Treatment

Under local anesthesia, a full-thickness flap around area of teeth #s 30 & 31 was raised and an incisional biopsy was performed. The tissue was fleshy and vascular. The area was sutured and the specimen submitted for microscopic evaluation.

Excisional Biopsy

Histologic examination reveals multiple pieces of soft tissue composed of connective tissue with sheets of plasma cells intermixed with scattered small lymphocytes. The plasma cells were fairly uniform in appearance with scattered nucleoli present (Figure 2). Occasional Dutcher bodies were seen overlying the plasma cell nuclei. The plasma cell infiltrate was uniformly positive for CD138 (Figure 3) and kappa light chain (Figure 4) and negative for lambda light chain. Rare CD3+ T-cells were present. No immunoreactivity for CD20 was seen on the plasma cells; however, rare CD20+ cells were present.

Figure 2 High power (x400) H & E histology shows sheets of plasma cells intermixed with scattered small lymphocytes. The plasma cells are fairly uniform in appearance.

Figure 3 High power (x400) immunohistochemistry for CD138. Note uniformly positive staining with CD138, a marker for plamacytoid cells.

Figure 4 High power (x400) immunohistochemistry for kappa. Note uniformly positive staining with kappa light chain.