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SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences
Circumorificial plasmacytosis - Oral Mucosal Lesion
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Circumorificial plasmacytosis - Oral Mucosal Lesion

Contributors: Michelle Croda BS, Lauren Mihailides MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Circumorificial plasmacytosis (CP; also known as plasma cell orificial mucositis and plasma cell mucositis) is a rare, benign plasma cell disorder of the oral cavity. It commonly affects the gingivae and buccal mucosa, but any intraoral surface may be affected. It has occasionally been reported to involve the lower lip, oral commissures, larynx, and trachea.

CP presents as one or more erythematous mucosal plaque(s) with a cobblestoned, velvety, nodular, or papillomatous appearance. While CP can be asymptomatic, oral pain, swelling, dysphagia, hoarseness, and stridor have been reported. Secondary erosions may occur.

The etiology of CP is unknown, although patients with CP may have a history of autoimmune disease and/or atopy. CP has been reported to occur in a wide age range, but it most commonly occurs in patients older than 50 years.

Codes

ICD10CM:
D72.822 – Plasmacytosis

SNOMEDCT:
37465004 – Plasmacytosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Oral Crohn disease – Presents with "knife cut"-like linear ulcerations, pseudopolyps, or swelling / induration of the lips or oral mucosa. May be associated with gastrointestinal complaints or a history of inflammatory bowel disease. Biopsy will show a granulomatous dermatitis.
  • Oral histoplasmosis – Presents with erythema, ulceration, and/or fungating mass of the buccal mucosa, tongue, or palate. May be associated with a history of immunosuppression and/or HIV and generally occurs with disseminated histoplasmosis infection. Biopsy will show granulomatous inflammation with intracellular yeasts.
  • Oral squamous cell carcinoma – Presents with a red or white plaque or ulcer on the floor of the mouth, lateral tongue, or oral mucosa and is often indurated. May be associated with a history of smoking or alcohol use. Biopsy will show atypical squamous cells.
  • Granulomatosis with polyangiitis (GPA) ­– Presents with gingival hyperplasia or gingivitis, mucosal ulceration, osteonecrosis of the palate, or oro-antral fistula formation. May be associated with other systemic findings of vasculitis / GPA such as respiratory tract involvement. Biopsy will show vasculitis.
For CP-like lesions with an identifiable offending agent / practice:
  • Plasma cell gingivitis ­(PCG) – Erythematous, reactive lesions resulting from a hypersensitivity reaction to chewing qat, betel nuts, tobacco, or highly flavored gum or candy. PCG spans a period of a few weeks, opposed to the months-long time course of CP, and resolves with removal of the offending agent.
For widespread cutaneous or systemic disease:
  • Cutaneous or systemic plasmacytosis – Exceedingly rare and distinct from CP, occurring in those of Japanese ancestry. Typically presents with widespread cutaneous involvement and lymphadenopathy.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:05/05/2021
Last Updated:05/05/2021
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Circumorificial plasmacytosis - Oral Mucosal Lesion
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A medical illustration showing key findings of Circumorificial plasmacytosis : Hoarseness, Dysphagia, Gingival hemorrhage, Oropharyngeal erythema
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