Zizzo Maurizio, Zanelli Magda, Martiniani Roberta, Sanguedolce Francesca, De Marco Loredana, Martino Giovanni, Parente Paola, Annessi Valerio, Manzini Lorenzo, Ascani Stefano
Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena.
Medicine (Baltimore). 2020 Sep 25;99(39):e22335. doi: 10.1097/MD.0000000000022335.
Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency viruses -positive patients. Oral cavity is the most commonly PBL affected site. Most oral PBLs presented as asymptomatic swellings, frequently associated with ulcerations and bleeding. Most cases lacked B-symptoms, suggesting a more local involvement of the disease. No standard treatment is yet for oral PBL. Five-year survival rate recorded no more than 33.5%.
A 39-year-old male presented to Dental Clinic with 1 month swelling of the oral cavity, in absence of any other symptoms or signs. He followed antibiotic therapy just on suspicion of an oral abscess and later oral surgical treatment on suspicion of bone neoplasm.
Surgical specimen analysis highlighted a diffuse infiltrate of large-sized atypical cells with plasmablastic appearance and plasma cell phenotype. Oral cavity PBL was diagnosed. Blood tests recorded mild lymphopenia and positive human immunodeficiency viruses serology.
Patient underwent chemotherapy including intrathecal methotrexate prophylaxis, in addition to a highly active antiretroviral therapy.
At 12 months from diagnosis, patient recorded complete hematological remission.
Oral PBL diagnosis requires a high level of suspicion and awareness both by physicians and pathologists. They should be aware of the extent of such disease which is often mistaken as oral abscess or infected tooth, thus leading to delay the most appropriate diagnostic evaluation. As PBL is an aggressive non-Hodgkin lymphoma, a delayed diagnosis might negatively impact on both treatment and survival.
浆母细胞淋巴瘤（PBL）是一种罕见的侵袭性大B细胞淋巴瘤，常见于人类免疫缺陷病毒阳性患者。口腔是PBL最常累及的部位。大多数口腔PBL表现为无症状性肿胀，常伴有溃疡和出血。大多数病例无B症状，提示疾病多为局部累及。目前尚无口腔PBL的标准治疗方法。记录的五年生存率不超过33.5%。
一名39岁男性因口腔肿胀1个月就诊于牙科诊所，无任何其他症状或体征。他因怀疑口腔脓肿接受了抗生素治疗，后来因怀疑骨肿瘤接受了口腔外科治疗。
手术标本分析显示有大量具有浆母细胞外观和浆细胞表型的非典型细胞弥漫浸润。诊断为口腔PBL。血液检查显示轻度淋巴细胞减少，人类免疫缺陷病毒血清学阳性。
患者接受了化疗，包括鞘内注射甲氨蝶呤预防，此外还接受了高效抗逆转录病毒治疗。
诊断后12个月，患者实现了完全血液学缓解。
口腔PBL的诊断需要医生和病理学家高度怀疑并提高认识。他们应了解这种疾病的范围，因为它常被误诊为口腔脓肿或感染牙齿，从而导致延误最恰当的诊断评估。由于PBL是一种侵袭性非霍奇金淋巴瘤，诊断延迟可能对治疗和生存产生负面影响。
