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Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature.

Gowda TM, Thomas R, Shanmukhappa SM, Agarwal G, Mehta DS - J Indian Soc Periodontol (2013)

Bottom Line: Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML).As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases.Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India.

ABSTRACT
Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML). Gingival enlargement associated with bleeding and ulceration is the most common rapidly appearing oral manifestations of leukemic involvement. An 8 months pregnant patient reported with generalized gingival enlargement, with localized cyanotic and necrotic papillary areas. Co-relating the hematological report with the oral lesions and her past medical history of HL, a diagnosis of t-AML secondary to treatment for HL was made by the oncologist. As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases. Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.

No MeSH data available.


Related in: MedlinePlus

Clinical photographs of patient (a-d) on 27th June 2011, exhibiting generalized gingival enlargement with localized necrotic and cyanotic areas
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Figure 1: Clinical photographs of patient (a-d) on 27th June 2011, exhibiting generalized gingival enlargement with localized necrotic and cyanotic areas

Mentions: On 27th June 2011, the patient reported with increased gingival pain and swelling accompanied with fever. On examination, there was severe generalized gingival overgrowth with localized necrosis and sloughing involving the interdental papilla in relation to tooth #3. Interdental and marginal gingiva in relation to teeth #10 and 11 revealed the first instance of an abnormal color change and had become more erythematous, boggy, and cyanotic [Figure 1]. Routine blood investigations were advised. The hematological findings are presented in Table 1. Peripheral blood smear revealed 90% myeloblasts with large round nucleus, coarse chromatin and ill-defined nucleoli with moderately pale blue cytoplasm [Figures 2 and 3]. Hematology clinic diagnosed the case as AML M4/M5 (French-American-British Classification, 2000). After observing the hematological report, the patient was further probed for her past medical history, on which she disclosed that she had taken systemic CT for HL 4 years back. Considering her medical status (8th month of pregnancy), she was referred to her consulting obstetrician and oncologist for any required immediate needful treatment. The oncologist informed us that the patient was diagnosed for Malignant HL 4 years back in May 2007, for which she had received CT with six cycles of ABVD and RT (40 Grays) for 1 month. Co-relating the past medical history with present findings, the case was diagnosed as therapy-related AML (t-AML). The clinical photographs from the day the necrotic areas were observed till the delivery of the baby showed classical gingival changes [Figures 4 and 5].


Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature.

Gowda TM, Thomas R, Shanmukhappa SM, Agarwal G, Mehta DS - J Indian Soc Periodontol (2013)

Clinical photographs of patient (a-d) on 27th June 2011, exhibiting generalized gingival enlargement with localized necrotic and cyanotic areas
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713761&req=5

Figure 1: Clinical photographs of patient (a-d) on 27th June 2011, exhibiting generalized gingival enlargement with localized necrotic and cyanotic areas
Mentions: On 27th June 2011, the patient reported with increased gingival pain and swelling accompanied with fever. On examination, there was severe generalized gingival overgrowth with localized necrosis and sloughing involving the interdental papilla in relation to tooth #3. Interdental and marginal gingiva in relation to teeth #10 and 11 revealed the first instance of an abnormal color change and had become more erythematous, boggy, and cyanotic [Figure 1]. Routine blood investigations were advised. The hematological findings are presented in Table 1. Peripheral blood smear revealed 90% myeloblasts with large round nucleus, coarse chromatin and ill-defined nucleoli with moderately pale blue cytoplasm [Figures 2 and 3]. Hematology clinic diagnosed the case as AML M4/M5 (French-American-British Classification, 2000). After observing the hematological report, the patient was further probed for her past medical history, on which she disclosed that she had taken systemic CT for HL 4 years back. Considering her medical status (8th month of pregnancy), she was referred to her consulting obstetrician and oncologist for any required immediate needful treatment. The oncologist informed us that the patient was diagnosed for Malignant HL 4 years back in May 2007, for which she had received CT with six cycles of ABVD and RT (40 Grays) for 1 month. Co-relating the past medical history with present findings, the case was diagnosed as therapy-related AML (t-AML). The clinical photographs from the day the necrotic areas were observed till the delivery of the baby showed classical gingival changes [Figures 4 and 5].

Bottom Line: Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML).As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases.Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India.

ABSTRACT
Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML). Gingival enlargement associated with bleeding and ulceration is the most common rapidly appearing oral manifestations of leukemic involvement. An 8 months pregnant patient reported with generalized gingival enlargement, with localized cyanotic and necrotic papillary areas. Co-relating the hematological report with the oral lesions and her past medical history of HL, a diagnosis of t-AML secondary to treatment for HL was made by the oncologist. As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases. Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.

No MeSH data available.


Related in: MedlinePlus