Plasmablastic lymphoma of the upper gingiva in an HIV-negative elderly patient

摘要

Plasmablastic lymphoma (PBL) is a highly aggressive variant of diffuse large B-cell lymphoma and is usually treated by chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens. However, elderly patients tend to have difficulty with the chemotherapy. We successfully treated an HIV-negative elderly PBL patient with surgery alone. An 87-year-old Japanese man was referred to our hospital because of gingival swelling of the left maxilla. After several examinations, a multilobular 3-cm tumor of the left maxilla and lymph node swelling on the left side of the neck were revealed. The patient was HIV negative and human T-cell leukemia virus negative. He was diagnosed with PBL, or undifferentiated carcinoma/sarcoma, and we performed surgical therapy, radical neck dissection, and a partial maxillectomy. The surgical margin of the resected specimen was negative for tumor cells, and 6 of 27 lymph nodes contained tumor cells. Histologically, the tumor consisted of basophilic large cells with deviated nuclei. Together with the immunohistochemical findings, the final diagnosis was PBL. The patient and his family did not agree to chemotherapy. Nineteen months after surgery, he is fine and no signs of recurrence were observed. Surgery-only therapy may be a reasonable alternative for elderly PBL patients. Highlights ? Plasmablastic lymphoma (PBL) is an aggressive variant of diffuse large B-cell lymphoma with a poor prognosis. ? Twenty-two intraoral and HIV-negative PBL cases have been reported in the literature including our case. Treatment was mostly chemotherapy with or without radiation therapy; however, surgical therapy was not reported. ? Our patient was very old and was at risk for anticancer agents. Surgery-only therapy was successful. ? Surgery may be a reasonable alternative for elderly PBL patients, if tumors are localized and general anesthesia can be used.