Authors: Turki Nasser Alotaibi , Ahmed Mufadhi Marzouq Alanazi , Talal Alhumaidi Alshammari , Sultan Khalid M Albaqawi , Mohammed Hassan Aljezoli , Majed Mamdouh Alshammari , Abdulrahman Ibrahim Alsanea , Ebtehal Mohammed Aloudah , Abdulrahman Muteb Alanazi , Alanoud Sultan Alshamari , Esam Sami Almuzaini

Abstract

Background: Plasmablastic lymphoma (PBL) is an uncommon and highly aggressive variant of diffuse large B-cell lymphoma, which was first recognized in association with human immunodeficiency virus (HIV). Although an increasing number of cases occurring in HIV-negative immunocompetent individuals have been described, thereby expanding the clinical picture of this tumor.
Methods: We present a case of a 27-year-old HIV negative, medically fit male who came with a rapidly enlarging gingival mass. Clinical, radiographic, and histopathological assessments were done, plus immunohistochemical staining for plasma cell and B-cell markers. We also checked for Epstein-Barr virus (EBV) and then the Ki‑67 proliferation index, basically.
Results: The patient had about a 2-week history of progressive swelling on the left lower jaw. On examination, there was a lobulated 1.5 × 2.0 cm red to violaceous mass, sitting on the buccal gingiva. Radiographs suggested minimal involvement of the bone. Histopathology showed a diffuse sheet-like infiltrate of atypical plasmablastic cells. In immunohistochemistry, the tumor was positive for CD138, CD38, c‑Myc, and EBV, with loss of CD20 expression. The Ki‑67 index was above 90%. Altogether, this confirmed the diagnosis of oral PBL.
Conclusion: Although it is an uncommon entity and usually occurs in patients with HIV infection, oral PBL should be included when comparing treatments for gingival masses that rapidly harden, even in people who do not have AIDS. Patients will have a favorable outcome if they can be identified early, definitely diagnosed by pathologists, and then treated promptly with the proper therapy for this aggressive malignancy.

Keywords: Plasmablastic lymphoma, oral cavity, HIV-negative, immunocompetent, Epstein-Barr virus, gingival mass.