Lingual submucosal neoplasm: a rare case of plasma cells granuloma

OBJECTIVES Goal of the present article is to illustrate the workflow between the diagnostic and therapeutic phases in an emblematic case of plasmacells granuloma, while underlinig the typical aspects reported in literature in particular its possible connection with IgG4-RD (IgG4-related disease). Furthermore, we hope to compensate for the lack of articles in literature regarding submucosal lingual neoplasms due to the rarity of oral manifestation as to aid clinicians in their differential diagnosis. Understanding the possible malignicy of oral neoplasms is important to define a correct diagnostic-therapeutic protocol. The most important phase of this protocol is the biopsy of the lesion. Histologycal and clinical exam permit the clinicians to create a good path of healing. In case of malignity suspect we suggest to proceed with a incisional biopsy in order to validate the clinical diagnosis and understand the correct clinical and surgical therapy. MATERIALS AND METHODS The article presents the case of a 73 years old female patient presenting a large area of swelling on the upper left side of her toungue which developted in few days. No diseases have been reported and no drugs had been taken by the patient. Clinical examination and anamnesis validate mainly an irritating etiology of the neoformation. Local anesthesia was administered and surgery excision was perfomed by means of blunted instrumentation of the entire neoplasm. At the first and third week (first follow-up) healing was regular and, according to patient, post-operative progress has been extremely good. Histopathological diagnosis was "plasmacells granuloma". Inflammatory content mainly characterzes these types of lesions in particular polyclonal plasma cells. Polyclonality is an important factor that permits to exclude lymphoproliferative disorders (e.g., multiple myeloma). Serum and haemochemistry exams excluded IgG4RD; this is a systemic disease characterized by collection of plasma cells in different organs. Depending on the numbers and the seriousness of the involved organs disease could be more or less aggressive. Described neoplasm has been related to an irritative cause. A six-month follow-up has been recommended during the usual dentistry visits. RESULTS AND CONCLUSIONS The right framework of neoplasms and mucosal lesions of oral cavity is an essential aspect for every clinician. The exteriority of submucosal lesion do not always help clinicians in diagnostic phase so much so that only intra-operative phase, associated with hystopathological exam, is significant. Correlation of oral diseases or neoplasms to systemic pathologies, serious too, is eloquent. In fact dentists can play an important role in the interception of complex diseases. CLINICAL SIGNIFICANCE Definig the aspects of oral lesions, in order to perform a correct clinical and surgery protocol, is fundamental; in particular wide extensions of neoplasms or critical anatomical sites need an appropriate knowledges to avoid anatomical damages or complications (intra- and post-operative) also very serious.