{'fraction_non_alphanumeric': 0.037037037037037035, 'fraction_numerical': 0.01131687242798354, 'mean_word_length': 5.615646258503402, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A tip of the iceberg: Disseminated plasmablastic lymphoma, diagnosed from a local oral lesion

Dear Editor, A 41-year-old man with no known underlying disease visited our clinic and presented with gingival swelling over the right lower posterior teeth area (Figure 1A), which had been ongoing for 2 months. Upon examination, no obvious abnormality was observed except for an oral lesion. Squamous cell carcinoma was suspected on the basis of risk factors including being a current heavy smoker and frequent drinker. Pathology of the tumor excision revealed a plasmacytoid tumor with immunohistochemical (IHC) staining results positive for CD138, Kappa, Lambda, and Ki-67 (70%; Figure 1B–D) and negative for cytokeratin, CD3, CD20, and HHV-8. Bone marrow of right iliac crest aspiration/biopsy disclosed mild hypercellular marrow (approximately 70%) and more than 10% plasmacytoid cells. No symptoms of hypercalcemia, renal failure, anemia, or bone lesions were identified. Anaplastic plasmacytoma or nonsecretory multiple myeloma was not favored. We tested serum for human immunodeficiency virus (HIV) and performed IHC staining for Epstein–Barr virusencoded small RNAs, and both results were positive. Bone scan indicated local bone involvement of mandible. Unexpectedly, positron emission tomography/computed tomography (PET/CT) disclosed multiple disseminated bone lesions (Figure 1E)–H)). After we discussed these results in the team conference, he was finally diagnosed with plasmablastic lymphoma (PBL) with multiple bone involvement. The patient started antiretroviral therapy (ART) 1 month prior to commencing chemotherapy with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone (CHOP) and radiotherapy of the oral lesion. According to the laboratory data and CT, the patient showed response to ART, achieving an undetectable viral load, and shrinkage of the mass after three cycles of CHOP and completion of radiotherapy.