One week later, there was a sudden onset of extremely generalized gingival enlargement and very high wbc count 144,000cmm was noted. If gingival enlargement isnt treated, it may some aesthetic problems, plaque accumulation, gingival bleeding, and periodontitis. Pdf gingival enlargement as oral manifestation in acute. We study the prevalence of acute myeloid leukemia aml among patients with severe gingival enlargement. Pdf the oral cavity manifests signs of various systemic diseases. Gingival hyperplasia in acute leukemia stanford medicine 25. Soft, edematous, tender gingiva with ease to bleeding is a sign in blood disorders. A case of diffuse gingival enlargement in acute myeloblastic. Pediatric leukemia an overview utsav mukherjee abstract leukemia is characterized by widespread, rapid, and disorderly proliferation of leukocytes.
Gingival overgrowth may vary from isolated mild enlargement of interdental papilla or a uniform enlargement which may affect either one or both jaws. This is a common symptom that aids in the diagnosis of leukemia and warrants dental consultation. Primary gingival enlargement as a diagnostic indicator in. Gingival hyperplasia is secondary to infiltration of the gingival tissue with leukemia cells and is well described in the literature. Acute monoblastic leukemia aleukemic leukemia presenting as. 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. Oral findings in acute leukemia al are common and could be the presenting feature of the disease, namely, gingival enlargement, ulceration, bleeding, and infection. This case stresses the importance of taking a thorough. Gingival enlargement as oral manifestation in acute myeloid leukemia patient. A case of acute monocytic leukemia in a 25 year old pregnant lady who reported with gingival enlargement is presented here. Gingival enlargement associated with acute myelocytic leukemia. Gingival enlargement is one of the frequent features of gingival diseases.
Pdf gingival enlargement leading to the diagnosis of acute. 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. Gingival enlargement in myelodysplastic syndrome george n. Pdf gingival enlargement leading to the diagnosis of. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. They found that at the end of 12 months, 25 per cent of patients with acute leukaemia without intraoral. Even though many cases of gingival enlargement associated. Although many cases of gingival enlargement in patients with acute myeloid leukemia s have been reported in the literature, cases diagnosed by the oral manifestations in india are very few. Nov 10, 2007 acute onset gingival enlargement is an unusual physical sign with a narrow differential diagnosis. Chemotherapy for chorio carcinoma was a prominent note in history. A case of gingival enlargement in acute myeloid leukemia. Unusual clinical presentation of generalised gingival.
A 21 year old male presented with fever, weakness and petechiae. Gingival enlargement, chronic myeloid leukemia, zimmermannlaband syndrome, nifedipine introduction gingival enlargement ge is defined as an abnormal overgrowth of gingival tissues. Acute myelomonocytic leukemia presenting with gingival enlargement as the only clinical manifestation. The role of oral lesions as a diagnostic indicator is. Gingival enlargement as oral manifestation in acute myeloid leukemia patient background. Acute onset gingival enlargement is an unusual physical sign with a narrow differential diagnosis. Jun, 2012 gingival hypertrophy in a patient of acute biphenotypic leukemia. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement.
Gingival hyperplasia complicating acute myelomonocytic leukemia. Gingival hyperplasia secondary to infiltration of the gingival tissue with leukemia cells is thoroughly described in the literature. Gingival enlargement is an increase in the size of the gingiva gums. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease.
Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. Leukemia, myeloblastic, gingival enlargement, signs and symptoms, acute, diffuse. 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. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Gingival infiltration in acute monoblastic leukaemia. Oral lesions occur in both acute and chronic form of all types of leukaemias. Gingival enlargement associated with acute myelocytic. Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. Periodontal findings of a 19yearold female with previously undiagnosed acute myeloid leukemia aml are presented. This is a case report of gingival enlargement in acute lymphoblastic leukemia. Gingivectomy 00109 abstract gingival enlargement is a common feature in gingival disease. Extramedullary involvement of leukemia can occur in up to 40% of patients. Aleukemic leukemia is a type of leukemia in which abnormal or leukemic cells are absent in the peripheral blood.
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. Gingival enlargement leading to the diagnosis of acute lymphoblastic leukemia in an 8year old girl. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Gingival leukemic infiltration in chronic lymphocytic leukemia. Chronic inflammatory gingival enlargement and treatment. Leukemia gingival enlargement, petechiae, mucosal bleeding, and ulcerations are findings within the oral cavity that are suggestive of.
A 46yearold woman who was not taking any medications presented with anemia and gingival hypertrophy that had. Gingival enlargement and its treatment authorstream. Leukemic gingival enlargement a role of periodontist in. Aug 12, 2014 systemic diseases that cause gingival enlargement several systemic diseases may result in gingival enlargement through different mechanisms these are usually uncommon cases leukemia granulomatous diseases. Acute myeloblastic leukemia aml is a malignant disease of bone marrow, usually presenting gingival overgrowth as its first clinical manifestation. Gingival hyperplasia is most commonly seen with the aml subtypes acute monocytic leukemia m5 66. The patient was diagnosed with acute myelocytic leukemia. Case report this case report describes a 9yearold female who presented with gingival enlargement after wearing an orthodontic appliance. Lynch and ship 10 have also reported that the presence of intraoral bleeding in patients with acute leukaemia was prognostically significant. Gingival leukemic infiltration in chronic lymphocytic leukemia cary a. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Systemic conditions such as hormonal changes, drug therapy, or tumor infiltrates may also cause or contribute to the severity of gingival enlargement.
However, the oral manifestations are far more common in the acute stages. Typical oral manifestations of acute leukemia include gingival swelling, oral ulceration, spontaneous gingival bleeding, petechiae, mucosal pallor, herpetic. Gingival fine needle aspiration cytology in acute leukemia. Intra oral examination revealed generalized gingival enlargement, inconsistent with the amount of calculus. Gingival enlargement gingival enlargement or overgrowth is usually caused by local inflammatory conditions such as poor oral hygiene, food impaction, or mouth breathing. Ruling out other etiologies, second cbc and peripheral blood smear results confirmed aml. 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. The oral manifestations of leukaemia include gingival enlargement, oral ulcerations, gingival bleeding, petechia and mucosal pallor. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. May 22, 2014 gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. The saxer and muhlemann index were used to measure inflammation and gingival bleeding. Gingival hyperplasia in acute leukemia stanford medicine. In this paper, inflammatory gingival enlargement and treatment was presented.
A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Leukemia leukemia, like other cancers, results from mutations in the dna. 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. In india, leukemia is the most common childhood cancer with a relative proportion varying between 25% and 40% and continues to be the largest contrib utor to cancerrelated mortality in children. 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. Gingival hyperplasia as an early manifestation of acute. Gingival enlargement associated with acute myelocytic leukemia in a child.