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Myeloid sarcoma of the Gingiva with myelodysplastic syndrome

View Article: PubMed Central - PubMed

ABSTRACT

The purpose of this report is to present a case of myeloid sarcoma of the gingiva with myelodysplastic syndrome.

A 52-year-old male diagnosed with myelodysplastic syndrome with skin lesions presented with gingival swelling and gingival redness involving the maxillary left second premolar and the maxillary left first molar. The patient was referred from the Department of Hematology for a biopsy of the lesion. Full-thickness flaps were elevated and inflamed, and neoplastic soft tissue was removed from a lesion and the samples sent for histopathologic analysis.

Histopathologic results showed leukemic cell infiltration beneath the oral epithelium, and the specimen was positive for the leukocyte marker. The diagnosis was myeloid sarcoma. Uneventful healing was observed at 2-week follow-up, but relapse of the lesions with the hyperplastic and neoplastic tissue was noted at 4-week follow-up. Further follow-up or treatment could not be performed because the patient did not visit at the next follow-up.

In conclusion, myeloid sarcoma should be a diagnosis option for gingival growth because it can involve intraoral lesion. In this report, a biopsy was performed due to referral considering the patient's medical history. Although myeloid sarcoma in the oral cavity is extremely rare, a small biopsy and consultation with a hematologist may be beneficial for patients and may provide a differential diagnosis.

No MeSH data available.


Related in: MedlinePlus

Clinical view and radiograph at the first visit. (A) Clinical view indicating gingival swelling with gingival redness involving the maxillary left second premolar and the maxillary left first molar. (B) Periapical radiograph indicating the widening of periodontal ligament space at the maxillary left second premolar. (C) Buccal view showing the removal of inflamed or neoplastic soft tissues. (D) Occlusal view after removal of the tissues.
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Figure 2: Clinical view and radiograph at the first visit. (A) Clinical view indicating gingival swelling with gingival redness involving the maxillary left second premolar and the maxillary left first molar. (B) Periapical radiograph indicating the widening of periodontal ligament space at the maxillary left second premolar. (C) Buccal view showing the removal of inflamed or neoplastic soft tissues. (D) Occlusal view after removal of the tissues.

Mentions: The 52-year-old male patient was previously diagnosed with myelodysplastic syndrome at another hospital. A hematologic test showed that the patient was suspected of conversion to acute myeloid leukemia. Closer examination showed that the patient was suspected of refractory anemia with excess blasts-1 or chronic myelomonocytic leukemia. Multiple skin-colored or bluish masses were presented on the trunk for 10 days. Skin biopsy and histologic sections showed perivascular and diffuse infiltration of atypical mononuclear cells in the mid and deep dermis (Fig. 1A and B). On immunohistochemical staining, the tumor cells were positive for CD68 (Fig. 1C) and myeloperoxidase (Fig. 1D). Histopathological findings were compatible with leukemia cutis. The patient was referred from the Department of Hematology to the Department of Periodontics for the biopsy of the lesion to evaluate the leukemic infiltration after visiting the Department of Oral and Maxillofacial Surgery. The patient's chief complaint was swelling of the maxillary left gingiva. Oral examination revealed gingival swelling with gingival redness involving the maxillary left second premolar and the maxillary left first molar (Fig. 2A). The deepest probing depth was 12 mm at the maxillary left second premolar and the maxillary left first molar interdental area. In periapical radiograph, the widening of periodontal ligament space was observed at the maxillary left second premolar (Fig. 2B). There was consultation with the Department of Hematology for the possibilities and considerations of the flap operation and an extraction was made. Full-thickness flaps were elevated and inflamed and neoplastic soft tissues were removed from lesion (Fig. 2C and D). The samples were sent to the Department of Pathology for histopathologic analysis. Hematoxylin-eosin-stained sections revealed mass formation with atypical mononuclear cells beneath the oral epithelium (Fig. 3A and B). The tumor cells were positive for leukocyte common antigen CD45RB (Fig. 3C) and myeloperoxidase (Fig. 3D). In addition, some scattered cells were positive for CD34 and CD117 (Fig. 3E and F). The histopathological findings were compatible with myeloid leukemic infiltration of myeloid sarcoma. Uneventful healing was observed at 2-week follow-up (Fig. 4A and B). At the 4-week follow-up, relapse of the lesions with the hyperplastic and neoplastic tissue was noted (Fig. 4C). Periapical radiograph showed bone loss at the interdental area between the maxillary left second premolar and the maxillary left first molar (Fig. 4D). Extraction of the maxillary left second premolar was planned, but the patient did not visit at the next follow-up.


Myeloid sarcoma of the Gingiva with myelodysplastic syndrome
Clinical view and radiograph at the first visit. (A) Clinical view indicating gingival swelling with gingival redness involving the maxillary left second premolar and the maxillary left first molar. (B) Periapical radiograph indicating the widening of periodontal ligament space at the maxillary left second premolar. (C) Buccal view showing the removal of inflamed or neoplastic soft tissues. (D) Occlusal view after removal of the tissues.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998473&req=5

Figure 2: Clinical view and radiograph at the first visit. (A) Clinical view indicating gingival swelling with gingival redness involving the maxillary left second premolar and the maxillary left first molar. (B) Periapical radiograph indicating the widening of periodontal ligament space at the maxillary left second premolar. (C) Buccal view showing the removal of inflamed or neoplastic soft tissues. (D) Occlusal view after removal of the tissues.
Mentions: The 52-year-old male patient was previously diagnosed with myelodysplastic syndrome at another hospital. A hematologic test showed that the patient was suspected of conversion to acute myeloid leukemia. Closer examination showed that the patient was suspected of refractory anemia with excess blasts-1 or chronic myelomonocytic leukemia. Multiple skin-colored or bluish masses were presented on the trunk for 10 days. Skin biopsy and histologic sections showed perivascular and diffuse infiltration of atypical mononuclear cells in the mid and deep dermis (Fig. 1A and B). On immunohistochemical staining, the tumor cells were positive for CD68 (Fig. 1C) and myeloperoxidase (Fig. 1D). Histopathological findings were compatible with leukemia cutis. The patient was referred from the Department of Hematology to the Department of Periodontics for the biopsy of the lesion to evaluate the leukemic infiltration after visiting the Department of Oral and Maxillofacial Surgery. The patient's chief complaint was swelling of the maxillary left gingiva. Oral examination revealed gingival swelling with gingival redness involving the maxillary left second premolar and the maxillary left first molar (Fig. 2A). The deepest probing depth was 12 mm at the maxillary left second premolar and the maxillary left first molar interdental area. In periapical radiograph, the widening of periodontal ligament space was observed at the maxillary left second premolar (Fig. 2B). There was consultation with the Department of Hematology for the possibilities and considerations of the flap operation and an extraction was made. Full-thickness flaps were elevated and inflamed and neoplastic soft tissues were removed from lesion (Fig. 2C and D). The samples were sent to the Department of Pathology for histopathologic analysis. Hematoxylin-eosin-stained sections revealed mass formation with atypical mononuclear cells beneath the oral epithelium (Fig. 3A and B). The tumor cells were positive for leukocyte common antigen CD45RB (Fig. 3C) and myeloperoxidase (Fig. 3D). In addition, some scattered cells were positive for CD34 and CD117 (Fig. 3E and F). The histopathological findings were compatible with myeloid leukemic infiltration of myeloid sarcoma. Uneventful healing was observed at 2-week follow-up (Fig. 4A and B). At the 4-week follow-up, relapse of the lesions with the hyperplastic and neoplastic tissue was noted (Fig. 4C). Periapical radiograph showed bone loss at the interdental area between the maxillary left second premolar and the maxillary left first molar (Fig. 4D). Extraction of the maxillary left second premolar was planned, but the patient did not visit at the next follow-up.

View Article: PubMed Central - PubMed

ABSTRACT

The purpose of this report is to present a case of myeloid sarcoma of the gingiva with myelodysplastic syndrome.

A 52-year-old male diagnosed with myelodysplastic syndrome with skin lesions presented with gingival swelling and gingival redness involving the maxillary left second premolar and the maxillary left first molar. The patient was referred from the Department of Hematology for a biopsy of the lesion. Full-thickness flaps were elevated and inflamed, and neoplastic soft tissue was removed from a lesion and the samples sent for histopathologic analysis.

Histopathologic results showed leukemic cell infiltration beneath the oral epithelium, and the specimen was positive for the leukocyte marker. The diagnosis was myeloid sarcoma. Uneventful healing was observed at 2-week follow-up, but relapse of the lesions with the hyperplastic and neoplastic tissue was noted at 4-week follow-up. Further follow-up or treatment could not be performed because the patient did not visit at the next follow-up.

In conclusion, myeloid sarcoma should be a diagnosis option for gingival growth because it can involve intraoral lesion. In this report, a biopsy was performed due to referral considering the patient's medical history. Although myeloid sarcoma in the oral cavity is extremely rare, a small biopsy and consultation with a hematologist may be beneficial for patients and may provide a differential diagnosis.

No MeSH data available.


Related in: MedlinePlus