This image is from an oral biopsy specimen from a 48 y/o HIV-positive male who presented with pain and swelling of the left side of his face. He was found to have a large ulcerated mass involving the hard palate with surrounding edema. The tumor is composed of sheets of large atypical lymphoid cells with features of immunoblasts. They have large vesicular nuclei, multiple prominent nucleoli, and moderate amount of eosinophilic cytoplasm. Mitotic activity is brisk. Mature plasma cells are not present. The immunophenotypic profile was as follows: POSITIVE: CD38, CD138, EBER (strongly positive). NEGATIVE: CD3, CD5, CD20, CD79a, HHV8, CD30, CD10, and cytokeratin AE1/AE3. The clinical setting (oral cavity lesion in a HIV+ male), morphologic and immunophenotypic features are diagnostic of plasmablastic lymphoma. Although plasmablastic lymphoma was originally described as a new entity in the setting of HIV infection in the late 1990's, it has since been recognized that plasmablastic morphology and phenotype can be expressed by many other aggressive variants of large B-cell lymphomas and plasma cell neoplasms.
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