Gingival hyperplasia in acute leukemia extramedullary involvement of leukemia can occur in up to 40% of patients. Case report gingival enlargement as a diagnostic indicator in leukaemia. The main symptoms are fatigue, weight loss, fever and gingival bleeding. Idiopathic gingival hyperplasia may be observed as fibrotic hyperplasia of gingival tissue, which leads to esthetic and functional problems. Systemic diseases causing gingival enlargement leukemia. Histopathological evaluation of a gingival biopsy specimen revealed a myeloblastoma. Gingival hyperplasia in acute leukemia stanford medicine. At this moment the patient presented hemoglobin level of 14.
Leukemia has been associated with oral manifestations. Table 1 from gingival hyperplasia as an early diagnostic oral. Gingival hyperplasia can be seen in patients with familial gingival enlargement, pregnancy and leukemia. Gingival fine needle aspiration cytology in acute leukemia. Acute myelomonocytic leukemia presenting with gingival. Chronic inflammatory gingival enlargement associated with. To differentiate between them a biopsy is required, but being highly contraindicated, biopsy has been substituted in. Gingival hyperplasia as an early manifestation of acute. Rapidly forming gingival hyperplasia is usually the first sign of this disease. Dec 28, 2015 leukemic enlargement is due to gingival infiltration of immature blasts and proliferating leukocytes and most commonly occur in acute monocytic leukemia and acute myelomonocytic leukemia. Intraorally it was noted both alveolar ridge and gingival enlargement. We study the prevalence of acute myeloid leukemia aml among patients with severe gingival enlargement.
Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Gingival enlargement associated with acute myelocytic leukemia. A case of gingival enlargement in acute myeloid leukemia. He was diagnosed to have a acute biphenotypic leukaemia on a bone marrow. The gingival enlargement causes food excursion, collects food debris and irritating plaque. They concluded that diseasefree survival and overall survival of patients with m5a, m5b and nonm5 appear not to differ with currently available therapy. Orofacial complications of leukemia include lymphadenopathy, gingival bleeding, petechiae, ulceration, gingival enlargement and infections. Acute myeloid leukemia aml is a malignancy of the hematopoietic progenitor cells that provokes bleeding and fever as a result of infection1. Gingival inflammation and platelet count in patients with leukemia. Acute myeloblastic leukemia aml is a malignant disease of bone marrow. Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. Periodontal findings of a 19yearold female with previously undiagnosed acute myeloid leukemia aml are presented. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Gingival hyperplasia treatment, symptoms, causes, pictures.
Systemic conditions such as hormonal changes, drug therapy, or tumor infiltrates may also cause or contribute to the severity of gingival enlargement. Due to its high morbidity rate, early diagnosis and appropriate medical therapy is essential. Acute myeloid leukemia aml is a bone marrow cancer, a malignant disease that triggering the cells develops into. One of the rarest sites of extramedullary involvement is the oral cavity, with only 5% or less of all patients with aml present with gum infiltration.
The patient was diagnosed with acute myelocytic leukemia. The enlargement can be inflammatory,fibrotic or a combination of both. Gingival overgrowth may vary from isolated mild enlargement of interdental papilla or a uniform enlargement which may affect either one or both jaws. Gingival hyperplasia is secondary to infiltration of the gingival tissue with leukemia cells and is well described in the literature.
Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Typical oral manifestations of acute leukemia include gingival swelling, oral. Gingival hyperplasia is a medical condition in which the gums increase in size. Primary gingival enlargement as a diagnostic indicator in acute myelomonocytic leukemia. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. We put forth a unique case of aleukemic leukemia presenting as gingival enlargement, that was diagnosed by immunophenotyping and flow cytometery as acute monoblastic leukemia aml fab 5a. This case stresses the importance of taking a thorough. Leukemic gingival enlargement a role of periodontist in.
The case described here had adequate local factors which are the predisposing factor for gingival enlargement. Table 1 from gingival hyperplasia as an early diagnostic. Acute myeloid leukemia, chemotherapy, gingival overgrowth. May 22, 2014 gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. Gingival hyperplasia complicating acute myelomonocytic leukemia. Extramedullary involvement of leukemia can occur in up to 40% of patients.
The saxer and muhlemann index were used to measure inflammation and gingival bleeding. Leukaemia cell gingival infiltrate is not observed in edentulous individuals, suggesting that local irritation and trauma associated with the presence of teeth may play a role in the pathogenesis of this abnormality 6,7. In some instances, gingival hyperplasia is drug induced or may exist as an isolated abnormality or as part of a syndrome. The whitecell count was 10,300 per cubic millimeter, the hematocrit was 26%, and the platelet count was 81,000. Intra oral examination revealed generalized gingival enlargement, inconsistent with the amount of calculus. Acute leukemia knowledge for medical students and physicians. Division op hematology and oral pathology, washington university school of medicine, and hematology research laboratory, john cochran veterans administration hospital g i ingival hyperplasia with leukemic cell infiltration is a common.
The accepted current terms for this condition are gingival enlargement and gingival overgrowth. The patient had only five teeth, all poorly conserved. Even though many cases of gingival enlargement associated. Case report anil, s smaranayake, lakshman p nair, raj g beena, v. In such cases, overgrown gums may need to be surgically removed. Gingival enlargement as a diagnostic indicator in leukaemia. Oral manifestations have been described primarily in acute leukemia and consist of cervical lymphadenopathy, petechiae, and mucosal ulcers as well as gingival inflammation and enlargement. The gingival enlargement involved the buccal, labial, palatal and lingual. Learn the shocking truth about uterine fibroids, drugs and surgeries. Gingival enlargement associated with acute myelocytic. Although many cases of gingival enlargement in patients with acute myeloid leukemia have been reported in literature, cases of gingival hypertrophy secondary to acute lymphoblastic leukemia in adult female are rare. Evaluation of medical history revealed that the patient was under chemotherapy for 1 year ending 5 months before, for a. In addition to oral ulceration and infection and gingival bleeding, oral and periodontal manifestations of leukemia consist of infiltration of gingivae by leukemic cells, resulting in gingival overgrowth, which develops into pseudopockets where dental biofilm accumulates producing, in turn, a second inflammatory lesion that contributes to gum enlargement, so that, gingival enlargement is as much the result of leukemic infiltration as of reactive gingival hyperplasia. There are several types available, which will be discussed further down but two of the most important ones are the one induced by.
Gingival enlargement in myelodysplastic syndrome george n. This condition is also known as gingival overgrowth, hypertrophic gingivitis or gingival hypertrophy. Although the enlargement persisted, it did not progress and was devoid of its inflammatory and necrotic component. Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. However, the available literature on this topic consists of mostly reports of cases, without data about the periodontal parameters that may be under the influence of hematologic factors.
Gingival enlargement associated with acute myelocytic leukemia in a child. Gingival enlargement, chronic myeloid leukemia, zimmermannlaband syndrome. Based on these observations, it appears that leukemic cell infiltration was the major cause of the sudden onset of gingival enlargement,, thereby excluding other. A 21 year old male presented with fever, weakness and petechiae. Oral manifestations in acute leukemia as the first sign. Gingival hyperplasia in acute leukemia stanford medicine 25. Acute myloid leukemia, gingival hyperplasia, oral manifestations ab s tr c acute myeloblastic leukemia aml is a malignant disease of bone marrow, usually presenting gingival overgrowth as its first clinical manifestation. Factors that lead to gingival hyperplasia include inflammatory causes, hormonerelated causes, leukemia, vitamin c deficiency, nonspecific causes, neoplasia and drugs. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Acute monoblastic leukemia aleukemic leukemia presenting. Meningeal leukemia or leukemic meningitis headache, neck stiffness, visual field changes, or other cns symptoms caused by cns involvement 1 16 testicular enlargement rare finding leukemia cutis or myeloid sarcoma.
Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. This is a common symptom that aids in the diagnosis of leukemia and warrants dental consultation. Soft, edematous, tender gingiva with ease to bleeding is a sign in blood disorders. Pdf the oral cavity manifests signs of various systemic diseases. Gingival enlargement is one of the frequent features of gingival diseases. Also, early medical therapy in acute monocytic leukemia may resolve the gingival hyperplasia that companies the disease progression. These are strictly clinical descriptive terms, and they avoid the erroneous pathologic connotations of terms used in the past, such as hypertrophic gingivitis and gingival hyperplasia. Pdf oral cavity functions as an early indicator for a variety of systemic. Gingival enlargement and its treatment authorstream. Ruling out other etiologies, second cbc and peripheral blood smear results confirmed aml. Gingival hyperplasia complicating acute myelomonocytic. Gingival enlargement in a pregnant woman with acute monocytic. Gingival enlargement in patients with leukaemia has been described in several subtypes of acute myeloid leukaemia aml, 719 chronic myeloid leukaemia, 20 acute lymphocytic leukaemia 21 and chronic lymphocytic leukaemia. Leukemia, myeloblastic, gingival enlargement, signs and symptoms, acute, diffuse.
Surgical therapy was carried out to provide a good. Gingival leukemic infiltration in chronic lymphocytic leukemia. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Gingival enlargement, leukemia, oral manifestations. Gingival enlargement as an early diagnostic indicator in therapy. These are strictly clinical descriptive terms and they avoid the erroneous pathologic connotations of terms of terms used in the past, such as hypertrophic and gingival hyperplasia. Gingival enlargements inflammation mouth free 30day. A case of diffuse gingival enlargement in acute myeloblastic. Jun, 2012 gingival hypertrophy in a patient of acute biphenotypic leukemia.
However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Management of gingival hyperplasia associated with sore. Gingival leukemic infiltration in chronic lymphocytic leukemia cary a. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Oral signs of leukemia and dental management literature. A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Chronic lymphocytic leukemia cll is the most prevalent type of adult lymphoproliferative disorder, but oral manifestations are uncommon.
Large infiltration of chronic lymphocytic leukemia in the. A closely related term is epulis, denoting a localized. Gingival enlargement associated with different medical disorders systemic involvement gingival enlargement associated with cancer. Evaluation of medical history revealed that the patient was under chemotherapy for 1 year ending 5 months before, for a curetted mole which had appeared. Gingival enlargement in leukemia occurs due to in ltration of premature leuk ocytes. Gingival enlargement is an increase in the size of the gingiva gums. Gingival hyperplasia is most commonly seen with the aml subtypes acute monocytic leukemia m5 66. Hematological findings of the patient, before and eight weeks after the initiation of chemotherapy. Gingival hyperplasia as an early diagnostic oral manifestation in. Aleukemic leukemia is a type of leukemia in which abnormal or leukemic cells are absent in the peripheral blood. Gingival enlargement in al is either due to leukemic infiltration, or due to reactive hyperplasia. Gingival hyperplasia is a wellestablished extramedullary presentation of leukemia. Acute monoblastic leukemia aleukemic leukemia presenting as. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both.
An increase in size of the gingiva is a common feature of gingival disease. A case report, authorserhat demirer and hakan \ozdemir and m. Gingival enlargement in a pregnant woman with acute. Gingival hyperplasia as an early diagnostic oral manifestation in acute monocytic leukemia. Case report this case report describes a 9yearold female who presented with gingival enlargement after wearing an orthodontic appliance. Gingival inflammation and platelet count in patients with. Gingival enlargement as oral manifestation in acute myeloid. This is a common symptom that aids in the diagnosis of leukemia and warrants. This is a case report of gingival enlargement in acute lymphoblastic leukemia.
Gingival hypertrophy in a patient of acute biphenotypic leukemia. Recently it is known that gingival overgrowth may be a consequence of the administration of three groups of medicaments anticonvulsants 2, calcium channel blockers. Division op hematology and oral pathology, washington university school of medicine, and hematology research laboratory, john cochran veterans administration hospital g i ingival hyperplasia with leukemic cell. Jun 20, 2018 oral manifestations have been described primarily in acute leukemia and consist of cervical lymphadenopathy, petechiae, and mucosal ulcers as well as gingival inflammation and enlargement. Among the oral manifestations, gingival hyperplasia is frequently encountered by patients with aml.
To get the facts on exactly how to eliminate your uterine fibroids from the root 100% naturally and permanently and achieve lasting freedom from pcos related symptoms without spending your hardearned money on drugs and over the counters. Leukemic enlargement is due to gingival infiltration of immature blasts and proliferating leukocytes and most commonly occur in acute monocytic leukemia and acute myelomonocytic leukemia. Gingival hyperplasia is a rare condition affecting the patient cosmetically and functionally. Leukemia gingival enlargement, petechiae, mucosal bleeding, and ulcerations are findings within the oral cavity that are suggestive of. Chemotherapy for chorio carcinoma was a prominent note in history. Aleukemic or subleukemic forms of amls are more likely to present as gingival enlargements in adults. Pregnancy puberty vitamin c deficiency plasma cell gingivitis pyogenic granuloma non specific conditioned enlargement b. Gingival enlargements free download as powerpoint presentation. Gingival involvement is common in aml, and in these kinds of patients, a. Dental plaqueinduced gingival conditions murakami 2018. Determining the type of gingival enlargement is essential, because each type has its own set of causes. Gingival enlargement gingival enlargement or overgrowth is usually caused by local inflammatory conditions such as poor oral hygiene, food impaction, or mouth breathing. Unusual clinical presentation of generalised gingival enlargement.
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