title: Unusual case of oral chronic lymphocytic leukemia presenting as recurrent epistaxis and asymptomatic intraoral swelling.
abstract: BACKGROUND
  Usually, oral manifestations of chronic lymphocytic leukemia CLL are related to an advanced stage of a diagnosed disease, and rarely may lead to diagnosis. CLL can also present as bleeding, rarely isolated. We report a rare case of CLL the first symptoms of which were recurrent epistaxis and asymptomatic intraoral swelling.
  
  
  METHODS
  A 74-year-old woman consulted for recurrent epistaxis. She presented with a small asymptomatic swelling in the left superior vestibule. Computed tomography revealed a tissular-like mass without invasion of surrounding tissues. The hemogram revealed thrombocytopenia and leukocytosis with 51% of lymphocytes. The immuno-histochemical analysis of the lesion and of the bone marrow allowed diagnosing stage IV CLL.
  
  
  CONCLUSIONS
  CLL may present as unusual symptoms. It should be suspected in elderly patients presenting with atypical clinical signs such as oral swelling or signs of bone marrow involvement.
authors.affiliation: ENT Department of "Tor Vergata", University Hospital; Viale Oxford, 81 00133 Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Alessandrini
authors.forename: A
authors.initials: A
authors.lastname: Micarelli
authors.forename: F
authors.initials: F
authors.lastname: Mugnaini
authors.forename: A
authors.initials: A
authors.lastname: De Padova
authors.forename: I
authors.initials: I
authors.lastname: Pavone
authors.forename: E
authors.initials: E
authors.lastname: Bruno
mesh_terms: D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D004844:Epistaxis / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis*; D007964:Leukocytosis / Q000175:diagnosis; D009059:Mouth Diseases / Q000175:diagnosis*; D009061:Mouth Mucosa / Q000473:pathology; D009062:Mouth Neoplasms / Q000175:diagnosis*; D009367:Neoplasm Staging; D012008:Recurrence; D013921:Thrombocytopenia / Q000175:diagnosis; D014057:Tomography, X-Ray Computed