 cases of cutaneous plasmacytosis, one in a white, female adolescent aged 15 years with an 11-year history of a solitary, asymptomatic, violaceous plaque on the left anterior tibia and the other in a white, male child aged 7 years with a 2-year history of a solitary erythematous plaque on the right anterior tibia. In both patients, infiltration of mature polyclonal plasma cells was confined to an area on the skin with papulonodules. There was no history of previous trauma, malignant conditions, autoimmune disease, or infection in either child.

CONCLUSION

Although incipient or occult systemic disease cannot be definitively ruled out, the course of these 2 individuals suggests that isolated primary cutaneous plasmacytosis in children is a benign chronic process with no adverse sequelae.

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.

Cutaneous castleman's disease responds to anti interleukin-6 treatment

Castleman's disease is uncommon, and cutaneous involvement is even rarer. We report a 42-year-old Asian woman with the multicentric plasma cell variant of Castleman's disease limited to her skin. The literature suggests that Castleman's disease is driven by interleukin-6 (IL-6). Based on these data, we hypothesized that suppression of IL-6 would have a salutary effect. Therefore, our patient was treated with CNTO328, a chimeric murine anti-human IL-6 antibody. She has shown a remarkable, ongoing response to this treatment, with almost complete clearing of her skin lesions after six doses.