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Generalised Leukaemic Gingival Enlargement: a Case Report

Identifieur interne : 000784 ( Pmc/Checkpoint ); précédent : 000783; suivant : 000785

Generalised Leukaemic Gingival Enlargement: a Case Report

Auteurs : Mechery Reenesh ; Singh Munishwar ; Saroj Kumar Rath

Source :

RBID : PMC:3886083

Abstract

ABSTRACTBackground

Acute myeloblastic leukaemia is a malignant bone marrow neoplasm of myeloid precursors of white blood cells. Due to its high morbidity rate, early diagnosis and appropriate medical therapy is essential.

Methods

The article highlights normal blood alterations like anaemia, thrombocytopenia, leukocytosis and advanced diagnostic aids like flow cytometry, special staining as a diagnostic modality as well as for prognostic information in acute leukaemia, particularly as a tool for assigning lineage and facilitating further pathologic classification which may be helpful in influencing treatment strategies.

Results

On clinical examination the case presented with features of inflammatory gingival enlargement with presence of local deposits and calculus. Routine blood examination anaemia, thrombocytopenia, leukocytosis with haemoglobin 5.6 gm% and total leukocyte count of 1,12,000 / cu mm suggestive of leukaemia. Myeloperoxidase and leukocyte nonspecific esterase (NSE) special stain were used which showed presence of myeloblasts in the peripheral smear suggestive of acute myelocytic leukaemia. Flow cytometry were done which further helped in interpretation of these cells which showed to be strongly positive for CD45, CD13, CD14, and anti HLADR and moderately positive for CD4, CD34 and Anti MPO confirming to be case of AML-M4 with 57.73% gating.

Conclusions

Fact that gingival alterations are sometimes the first manifestations of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of systemic diseases. The timely referral by the general dentist for a suspicious lesion provided an early diagnosis and early intervention reducing the patient morbidity.


Url:
DOI: 10.5037/jomr.2012.3305
PubMed: 24422017
PubMed Central: 3886083


Affiliations:

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PMC:3886083

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<p>Acute myeloblastic leukaemia is a malignant bone marrow neoplasm of myeloid precursors of white blood cells. Due to its high morbidity rate, early diagnosis and appropriate medical therapy is essential.</p>
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<p>The article highlights normal blood alterations like anaemia, thrombocytopenia, leukocytosis and advanced diagnostic aids like flow cytometry, special staining as a diagnostic modality as well as for prognostic information in acute leukaemia, particularly as a tool for assigning lineage and facilitating further pathologic classification which may be helpful in influencing treatment strategies.</p>
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<p>On clinical examination the case presented with features of inflammatory gingival enlargement with presence of local deposits and calculus. Routine blood examination anaemia, thrombocytopenia, leukocytosis with haemoglobin 5.6 gm% and total leukocyte count of 1,12,000 / cu mm suggestive of leukaemia. Myeloperoxidase and leukocyte nonspecific esterase (NSE) special stain were used which showed presence of myeloblasts in the peripheral smear suggestive of acute myelocytic leukaemia. Flow cytometry were done which further helped in interpretation of these cells which showed to be strongly positive for CD45, CD13, CD14, and anti HLADR and moderately positive for CD4, CD34 and Anti MPO confirming to be case of AML-M4 with 57.73% gating.</p>
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<article-id pub-id-type="pmid">24422017</article-id>
<article-id pub-id-type="pmc">3886083</article-id>
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<name>
<surname>Reenesh</surname>
<given-names>Mechery</given-names>
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<surname>Munishwar</surname>
<given-names>Singh</given-names>
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<surname>Rath</surname>
<given-names>Saroj Kumar</given-names>
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<xref ref-type="aff" rid="aff2">2</xref>
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<sup>1</sup>
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<addr-line>Pune</addr-line>
<country>India.</country>
</aff>
<aff id="aff2" rid="aff2">
<sup>2</sup>
<institution>Department of Dental Surgery, Armed Forces Medical College</institution>
<addr-line>Pune</addr-line>
<country>India.</country>
</aff>
<author-notes>
<corresp>Reenesh Mechery,
<institution>Department of Dental Surgery. Armed Forces Medical College</institution>
<addr-line>Pune-411040</addr-line>
India
<email>captreenesh@gmail.com</email>
</corresp>
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<pub-date pub-type="collection">
<season>Jul-Sep</season>
<year>2012</year>
</pub-date>
<pub-date pub-type="epub">
<day>1</day>
<month>10</month>
<year>2012</year>
</pub-date>
<volume>3</volume>
<issue>3</issue>
<elocation-id>e5</elocation-id>
<history>
<date date-type="received">
<day>26</day>
<month>7</month>
<year>2012</year>
</date>
<date date-type="accepted">
<day>25</day>
<month>9</month>
<year>2012</year>
</date>
</history>
<permissions>
<copyright-statement> Copyright © Reenesh M, Munishwar S, Rath SK. Published in the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH (http://www.ejomr.org), 1 October 2012.</copyright-statement>
<copyright-year>2012</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/">
<license-p>This is an open-access article, first published in the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH, distributed under the terms of the Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/">http://creativecommons.org/licenses/by-nc-nd/3.0/</ext-link>
), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work and is properly cited. The copyright, license information and link to the original publication on
<ext-link ext-link-type="uri" xlink:href="http://www.ejomr.org">http://www.ejomr.org</ext-link>
must be included.</license-p>
</license>
</permissions>
<self-uri xlink:type="simple" xlink:href="http://www.ejomr.org/JOMR/archives/2012/3/e5/v3n3e5ht.htm"></self-uri>
<abstract>
<title>ABSTRACT</title>
<sec sec-type="background">
<title>Background</title>
<p>Acute myeloblastic leukaemia is a malignant bone marrow neoplasm of myeloid precursors of white blood cells. Due to its high morbidity rate, early diagnosis and appropriate medical therapy is essential.</p>
</sec>
<sec sec-type="methods">
<title>Methods</title>
<p>The article highlights normal blood alterations like anaemia, thrombocytopenia, leukocytosis and advanced diagnostic aids like flow cytometry, special staining as a diagnostic modality as well as for prognostic information in acute leukaemia, particularly as a tool for assigning lineage and facilitating further pathologic classification which may be helpful in influencing treatment strategies.</p>
</sec>
<sec sec-type="results">
<title>Results</title>
<p>On clinical examination the case presented with features of inflammatory gingival enlargement with presence of local deposits and calculus. Routine blood examination anaemia, thrombocytopenia, leukocytosis with haemoglobin 5.6 gm% and total leukocyte count of 1,12,000 / cu mm suggestive of leukaemia. Myeloperoxidase and leukocyte nonspecific esterase (NSE) special stain were used which showed presence of myeloblasts in the peripheral smear suggestive of acute myelocytic leukaemia. Flow cytometry were done which further helped in interpretation of these cells which showed to be strongly positive for CD45, CD13, CD14, and anti HLADR and moderately positive for CD4, CD34 and Anti MPO confirming to be case of AML-M4 with 57.73% gating.</p>
</sec>
<sec sec-type="conclusions">
<title>Conclusions</title>
<p>Fact that gingival alterations are sometimes the first manifestations of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of systemic diseases. The timely referral by the general dentist for a suspicious lesion provided an early diagnosis and early intervention reducing the patient morbidity.</p>
</sec>
</abstract>
<kwd-group>
<kwd>acute myeloid leukemia</kwd>
<kwd>flow cytometry</kwd>
<kwd>gingival hyperplasia.</kwd>
</kwd-group>
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<name sortKey="Munishwar, Singh" sort="Munishwar, Singh" uniqKey="Munishwar S" first="Singh" last="Munishwar">Singh Munishwar</name>
<name sortKey="Rath, Saroj Kumar" sort="Rath, Saroj Kumar" uniqKey="Rath S" first="Saroj Kumar" last="Rath">Saroj Kumar Rath</name>
<name sortKey="Reenesh, Mechery" sort="Reenesh, Mechery" uniqKey="Reenesh M" first="Mechery" last="Reenesh">Mechery Reenesh</name>
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