PMC3697140_01
Clinical presentation: a 2,5 cm red nodule, pedunculated, located on the gingival between upper central incisors.
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The intraoral examination showed advanced chronic periodontitis and the presence of a lobulated reddish nodule, pedunculated, measuring around 2.5 cm on the gingival area between both upper central incisors which had mobility and accumulation of dental plaque (Figure 1).
Radiographic image: panoramic radiography showing the extensive bone resorption in the anterior area of the maxilla compatible with advanced periodontal disease.
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Panoramic radiography showed a significant resorption of bone mainly in the anterior area of the maxillary, compatible with advanced chronic periodontitis (Figure 2).
Histologic features: (a) diffuse proliferation of lymphoid tumor cells (hematoxylin-eosin stain (HE), magnification x200) was observed. (b) Large pleomorphic cells with an abundant cytoplasm, sometimes containing prominent nucleoli, were verified. "Hallmark" cells with eccentric, horse-shoe, or kidney-shaped nuclei were also identified (HE, magnification x400). Immunohistochemical findings: sections showing tumor cells are positive for (c) CD30 with a membrane and Golgi distribution (streptavidin-biotin, x400 magnification) and (d) Ki-67 (streptavidin-biotin, x400 magnification).
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Hematoxylin and eosin-stained sections showed a lesion characterized by a diffuse proliferation of lymphoid tumor cells underneath an epithelium (Figure 3(a)). The slices also showed large pleomorphic cells with an abundant cytoplasm, sometimes containing prominent nucleoli. "Hallmark" cells with eccentric, horse-shoe, or kidney-shaped nuclei were also observed (Figure 3(b)). The tumor cells showed strong CD30 expression with a membrane and Golgi distribution in the majority of tumor cells (Figure 3(c)). Ki-67 positive stain was observed in 90% of tumor cells (Figure 3(d)).