PMC3891080_01
Gross findings in a patient with gingival hyperplasia. Compared with cyclosporine-induced gingival hyperplasia, the gingival lesion in this patient was characterized by a focal, irregular surface and ulceration.
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F1
A male, 41 years old, visited the clinic in April 2002 after experiencing bleeding, pus discharge, edema, and pain of the gingivae over the previous three months (Figure 1A, 1B).
Serum cyclosporine levels in this patient decreased simultaneously with a reduction in the dose of cyclosporine from January 2002 onwards, but gingival hyperplasia was not alleviated despite this.
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F2
Serum cyclosporine levels were low (Figure 2).
Microscopic image of a gingival biopsy showing atypical lymphocytes. These findings are indicative of the presence of leukemic cell infiltration and a malignant lymphoma or histiocytic tumor (x400, H-E stain).
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F3
The biopsy established the presence of leukemic cell infiltration including a malignant lymphoma or histiocytic tumor (Figure 3).
An immunohistochemical image of a tissue section showing positive reactions to LCA (A) and L26 (B) and negative reactions to UCHL-1 and CD68. This is indicative of a diffuse large B cell type malignant lymphoma (x400).
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F4
Muramidase and immunohistochemical stains specific for LCA (Figure 4A), L26 (Figure 4B), UCHL1, and CD68 revealed a large diffuse B cell type of malignant lymphoma.
An immunohistochemical stain showing a positive reaction to EBV (LMP) (x400).
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F5
The latent membrane protein for the Epstein-Barr virus (EBV-LMP) immunohistochemical stain was positive (Figure 5).