Bouanani Nouama, Bouyaqine Houda, Coulibaly Konimba, Benslima Najwa, Youssefi Houda
Department of Hematology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.
Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.
Cureus. 2022 Dec 9;14(12):e32350. doi: 10.7759/cureus.32350. eCollection 2022 Dec.
Acute myeloid leukemia (AML) is an aggressive hematological malignancy due to genetic alterations characterized by an overproduction of neoplastic clonal myeloid stem cells in both the bone marrow and peripheral blood. We report a case of a 43-year-old man referred to the department of hematology with a three-week history of palatal pain and weakness. The physical examination revealed an ecchymosis on the left hard palatal mucosa and necrosis. The maxillofacial computerized tomography (CT) scan revealed large osteolysis of the left maxillary bone and a fistulated soft palate. The lesion's biopsy showed an acute polymorphic inflammation with no sign of malignancy. Laboratory findings revealed anemia, thrombocytopenia, elevated lactic dehydrogenase, and elevated serum ferritin. The diagnosis was subsequently confirmed by a peripheral-blood smear revealing 60% of circulating blasts and bone marrow aspiration with 80% of blast infiltration. The latter was further classified through cytogenetic studies as an AML with deletion of chromosome 7q. This case report aims to highlight the need for clinicians to be aware of palatal necrosis as an initial manifestation of the disease and to emphasize the role of multidisciplinary collaboration between dental surgeons, oral and maxillofacial surgeons, and hematologists for early detection and treatment.
急性髓系白血病（AML）是一种侵袭性血液系统恶性肿瘤，由基因改变引起，其特征是骨髓和外周血中肿瘤性克隆髓系干细胞过度增殖。我们报告一例43岁男性患者，因腭部疼痛和乏力3周就诊于血液科。体格检查发现左侧硬腭黏膜瘀斑及坏死。颌面计算机断层扫描（CT）显示左侧上颌骨大片骨质溶解及软腭瘘管形成。病变活检显示急性多形性炎症，无恶性迹象。实验室检查发现贫血、血小板减少、乳酸脱氢酶升高及血清铁蛋白升高。随后，外周血涂片显示60%的循环原始细胞，骨髓穿刺显示80%的原始细胞浸润，确诊为该病。通过细胞遗传学研究，后者进一步分类为伴有7号染色体长臂缺失的AML。本病例报告旨在强调临床医生需要意识到腭部坏死可能是该疾病的初始表现，并强调牙科医生、口腔颌面外科医生和血液科医生之间多学科协作在早期发现和治疗中的作用。
