Oral manifestations of acute myelomonocytic leukemia: a case report and review of the classification of leukemias.
BACKGROUND
Oral signs and symptoms may indicate a serious underlying systemic disease. The most frequently observed oral findings of leukemia are mucosal bleeding and ulceration, petechiae, and gingival hyperplasia. This case report describes a 53-year-old male who presented with gingival enlargement and bleeding, fatigue, and recent weight loss as initial manifestations of acute myelomonocytic leukemia.


METHODS
A gingival biopsy was performed, revealing the presence of a hypercellular infiltrate of atypical myeloid and monocytic cells. Further work-up consisted of a complete blood count, bone marrow biopsy, and immunohistochemical and histochemical analysis of biopsy material and flow cytometry of peripheral blood.


RESULTS
Flow cytometry results confirmed that the infiltrate was of a myelomonocytic origin, and a diagnosis of acute myelomonocytic leukemia was rendered. The patient responded well to a chemotherapeutic induction regimen of cytosine arabinoside and idarubicin hydrochloride, with regression of gingival enlargement and remission of disease. The patient continued with consolidation chemotherapy and an autologous bone marrow transplant, but eventually died 22 months after initial diagnosis.


CONCLUSIONS
Oral health care professionals, especially periodontists, must recognize that gingival enlargement may represent an initial manifestation of an underlying systemic disease. Acute myelogenous leukemia is a hematological disorder with a predilection for gingival involvement.
Wu
Josephine
J
Department of Dental Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
Fantasia
John E
JE
Kaplan
Robert
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D017809:Fatal Outcome; D005884:Gingival Hemorrhage / Q000209:etiology*; D019214:Gingival Overgrowth / Q000209:etiology*; D006801:Humans; D015255:Idarubicin / Q000627:therapeutic use; D007938:Leukemia / Q000145:classification; D015479:Leukemia, Myelomonocytic, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged
D003561:Cytarabine; D015255:Idarubicin