An Uncommon Case of Plasma Cell Mucositis of the Tongue in a
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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; it is considered a benign condition of adults, and there are no correlations in literature with the development of plasma cell neoplasm. Clinical features are an intensely erythematous mucosa with papillomatous, cobblestone, nodular, or velvety surface changes. Symptoms include dysphagia, oral pain, sore throat, and pharyngitis . PCM can be treated with corticosteroids, administered topically, systemically, or intralesionally.

Here described a case of PCM involving the tongue of a 14-year-old man. The practitioner suspected squamous cell carcinoma. His past medical history was not relevant, and the patient was a nonsmoker and non alcohol user. The patient had previously used a nocturnal bite to control bruxism. He reported a burning sensation in his mouth, local dysgeusia, and pain on the tip and on the right lingual border for 1 year. The patient also referred that he was unable to eat or drink any hot or spicy foods due to burning and pain on his tongue. He stated persistent hoarseness, sore throat, and difficulty sleeping due to continuous oral pain.

Extraoral examination was unremarkable, while intraoral examination revealed the presence of an ulcer and intense erythema of the tongue and gingival edema and erythema. In the first place, several diagnostic hypotheses were proposed, most of them discarded for incompatibility with full blood count, serum B12 and folate, urea and electrolytes, liver function tests, glucose, anti-nuclear antibody, and syphilis IgG that were normal or negative. The patient underwent an incisional biopsy under local anesthesia. Microscopically, a large area of ulceration of the coating epithelium subtended by dense plasma cell infiltrate was observed . CD20 and CD3 showed focal positivity for B and T cells, respectively. The plasma cell infiltrate was positive for CD138 and showed kappa light chain restriction with a kappa/lambda ratio of 20 : 1.
The final histopathological diagnosis was “plasmacytosis of the mucous membranes with restriction for the kappa chains.” Initial pharmacotherapy with prednisone began with 50 mg/day for two weeks, and the patient referred an improvement of his conditions (reduction of pain and swelling). He repeated this treatment one month later, and he experienced a partial regression of the lesions. At 1-year follow-up, there was no regression of the disease and no recurrence of the lesions

In Conclusion, it is important that PCM is recognized in the dental community, because diagnosis is dependent on clinical pathologic correlation. Only close communication between specialists in several disciplines prevented inappropriate treatment of a patient with an extremely rare condition. Nevertheless, it is very important to differentiate the PCM disease from other neoplastic conditions in order to achieve a better clinical management of the patients, so it is necessary to investigate this disease in depth.

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049820/
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