Acute monoblastic leukemia aleukemic leukemia presenting as gingival enlargement. Down syndrome is associated with gingival enlargement observed in acute leukemia is due to a 14 year old boy presents with bilateral white thickening of the buccal mucosa which has been present since. Rapidly forming gingival hyperplasia is usually the first sign of this disease. Leukemic gingival enlargements occur in aml because gingival tissue supports continuous trafficking of myeloid cells and contains specialized postcapillary. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue. Gingival enlargement or hypertrophy are the two other terms used to describe the condition. Gingival enlargement in dogs vetlexicon canis from. 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. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Gingival hyperplasia as an early manifestation of acute. Oral manifestations of acute promyelocytic leukemia. Gingival hyperplasia in acute leukemia stanford medicine 25.
Gingival enlargement as an early diagnostic indicator in therapy. Leukemic gingival enlargement a role of periodontist in. Gender has not been described as a risk factor for developing this manifestation. Gingival hypertrophy in a patient of acute biphenotypic leukemia. Systemic conditions such as hormonal changes, drug therapy, or tumor infiltrates may also cause or contribute to the severity of gingival enlargement. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. Clinical stomatology gingival swellings columbia ctl. Gingival hyperplasia can be seen in patients with familial gingival enlargement, pregnancy and leukemia. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications.
Note that the enlargement is more prominent in the maxilla and is associated with greater plaque accumulation b, lingual view of gingival enlargement in a patient with subacute monocytic. Determining a benign or malignant underlying cause for gingival enlargement requires biopsy and. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. Gingival enlargement a common feature of gingival disease which can be caused by gingival inflammation, fibrous overgrowth, or a combination of the two. Pdf the oral cavity manifests signs of various systemic diseases.
In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Gingival enlargement as a diagnostic indicator in leukaemia. Gingival hyperplasia in acute leukemia extramedullary involvement of leukemia can occur in up to 40% of patients. Management of druginduced gingival enlargement australian. Dental professionals should be aware of clinical manifestations and complications asso ciated with these malignant. Gingival enlargement and its treatment authorstream.
It usually occurs in people older men above age aleukemic granulocytic sarcoma and leukemia cutis. Learn the shocking truth about uterine fibroids, drugs and surgeries. Gingival hyperplasia complicating acute myelomonocytic leukemia. Aug 12, 2010 in some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Dental professionals should be aware of clinical manifestations and complications asso ciated with these malignant neoplastic diseases to aid in diagnosis and subsequent treatment and management. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Acute myeloblastic leukemia aml is a malignant disease of bone marrow, usually presenting gingival overgrowth as its first clinical manifestation. The lesion may involve the interproximal spaces, and become so extensive that the teeth are displaced and their crowns covered. The oral manifestations of leukaemia include gingival enlargement, oral ulcerations, gingival bleeding, petechia and mucosal pallor. Children with aml in general may present with a broad variety of. Case report, australian dental journal on deepdyve, the largest online rental service for scholarly research with thousands of academic.
Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. 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. Gingival hyperplasia is a disease in which the gum tissues overgrow abnormally. Recently it is known that gingival overgrowth may be a consequence of the administration of three groups of medicaments anticonvulsants 2, calcium channel blockers. However, the available literature on this topic consists. Gingival enlargement as oral manifestation in acute myeloid. Tissue enlargement may progress to the point that the tissue obscures the teeth and may interfere. Gingival hyperplasia in acute leukemia stanford medicine. Gingival enlargement leading to the diagnosis of acute lymphoblastic leukemia in an 8year old girl.
The differential diagnosis included enlargement due to drugs e. Jun, 2012 gingival hypertrophy in a patient of acute biphenotypic leukemia. Due to its high morbidity rate, early diagnosis and appropriate medical therapy is essential. How common is gingival infiltration as a manifestation of aml m5. Even though many cases of gingival enlargement associated. Orofacial complications of leukemia include lymphadenopathy, gingival bleeding, petechiae, ulceration, gingival enlargement and infections. Gingival fine needle aspiration cytology in acute leukemia. Gingival enlargment is a clinical term, referring to an increase in the size or thickness of gingiva. This paper aims to throw light on an interesting case of acute leukemia diagnosed on. A case of acute monocytic leukemia in a 25 year old pregnant lady who reported with gingival enlargement is presented here. Aleukemic leukemia definition of aleukemic leukemia by medical dictionary s. Down syndrome is associated with gingival enlargement observed in acute leukemia is due to a 14 year old boy presents with bilateral white thickening of the buccal mucosa which has been present since birth. Case report, australian dental journal on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Gingival enlargement associated with multiple factors is leading to gingival dimorphism agrawal, 2015.
Identifying gingival overgrowth as an initial oral manifestation of leukemic infiltration is extremely important for establishing an early diagnosis of acute leukemia 5. Tissue enlargement may progress to the point that the tissue obscures the teeth and may interfere with occlusion enlargement tissue appear firm fibrotic, pale pink and resilient, has little tendency to bleed, and has lobed surface appearance enlargement usually through out the mouth and appear more pronounced in the. Rieder cell leukemia a form of acute myelogenous leukemia in which the blood contains the abnormal cells called rieders lymphocytesasynchronously developed lymphocytes that have. To get the facts on exactly how to eliminate your uterine fibroids from. Leukemia, oral manifestations, gingival hyperplasia. A case of diffuse gingival enlargement in acute myeloblastic.
Oral changes may be the first and only presenting signs in leukemic patients. In some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Nevertheless, the overgrowth involves the gingival margin with extension to the interdental papilla. Oral lesions occur in both acute and chronic form of all types of leukaemias. There was more gingival enlargement in the patients taking diltiazem compared with controls. Leukemia has been associated with oral manifestations. The role of oral lesions as a diagnostic indicator is. A 21 year old male presented with fever, weakness and petechiae. A case of diffuse gingival enlargement in acute myeloblastic leukemia aml m1 jadhav varsha sukhdeo1, jadhav avinash sukhdeo2, singhal kapil3 tuteja neeraj4 1mds, junior resident. May 22, 2014 genetically induced gingival enlargement appears pink in color with minimal signs of inflammation, has a slow growth rate, and is firm in consistency. Gingival enlargement observed in acute leukemia is due to vitality tests are used to differentiate between median anterior maxillary cysts occur in the ameloblastomas originate from the it is possible to. However, the oral manifestations are far more common in the acute stages.
The case described here had adequate local factors which are the predisposing factor for gingival enlargement. One of the rarest sites of extramedullary involvement is. 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. Regimens are devised regularly and are tailored to specific illnesses. Acute myeloblastic leukemia aml is a malignant disease of bone marrow. To the right is an example of a localized gingival enlargement associated with pregnancy. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. Many types of leukemia gingival infiltrate assoc with myelomonocytic type generally bone marrow involvement leukemic infiltrate age and gender. Typical oral manifestations of acute leukemia include gingival swelling, oral ulceration, spontaneous gingival bleeding, petechiae, mucosal pallor, herpetic. Gingival enlargement has been studied in 46 patients taking diltiazem n 32 or verapamil n 14 compared with 49 cardiovascular controls who had never taken them 24 c. Gingival enlargement can be caused by a number of factors, including inflammatory. Jun 28, 2019 rieder cell leukemia a form of acute myelogenous leukemia in which the blood contains the abnormal cells called rieders lymphocytesasynchronously developed lymphocytes that have immature cytoplasm and a lobulated, indented, comparatively more mature nucleus. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous.
Abnormalities may also be seen in peripheral blood smears. Gingival enlargement an overview sciencedirect topics. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival. Enlargements associated with systemic diseases periodontal. Surgical treatment of gingival overgrowth with 10 years of. One of the main drugs associated with go is the antiepileptic. A case of diffuse gingival enlargement in acute myeloblastic leukemia aml m1 jadhav varsha sukhdeo1, jadhav avinash sukhdeo2, singhal kapil3 tuteja neeraj4 1mds, junior resident, department of periodontology and oral implantology, govt dental college and. Read gingival enlargement as a diagnostic indicator in leukaemia. Genetically induced gingival enlargement appears pink in color with minimal signs of inflammation, has a slow growth rate, and is firm in consistency. Extramedullary involvement of leukemia can occur in up to 40% of patients.
Oral signs of leukemia and dental management literature. A 46yearold woman who was not taking any medications presented with anemia and gingival hypertrophy that had. Gingival enlargement is a ordinary finding in clinical practice and the appropriate treatment depends on correctly diagnosing the cause of the enlargement. 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. Large infiltration of chronic lymphocytic leukemia in the. Gingival enlargement observed in acute leukemia is due to vitality tests are used to differentiate between median anterior maxillary cysts occur in the ameloblastomas originate from the it is possible to misdiagnose the midline palatal suture as a the lamina dura is if the image of a supernumerary tooth appears in a second radiograph to have. Oral lesions occur in both acute and chronic form of all types of.
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. In addition to gingival enlargement, cyclosporine induces other major side effects such as 1 nephrotoxicity 2 hypertension, and 3 hyperthricosis. Alekuemic to all leukemias are the tendency to bleed and the resultant anemia and increased susceptibility to infection. Systemic causes of gingival enlargement there are numerous physiologic and systemic conditions that may promote localized andor generalized gingival enlargement such as pregnancy, hormonal imbalances, and leukemia. Gingival hyperplasia is more common in acute than chronic leukemia, in adults and in people with aleukemia or subleukemic forms of leukemia. Gingival hyperplasia is a condition marked by the enlargement of the gingiva, or the soft tissue found in the mouth popularly known as the gums. The enlargement can be inflammatory,fibrotic or a combination of both. It is widely recognized that the main manifestation of aml could be gingival hyperplasia and bleeding. Jun 25, 2019 abnormalities may also be seen in peripheral blood smears. Oral manifestations of acute leukemia are often the first indications of disease.
Pdf gingival enlargement leading to the diagnosis of acute. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. The possibility of druginduced enlargement was ruled out based on the medical history. Gingival inflammation and platelet count in patients with leukemia. Gingival hyperplasia secondary to infiltration of the gingival tissue with leukemia cells is thoroughly described in the literature. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Gingival enlargement gingival enlargement or overgrowth is usually caused by local inflammatory conditions such as poor oral hygiene, food impaction, or mouth breathing.
Gingival enlargement and its treatment authorstream presentation. Soft, edematous, tender gingiva with ease to bleeding is a sign in blood disorders. 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. Chronic lymphocytic leukemia cll is the most prevalent type of adult lymphoproliferative disorder, but oral manifestations are uncommon.
Gingival enlargement is an increase in the size of the gingiva gums. Gingival enlargement observed in acute leukemia is due to. Chronic lymphocytic leukemia cll is the most prevalent type of. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. 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. Nevertheless, the overgrowth involves the gingival margin. 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. This is a case report of gingival enlargement in acute lymphoblastic leukemia. 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. Gingival inflammation and platelet count in patients with. A case of gingival enlargement in acute myeloid leukemia. 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 is one of the frequent features of gingival diseases.