Plasmablastic Lymphoma Masquerading as Plasma Cell Myeloma: A Case Report

Area of Science:

• Oncology
• Hematology
• Pathology

Background:

• Plasmablastic lymphoma (PBL) is an aggressive B-cell neoplasm, primarily affecting immunocompromised individuals, notably those with human immunodeficiency virus (HIV).
• PBL typically presents in the oral cavity and is frequently associated with Epstein-Barr virus (EBV) infection.
• Distinguishing PBL from other B-cell and plasma cell neoplasms is challenging due to shared morphology, particularly in rare EBV-negative and extra-oral presentations.

Observation:

• A 72-year-old patient with a prior diagnosis of plasma cell myeloma presented with aggressive, refractory disease progression.
• Histomorphological and immunohistochemical investigations revealed an unusual extra-oral, EBV-negative Plasmablastic Lymphoma.
• Rapid disease progression, lymphadenopathy, and plasmablastic morphology raised suspicion for PBL.

Findings:

• The case presented an atypical manifestation of Plasmablastic Lymphoma, occurring outside the oral cavity and without EBV association.
• Diagnostic challenges were encountered due to the overlapping morphology with other plasma cell and B-cell malignancies.
• The patient's history of plasma cell myeloma complicated the diagnostic pathway.

Implications:

• Accurate diagnosis of PBL, especially in extra-oral and EBV-negative cases, requires thorough histopathological and immunohistochemical evaluation.
• Clinical correlation is crucial for differentiating PBL from other hematologic malignancies.
• This case underscores the importance of considering rare presentations of aggressive lymphomas in elderly patients, even with prior diagnoses.