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de Oliveira EM, de Cáceres CVBL, Santos-Silva AR, Vargas PA, Lopes MA, Pontes HAR, Pontes FSC, Mesquita RA, de Sousa SF, Abreu LG, Xavier JCC, de Andrade BAB, Lacerda JCT, Resende RG, Tomasi RA, Fonseca FP. Clinical diagnostic approach for oral lymphomas: a multi-institutional, observational study based on 107 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:427-435. [PMID: 37150653 DOI: 10.1016/j.oooo.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate oral lymphomas' clinical manifestations and investigate whether clinical features are associated with lymphoma subtypes. STUDY DESIGN Oral lymphomas with at least 1 representative clinical image were evaluated. They were classified according to their microscopic grade (high vs low), predominant cell size (small vs medium/large), and cellular lineage (B cell vs T cell). Clinical images were described according to tumor location, number, swelling, ulcer, necrosis, telangiectasia, predominant color, and lobulation. Lymphomas affecting the palate were compared with salivary gland tumors (SGTs) affecting this location. RESULTS Data from 107 cases were included. High-grade subtypes (80.4%), with medium/large-sized cells (52.3%), and diagnosed as diffuse large B cell lymphomas (29%) predominated. High-grade lymphomas often presented as painful, ulcerative, and osteolytic diseases (P < .05). Tumors predominantly composed of medium/large-sized cells were associated with painful lesions, ulcerated, with necrosis and bone destruction (P < .05). When only palate tumors were considered, multiple and bilateral lesions, the presence of pain, ulceration, and necrosis were significantly more associated with a diagnosis of lymphoma than SGT (P < .001). CONCLUSION High-grade oral lymphomas are more associated with destructive presentation than low-grade subtypes, and bilateral lesions in the palate are more associated with a lymphoma diagnosis than SGT.
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Affiliation(s)
| | | | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | | | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Silvia Ferreira de Sousa
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - José Cândido Caldeira Xavier
- Pathology Institute of Araçatuba and School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil
| | | | | | | | | | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Oral manifestations of leukemia as part of early diagnosis. Hematol Transfus Cell Ther 2021; 44:392-401. [PMID: 34862157 PMCID: PMC9477758 DOI: 10.1016/j.htct.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective To identify oral manifestations as the first clinical signs of leukemia. Methods This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.
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Rosa BPP, Ito FA, Trigo FC, Mizuno LT, Junior AT. Oral Manifestation as the Main Sign of an Advanced Stage Acute Promyelocytic Leukemia. Acta Stomatol Croat 2018; 52:358-362. [PMID: 30666067 PMCID: PMC6336446 DOI: 10.15644/asc52/4/10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acute myeloid leukemia is an aggressive malignant neoplasm occurring mainly in elderly, with the median age of 65 years. Oral manifestations, mainly spontaneous bleeding, are a common finding in acute myelocytic leukemia and may represent the initial evidence of the disease. This report describes a case of a 47-year-old man with a one-month history of spontaneous oral bleeding. The patient had already been consulted by two professionals but he remained undiagnosed. The physical examination revealed paleness, fever, epistaxis and ecchymoses in the oral mucosa. The complete blood count revealed anemia, severe thrombocytopenia and leukocytosis with blasts predominance, reinforcing the diagnosis hypothesis of an acute leukemia. The patient was immediately referred to the Hospital and despite having received a quick intervention, he died 3 days after the admission due to diffuse pulmonary alveolar hemorrhage. According to the peripheral blood immunophenotyping the diagnosis of hypogranular variant of acute promyelocytic leukemia was established. The delay in the diagnosis may have influenced the unfavorable outcome. Early diagnosis and management are indispensable for survival of leukemia patients. In this way, dentists may be responsible for an early detection of oral manifestations of leukemia and for a fast referral to an adequate professional.
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Affiliation(s)
- Bianca Piscinato Piedade Rosa
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
| | - Fábio Augusto Ito
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
| | - Fausto Celso Trigo
- Departamento de Clínica Médica - Universidade Estadual de Londrina. Av. Robert Koch 60, Londrian-PR. Brasil
| | - Lauro Toyoshi Mizuno
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
| | - Ademar Takahama Junior
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
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Fernandes KS, Gallottini M, Castro T, Amato MF, Lago JS, Braz-Silva PH. Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia. SPECIAL CARE IN DENTISTRY 2018; 38:160-162. [PMID: 29645289 DOI: 10.1111/scd.12283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leukemic infiltration of the gingival tissue associated or not with gingival enlargement may be the first manifestation of acute leukemia, despite being rarely reported in the literature. A 10-year-old female patient presented with a 1-month history of an asymptomatic, firm, and pinkish-red generalized gingival overgrowth. There was no bone resorption. Incisional biopsy of the gingival tissue was performed, with histopathological examination revealing a diffuse and hypercellular infiltration of monocytoid cells. The patient was referred to a hematologist and underwent a bone marrow biopsy, which led to a conclusive diagnosis of acute myeloid leukemia. The patient was treated with chemotherapy and we observed regression of gingival enlargement after 4 weeks from the initial therapy.
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Affiliation(s)
- Karin Sá Fernandes
- Department of Stomatology, University of São Paulo School of Dentistry, São Paulo, Brazil.,Department of Orthodontics and Radiology, University of São Paulo City, UNICID, São Paulo, Brazil
| | - Marina Gallottini
- Department of Stomatology, University of São Paulo School of Dentistry, São Paulo, Brazil
| | - Talita Castro
- Department of Stomatology, University of São Paulo School of Dentistry, São Paulo, Brazil
| | | | - Juvani Saturno Lago
- Department of Stomatology, University of São Paulo School of Dentistry, São Paulo, Brazil
| | - Paulo Henrique Braz-Silva
- Department of Stomatology, University of São Paulo School of Dentistry, São Paulo, Brazil.,Laboratory of Virology, University of Sao Paulo Institute of Tropical Medicine of Sao Paulo, Sao Paulo, Brazil
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Prevalence of oral lesions in and dental needs of patients with newly diagnosed acute leukemia. J Am Dent Assoc 2018; 149:470-480. [PMID: 29606275 DOI: 10.1016/j.adaj.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dentists are generally taught that in a significant number of patients with newly diagnosed acute leukemia (NDAL), the diagnosis may be suspected based on oral signs. In this study, the authors determined the frequency of oral signs of leukemia and tabulated the clinical dental needs and hematologic aspects of these patients. METHODS Four calibrated dentists performed clinical examinations in 263 consecutive patients with NDAL. A standardized data form was used to direct and record presence or absence of oral signs of leukemia, clinically apparent dental disease, and circulating blood counts. RESULTS Oral signs of leukemia were detected on oral examination in 30.8% (95% confidence interval [CI], 25.2% to 36.4%) of patients with NDAL on examination. Only 5.7% (95% CI, 2.9% to 8.5%) of patients had gingival enlargement (GE). Although 33.7% (95% CI, 26.6% to 40.9%) of regular dental treatment seekers and 55.3% (95% CI, 45.3% to 65.4%) of nonregular dental treatment seekers had clinically detectable dental disease, only 18.6% (95% CI, 13.9% to 23.3%) had circulating blood counts that precluded all but urgent oral health care. CONCLUSION Although 30.8% of patients examined had some oral sign of leukemia, most adults with NDAL do not have GE at the initial examination. Even patients receiving regular oral health care may have unmet dental needs at the initial assessment that could safely be addressed before treatment. PRACTICAL IMPLICATIONS Dentists should not necessarily expect to be able to detect overt oral signs of leukemia, such as GE, in patients with NDAL on oral examination. Once patients receive the diagnosis, dentists may be able to safely eliminate dental disease in most patients in an appropriate setting. Dentists are encouraged to undertake a thorough review of systems.
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Fu YW, Xu HZ. Gingival enlargement in a pregnant woman with acute monocytic leukaemia: a case report. Aust Dent J 2017; 62:386-389. [PMID: 28466503 DOI: 10.1111/adj.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Y-W Fu
- Department of Stomatology; The First People's Hospital of Lianyungang; Lianyungang China
| | - H-Z Xu
- Department of Stomatology; The First People's Hospital of Lianyungang; Lianyungang China
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Francisconi CF, Caldas RJ, Oliveira Martins LJ, Fischer Rubira CM, da Silva Santos PS. Leukemic Oral Manifestations and their Management. Asian Pac J Cancer Prev 2017; 17:911-5. [PMID: 27039811 DOI: 10.7314/apjcp.2016.17.3.911] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Leukemia is the most common neoplastic disease of the white blood cells which is important as a pediatric malignancy. Oral manifestations occur frequently in leukemic patients and may present as initial evidence of the disease or its relapse. The symptoms include gingival enlargement and bleeding, oral ulceration, petechia, mucosal pallor, noma, trismus and oral infections. Oral lesions arise in both acute and chronic forms of all types of leukemia. These oral manifestations either may be the result of direct infiltration of leukemic cells (primary) or secondary to underlying thrombocytopenia, neutropenia, or impaired granulocyte function. Despite the fact that leukemia has long been known to be associated with oral lesions, the available literature on this topic consists mostly of case reports, without data summarizing the main oral changes for each type of leukemia. Therefore, the present review aimed at describing oral manifestations of all leukemia types and their dental management. This might be useful in early diagnosis, improving patient outcomes.
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Affiliation(s)
- Carolina Favaro Francisconi
- Bauru School of Dentistry, University of Sao Paulo, Department of Biological Sciences, Bauru, SP, Brazil E-mail :
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Ponnam SR, Srivastava G, Jampani N, Kamath VV. A fatal case of rapid gingival enlargement: Case report with brief review. J Oral Maxillofac Pathol 2014; 18:121-6. [PMID: 24959052 PMCID: PMC4065429 DOI: 10.4103/0973-029x.131938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary tumor composed of primitive granulocytic cells. These lesions are commonly associated with other hematologic disorders such as myeloid leukemia and other myeloproliferative neoplasms. Although extremely rare in the oral cavity, this lesion was reported in gingiva, palate, buccal mucosa and extraction sockets. MS is an aggressive lesion associated with poor prognosis. Early identification and prompt treatment holds the key for increasing the disease-free period in these patients. In this context, we report a rare and aggressive case of MS, which ran a fatal course in a 45-year-old female patient.
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Affiliation(s)
- Srinivas Rao Ponnam
- Department of Oral Pathology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Gautam Srivastava
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Narendradev Jampani
- Department of Periodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - V V Kamath
- Department of Oral Pathology, Dr. Syamala Reddy Dental College and Hospital, Bangalore, Karnataka, India
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Arul ASKJ, Verma S, Ahmed S, Arul ASSJ. A clinical and fine needle aspiration cytology study of gingiva in acute leukemia. Dent Res J (Isfahan) 2012; 9:80-5. [PMID: 22363368 PMCID: PMC3283984 DOI: 10.4103/1735-3327.92954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Oral manifestations are frequently the initial signs of acute leukemia, prompting the patient to consult the dentist first. The gingival tissue is one site commonly involved either by leukemic infiltration or by inflammatory reactive hyperplasia, causing gingival enlargement. The gingival infiltration may also be present without gingival enlargement. Early recognition of clinical findings in the oral cavity leads to its timely diagnosis and management. Since biopsy is highly contraindicated, gingival fine needle aspiration cytology was performed to assess its diagnostic value in detecting gingival infiltration in acute leukemia patients. Materials and Methods: Fifty patients of acute leukemia received clinical and gingival cytological examination. The cases were diagnosed based on bone marrow aspiration findings and classified according to the French–American–British criteria. The absence or presence of intraoral findings was recorded. Site for gingival fine needle aspiration cytology was selected. Results: Leukemic gingival infiltration was found to be more common in acute lymphoblastic leukemia, while the characteristic oral findings were seen more commonly in acute myeloblastic leukemia. All the eight cases of acute lymphoblastic leukemia that were positive for leukemic gingival infiltration showed no clinical evidence of gingival enlargement. In terms of leukemic gingival infiltration, L2 subtype was the only subtype involved, while M5 was more commonly involved than M4 subtype. Two cases of L2 subtype showed gingival enlargement due to local factors like plaque/calculus rather than due to leukemic infiltration. Conclusion: The technique was found to be safe and of definitive diagnostic value in detecting gingival infiltration in acute leukemia patients.
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Affiliation(s)
- A Sri Kennath J Arul
- Department of Oral and Maxillofacial Pathology, Best Dental Science College, Madurai, Tamil Nadu, India
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Angst PDM, Dutra DAM, Moreira CHC, Kantorski KZ. Periodontal status and its correlation with haematological parameters in patients with leukaemia. J Clin Periodontol 2012; 39:1003-10. [PMID: 22909091 DOI: 10.1111/j.1600-051x.2012.01936.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2012] [Indexed: 12/11/2022]
Abstract
AIM This cross-sectional study evaluated periodontal status in patients with leukaemia and its correlation with haematological parameters. METHODS Patients with different types of leukaemia and minimum age of 14 years were eligible. Calibrated examiners assessed Seymour index (SI), plaque index (PlI), gingival index (GI), probing depth (PD), bleeding on probing (BOP) and clinical attachment loss (CAL) and performed an interview. Haematological parameters were obtained from haemogram performed on the same day of the periodontal examinations. RESULTS Sixty-eight patients were evaluated, which corresponded to an 85% response rate. Periodontal parameters were in agreement with plaque accumulation (PlI 1.28 ± 0.5, GI 0.74 ± 0.4, PD 2.27 ± 0.6, BOP 33%, CAL 2.31 ± 1.6). PlI and CAL were statistically lower in acute leukaemia (1.13 ± 0.61 and 1.96 ± 1.7) in comparison with chronic leukaemia (1.46 ± 0.44 and 2.74 ± 1.4). Moreover, older age (95% confidence interval [CI]: 0.27-1.56), higher educational level (CI: -1.94 to -0.64) and smoker (CI: 0.39-1.96) were associated with CAL. Correlation between periodontal and haematological parameters was not observed. Correlations between GI x SI and PD x SI were statistically significant (r(S) = 0.390, p = 0.001; r(S) = 0.517, p = 0.000 respectively). CONCLUSIONS Periodontal parameters were consistent with plaque accumulation and did not correlate with haematological parameters irrespective of the leukaemia type.
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Infante-Cossio P, Lopez-Martin JC, Gonzalez-Cardero E, Martinez-de-Fuentes R, Casas-Fernandez-Tejerina A. Osteonecrosis of the maxilla associated with cancer chemotherapy in patients wearing dentures. J Oral Maxillofac Surg 2011; 70:1587-92. [PMID: 22177825 DOI: 10.1016/j.joms.2011.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/03/2011] [Accepted: 08/06/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Pedro Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, University of Seville, Seville, Spain.
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Angst PDM, Dutra DAM, Moreira CHC, Kantorski KZ. Gingival inflammation and platelet count in patients with leukemia: preliminary results. Braz Oral Res 2011; 25:544-9. [DOI: 10.1590/s1806-83242011000600012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 10/10/2011] [Indexed: 11/22/2022] Open
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