title: Histological and immunohistochemical features of gingival enlargement in a patient with AML.
abstract: Here, we discuss the pathophysiology of leukemia-associated gingival enlargement based on a case of acute myelomonocytic leukemia (AML-M4) with typical gingival enlargement. Uniquely, this patient was well enough to allow full periodontal examination and incisional gingival biopsy to be performed both before and after chemotherapy. The patient was a 39-year-old Japanese woman with AML-M4 showing gingival enlargement. Histological and immunohistochemical features of gingiva and bacterial counts in the periodontal pockets were examined before and after chemotherapy. The results were as follows: (1) infiltration of myelomonocytic blasts in enlarged gingiva; (2) resolution of gingival enlargement with complete remission of AML by anticancer chemotherapy; and (3) the numbers of bacteria in the periodontal pockets were not high and were not altered before or after chemotherapy. In patients with AML-M4, remarkable mucosal enlargement is not generally observed in the body except in the gingiva. We hypothesized that antigens derived from periodontal bacteria, even if they are not present in large numbers, could act as chemoattractants for myelomonocytic leukemic cells.
authors.affiliation: Department of Patho-physiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Sonoi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Soga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maeda
authors.forename: Koichi
authors.initials: K
authors.lastname: Ichimura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshino
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Aoyama
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Fujii
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
authors.forename: Richard
authors.initials: R
authors.lastname: Logan
authors.forename: Judith
authors.initials: J
authors.lastname: Raber-Durlacher
authors.forename: Shogo
authors.initials: S
authors.lastname: Takashiba
mesh_terms: D000328:Adult; D000942:Antigens, Bacterial / Q000276:immunology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D058491:Bacterial Load; D002630:Chemotactic Factors / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D019214:Gingival Overgrowth / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D015479:Leukemia, Myelomonocytic, Acute / Q000188:drug therapy / Q000473:pathology*; D017254:Leukemic Infiltration / Q000188:drug therapy / Q000473:pathology*; D010514:Periodontal Pocket / Q000382:microbiology / Q000473:pathology; D012074:Remission Induction
chemical_list: D000942:Antigens, Bacterial; D002630:Chemotactic Factors
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