Table 2.
Differential diagnosis of Plasma cell gingivitis
| Clinical differentials |
Histological differentials |
|||||
|---|---|---|---|---|---|---|
| Cicatricial pemphigoid (CP) discoid lupus erythematosus | Pyogenic granuloma | Oral lichen planus | Plasma cell dyscrasias |
IgG4^ related disease | ||
| Extramedullary plasmacytoma | Plasma cell Myeloma with extramedullary involvement | |||||
| Clinical entity presenting granulomatous overgrowth | Mucocutaneous lesions, vesicles, Nikolsky's sign | Pedunculated lesion involving gingiva most frequently | Bilaterally symmetrical lesion involving skin, buccal mucosa most frequently | Head and Neck most common, Soft tissue mass | Local growth of soft tissue in vicinity to skeleton or hematogenous spread to any other organ or tissue | Heterogeneous clinical and radiological presentation which mimics malignancy. |
| Histology | Subepithelial split with variable inflammation in CP* Hyperkeratosis, follicular plugging, degeneration of basal cells |
Abundant engorged blood vessels in the background of mixed inflammatory infiltrate | Saw toothed rete ridges, liquefactive degeneration of basal layer with intense lymphocytic infiltrate subepithelially | monoclonal plasmacytoid cells with light chain restriction | Similar to plasmacytoma, acquire blastoid morphology in plasmablastic plasma cell myeloma | Storiform fibrosis, obliterative phlebitis and more than10/high power field IgG4 positive plasma cells (more specifically ratio of IgG4 to IgG positive plasma cells as >0.4) |
| Treatment | Systemic corticosteroid, immunomodulator therapy | Conservative surgical excision | Symptomatic cases require variable treatment ranging from topic corticosteroids to antifungal or systemic steroids or immunomodulators | Radiation therapy | Chemotherapy | Corticosteroids |
| Prognosis | Generally good, spontaneous remission in 2-5 years | Excellent, occasional recurrence | Malignant potential controversial | Better prognosis than solitary plasmacytoma, 30% patient progress to PCM# | Usually incurable progressive disease, median survival rate 5.5 years | Irreversible injury to some organs if therapy is not initiated in time, once fibrosis is established treatment options are limited |
CP - Cicatricial pemphigoid, PCM - Plasma cell myeloma, IgG - Immunoglobulin G