title: Temporomandibular joint arthritis as an initial presentation of acute myeloid leukemia with myelodysplasia-related changes: a report of an unusual case.
abstract: OBJECTIVE
  Patients with acute myeloid leukemia (AML) often present with fatigue and severe pancytopenia. We report the case of a 68-year-old woman with no significant medical history who presented with 1 year of progressively worsening bilateral temporomandibular joint (TMJ) pain. She was otherwise asymptomatic. A computed tomography scan revealed degenerative joint disease in both TMJs. Bilateral TMJ replacement was performed.
  
  
  METHODS
  The excised TMJ tissue underwent formalin fixation and decalcification, and routine hematoxylin and eosin-stained sections were generated.
  
  
  RESULTS
  Immunohistochemical stains showed a population of monotonous cells in the marrow space expressing CD33, CD43, and myeloperoxidase, confirming the diagnosis of myeloid neoplasm. Subsequent bone marrow biopsy with flow cytometry confirmed AML with myelodysplasia-related changes.
  
  
  CONCLUSIONS
  Adult patients with AML can rarely present with musculoskeletal complaints alone, which could delay the diagnosis. To our knowledge, this is the first report of AML with myelodysplasia-related changes presenting in a patient with TMJ degenerative joint disease that was otherwise asymptomatic.
authors.affiliation: Resident, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Jason
authors.initials: J
authors.lastname: Brazelton
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Patrick
authors.initials: P
authors.lastname: Louis
authors.affiliation: Associate Professor, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sullivan
authors.affiliation: Assistant Professor, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: dpeker@uab.edu.
authors.forename: Deniz
authors.initials: D
authors.lastname: Peker
mesh_terms: D000368:Aged; D001168:Arthritis / Q000175:diagnosis*; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis*; D051917:Leukosialin / Q000032:analysis; D009190:Myelodysplastic Syndromes / Q000175:diagnosis*; D010003:Osteoarthritis / Q000175:diagnosis; D009195:Peroxidase / Q000032:analysis; D063268:Sialic Acid Binding Ig-like Lectin 3 / Q000032:analysis; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: C571163:CD33 protein, human; D051917:Leukosialin; C465014:SPN protein, human; D063268:Sialic Acid Binding Ig-like Lectin 3; D009195:Peroxidase