Ann Dermatol.  2017 Oct;29(5):536-542. 10.5021/ad.2017.29.5.536.

Plasma Cell Cheilitis: A Clinicopathological and Immunohistochemical Study of 13 Cases

• Lee JY
• Kim KH
• Hahm JE
• Ha JW
• Kwon WJ
• Kim CW
• Kim SS

• KMID: 2388903
• DOI: http://doi.org/10.5021/ad.2017.29.5.536

Abstract

BACKGROUND
Plasma cell cheilitis is an unusual benign plasma cell proliferative disease of an unknown etiology that typically presents on the lip.
OBJECTIVE
The aim of this study was to investigate the clinicopathological characteristics of 13 cases of plasma cell cheilitis.
METHODS
The present study investigated the clinical manifestations, treatment modalities, and outcome of 13 patients diagnosed with plasma cell cheilitis from 2011 to 2016 at Kangdong Sacred Heart Hospital and Hallym University Sacred Heart Hospital. Biopsy specimens of the all cases were evaluated using conventional hematoxylin and eosin staining with kappa and lambda immunoglobulin light chain immunohistochemistry.
RESULTS
The age of the patients ranged from 39 to 86 years (mean, 64.7 years), with male predominance. Histopathologically, 61.5% and 38.5% of patients showed band-like and pan dermal plasmacytic infiltrates, respectively. Eosinophilic infiltration was noted in 69.2% of patients. All cases showed both kappa and lambda immunoglobulin light chain reactivities, and kappa predominance was confirmed in 9 patients (69.2%). A majority of the patients was treated with local therapy, such as intralesional steroid injection with topical tacrolimus. Among the 13 patients, plasma cell cheilitis completely resolved, partially resolved, and recurred in 3 (23.1%), 5 (38.5%), and 5 patients (38.5%), respectively.
CONCLUSION
Plasma cell cheilitis presented as erosive edematous circumscribed patches or plaques affecting mainly the lower lip of elderly male patients. The majority of histopathology cases showed characteristic plasma cell aggregation on the upper dermis that was immunopositive for immunoglobulin light chain, with kappa predominance.

Keyword

Chelitis; Kappa chain; Lambda chain; Plasma cells

MeSH Terms

Aged
Biopsy
Cheilitis*
Dermis
Eosine Yellowish-(YS)
Eosinophils
Heart
Hematoxylin
Humans
Immunoglobulin lambda-Chains
Immunoglobulin Light Chains
Immunohistochemistry
Lip
Male
Plasma Cells*
Plasma*
Tacrolimus
Eosine Yellowish-(YS)
Hematoxylin
Immunoglobulin Light Chains
Immunoglobulin lambda-Chains
Tacrolimus

Figure

• 

  Fig. 1 (A) The lower lip shows a diffuse dark blue-grayish to erythematous patch with several fissures and hemorrhagic crusts (patient 3). (B) Painful ulcerative lesion is noted on the left lower angle of the lip on a patient who used dentures (patient 9). (C) Prominent edematous erosive lower lip mucosa is shown (patient 10). (D) Multiple well-demarcated erythematous patches with crust formation and marked swelling on the lower lip are identified (patient 6).

• 

  Fig. 2 This specimen from the lip shows an epidermal detachment with a dense, band-like infiltrate of plasma cells in the upper dermis. (A) Eosinophilic infiltration within the dermis is also present (H&E, ×100). (B) A high power view shows a monomorphic population of mature plasma cells without cellular atypia, pleomorphic figures, and mitotic activity (H&E, ×400). (C) A diffuse strong positivity for kappa light chain is noted in the plasma cell infiltrates (kappa chain, ×200). (D) Few plasma cells are positive for lambda light chain restriction (lambda chain, ×200).

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