Wu Josephine, Fantasia John E, Kaplan Robert
Department of Dental Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
J Periodontol. 2002 Jun;73(6):664-8. doi: 10.1902/jop.2002.73.6.664.
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.
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.
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.
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.
口腔体征和症状可能提示严重的潜在全身性疾病。白血病最常观察到的口腔表现为黏膜出血和溃疡、瘀点以及牙龈增生。本病例报告描述了一名53岁男性，其最初表现为牙龈肿大、出血、疲劳和近期体重减轻，最终被诊断为急性粒单核细胞白血病。
进行了牙龈活检，结果显示存在非典型髓样和单核细胞的细胞增多性浸润。进一步的检查包括全血细胞计数、骨髓活检、活检材料的免疫组织化学和组织化学分析以及外周血的流式细胞术。
流式细胞术结果证实浸润为髓单核细胞起源，确诊为急性粒单核细胞白血病。患者对阿糖胞苷和盐酸伊达比星的化疗诱导方案反应良好，牙龈肿大消退且疾病缓解。患者继续进行巩固化疗和自体骨髓移植，但最终在初诊后22个月死亡。
口腔保健专业人员，尤其是牙周病医生，必须认识到牙龈肿大可能是潜在全身性疾病的最初表现。急性髓细胞白血病是一种易累及牙龈的血液系统疾病。
