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Pamukcu U, Dal MS, Yaman S, Aslan Candır B, Bozan E, Secilmis S, Acik Kemaloglu S, Altuntas F, Peker I. Evaluation of oral manifestations and head and neck lymphadenopathy in newly diagnosed acute leukemia patients. SPECIAL CARE IN DENTISTRY 2024; 44:911-918. [PMID: 37994175 DOI: 10.1111/scd.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/08/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES To determine the frequency of head and neck lymphadenopathy (LAP) and intraoral findings (non-dental/dental) in patients with newly diagnosed acute leukemia (AL). SUBJECTS AND METHODS Twenty-eight (52.8%) females and 25 (47.2%) males in a total of 53 patients with newly diagnosed AL with a mean age of 46 years were included in the study. Personal information, the type of AL (AML [acute myelogenous leukemia]/ALL [acute lymphocytic leukemia]), and hematological findings (anemia, neutropenia, and thrombocytopenia) were obtained from medical records. One of two calibrated oral diagnosis and maxillofacial radiology specialists performed extraoral (head and neck LAPs) and intraoral (non-dental and dental) clinical examinations. The Chi-square (χ2) test was used to evaluate categorical variables. RESULTS LAP was observed in 22.6% and intraoral findings in 30.2% of the patients. LAP was most commonly observed in the neck and none in the parotid glands. The most intraoral findings were gingival/mucosal bleeding and oral petechiae/ecchymosis. While there was no statistical difference between AML and ALL patients in terms of LAP (p > .05), intraoral findings were observed more in patients with AML (p < .05). Only two (3.8%) patients had dental findings. With a slight difference, intraoral findings were more with thrombocytopenia and LAP with neutropenia. CONCLUSION In AL, especially non-dental intraoral findings are common. The fact that dentists working in the oral cavity are often the first specialists to encounter the oral manifestations of AL imposes an important role in early diagnosis and treatment.
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Affiliation(s)
- Umut Pamukcu
- Department of Oral Diagnosis and Maxillofacial Radiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Samet Yaman
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Burcu Aslan Candır
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersin Bozan
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sema Secilmis
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sibel Acik Kemaloglu
- Department of Statistics, Faculty of Sciences, Ankara University, Ankara, Turkey
| | - Fevzi Altuntas
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ilkay Peker
- Department of Oral Diagnosis and Maxillofacial Radiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Floodeen EG, Newman MF, Abdelsayed R, Patel P. Numb chin syndrome as initial symptom of T-cell acute lymphoblastic leukemia in a 14-year-old female: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Bhambal AM, Shrivastava H, Naik SP, Nair P, Saawarn N. Oral manifestations of systemic leukemia-first sign of presentation. J Indian Soc Periodontol 2021; 25:347-349. [PMID: 34393407 PMCID: PMC8336771 DOI: 10.4103/jisp.jisp_551_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive hematopoietic malignancy that left untreated or undiagnosed can lead to death within few days. Hence, early diagnosis and appropriate treatment become necessary. Oral manifestations in AML could be the presenting feature or could a part of systemic manifestations. Gingival lesions appear as generalized enlargement with hemorrhagic discoloration with or without spontaneous bleeding. Sometimes, gingival lesions itself could a presenting sign without any other systemic manifesto. We report a similar case which was undiagnosed earlier and the patient came with a complaint of only the gingival swelling.
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Affiliation(s)
- Annette Milton Bhambal
- Department of Oral Medicine and Radiology, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Himangi Shrivastava
- Department of Oral Medicine and Radiology, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Shantala Prashant Naik
- Department of Oral Medicine and Radiology, Rajendra Institute of Medical Sciences, Medical Institute of Ranchi University, Ranchi, Jharkhand, India
| | - Preeti Nair
- Department of Oral Medicine and Radiology, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Nisheeth Saawarn
- Department of Oral Medicine and Radiology, Bhabha Dental College, Bhopal, Madhya Pradesh, India
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Sánchez-Romero C, Pontes HAR, Pontes FSC, Rocha AC, Carlos R, Rendón JC, de Almeida OP, Fonseca FP. Acute lymphoblastic leukemia/lymphoma of the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:152-164. [DOI: 10.1016/j.oooo.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 12/13/2022]
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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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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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Abstract
Orofacial pain may be a symptom of diverse types of cancers as a result of local or distant tumor effects. The pain can be presented with the same characteristics as any other orofacial pain disorder, and this should be recognized by the clinician. Orofacial pain also can arise as a consequence of cancer therapy. In the present article, we review the mechanisms of cancer-associated facial pain, its clinical presentation, and cancer therapy associated with orofacial pain.
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Affiliation(s)
- Marcela Romero-Reyes
- Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, 345 East 24th Street, New York, NY, 10010, USA,
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Wu CF, Hong C, Klauck SM, Lin YL, Efferth T. Molecular mechanisms of rosmarinic acid from Salvia miltiorrhiza in acute lymphoblastic leukemia cells. JOURNAL OF ETHNOPHARMACOLOGY 2015; 176:55-68. [PMID: 26476154 DOI: 10.1016/j.jep.2015.10.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/18/2015] [Accepted: 10/12/2015] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Rosmarinic acid (RA), a major hydrosoluble bioactive compound found in the Chinese medicinal herb, Salvia miltiorrhiza Bunge, which has been used in traditional Chinese medicine to treat various diseases, including cancer. However, the mechanisms have not been fully elucidated. AIM OF THE STUDY Guided by microarray hybridization and Ingenuity Pathway Analysis, we identified modes of action of rosmarinic acid (RA) isolated from S. miltiorrhiza on acute lymphoblastic leukemia cells. MATERIALS AND METHODS Microarray data were verified by independent methods: Real-time RT-PCR (mRNA expression), resazurin assay (cytotoxicity of RA towards parental CCRF-CEM, multidrug-resistant CEM/ADR5000 cells and normal lymphocytes), flow cytometry (cell cycle arrest, apoptosis, necroptosis, generation of reactive oxygen species (ROS), disruption of mitochondrial membrane potential (MMP)), single cell gel electrophoresis (DNA damage), molecular docking and gene promoter binding motif analysis (NFκB), Western blotting (nuclear NFκB translocation, PARP cleavage, caspase 3/7/9 expression), and fibronectin-based cell adhesion assay. RESULTS RA dose-dependently inhibited CCRF-CEM and CEM/ADR5000 cells, but caused less cytotoxicity towards normal lymphocytes. RA simultaneously induced apoptosis and necrosis, as shown by cell morphology and annexin V-PI assay. DNA damage was dose-dependently induced without ROS generation, which subsequently led to cell cycle arrest. RA-stimulated MMP dysfunction activated PARP-cleavage and caspase-independent apoptosis. In accordance with molecular docking and gene promoter binding motif analyses, p65 translocation from the cytosol to the nucleus was blocked by RA, indicating a mechanistic role of the NFκB pathway to explain RA's action. RA affected cellular movement as evaluated by ameliorating cell adhesion to fibronectin. CONCLUSIONS RA induced apoptosis and necrosis in a ROS-independent DNA damage and caspase-independent manner. These results may contribute to the rationale use of S. miltiorrhiza and RA in traditional medicine of leukemia.
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Affiliation(s)
- Ching-Fen Wu
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Chunlan Hong
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Sabine M Klauck
- Working Group Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Yun-Lian Lin
- National Research Institute of Chinese Medicine, Taipei, Taiwan
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany.
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Lowal KA, Alaizari NA, Tarakji B, Petro W, Hussain KA, Altamimi MAA. DENTAL CONSIDERATIONS FOR LEUKEMIC PEDIATRIC PATIENTS: AN UPDATED REVIEW FOR GENERAL DENTAL PRACTITIONER. Mater Sociomed 2015; 27:359-62. [PMID: 26622207 PMCID: PMC4639337 DOI: 10.5455/msm.2015.27.359-362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/05/2015] [Indexed: 12/03/2022] Open
Abstract
The early signs of leukemia can usually manifest in the oral cavity due to infiltration of leukemic cells or due to associated decline in normal marrow elements, especially in the acute phase of leukemia, as common lesions at this stage of the disease can be screened and diagnosed by the dentist. Therefore, the dental community should be aware of the oral manifestations of leukemia and oral complications of anticancer treatment. This can eliminate the oral symptoms of the disease and to improve quality of life for these patients. An extensive search in PubMed line using a combination of terms like “leukemia, children, dental, Acute lymphoblastic leukemia, pediatric” for last ten years was made. Reviews and case reports concerned about acute lymphoblastic leukemia in children were all collected and analyzed and data were extracted. Accordingly, the aim of this review is to highlight on the oral presentations of leukemia in children attending dental clinics and the management of its undesirable side effects.
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Affiliation(s)
- Kholoud A Lowal
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Nader Ahmed Alaizari
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Bassel Tarakji
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Waleed Petro
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Khaja Amjad Hussain
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
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Hasan S, Khan NI, Reddy LB. Leukemic gingival enlargement: Report of a rare case with review of literature. Int J Appl Basic Med Res 2015; 5:65-7. [PMID: 25664273 PMCID: PMC4318106 DOI: 10.4103/2229-516x.149251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/11/2014] [Indexed: 11/21/2022] Open
Abstract
Oral cavity functions as an early indicator for a variety of systemic diseases. Early and accurate diagnosis of these underlying systemic disorders entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Although gingival changes may be related to local factors in the oral cavity, it can also be an expression of systemic conditions such as blood dyscrasias, endocrinal imbalance, and nutritional deficiencies. Leukemia, a malignancy of white blood cells is a dreadful disease, which, if not diagnosed properly and treated early may result in significant morbidity and mortality. Oral changes may be the first and only presenting signs in leukemic patients. This paper aims to throw light on an interesting case of acute leukemia diagnosed on the basis of oral signs and emphasizes the importance of thorough oral examination to identify the threatening condition.
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Affiliation(s)
- Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, Okhla, New Delhi, India
| | - Nabeel Ishrat Khan
- Department of Oral Medicine and Radiology, ZA Dental College and Hospitals, A.M.U., Aligarh, Uttar Pradesh, India
| | - L Bhaskar Reddy
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT University, Patia, Bubaneswar, Odisha, India
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Jham BC, Hill R, Mulholland M, Edwards PC. Clinicopathologic conference case 2: a man with progressive alveolar bone loss and spontaneous tooth exfoliation. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e86-9. [PMID: 25295343 DOI: 10.1016/j.oooo.2014.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brito AC, Capistrano HM, Torres ML, Ramos G, Viana MB, Oliveira BMD. Isolated relapse in the oral cavity of a child with t-lineage acute lymphoblastic leukemia. Braz Dent J 2012; 23:711-5. [DOI: 10.1590/s0103-64402012000600015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/15/2012] [Indexed: 11/22/2022] Open
Abstract
Despite high cure rates, approximately 20% of patients with acute lymphoblastic leukemia (ALL) have disease relapse. Isolated recurrence in oral cavity is extremely unusual. The aim of this paper is to report a case of an isolated relapse occurred in a child with T-lineage ALL. Clinical picture included swelling and pain in the right upper gingiva of the oral cavity, with no other clinical or hematological alterations. Diagnosis was confirmed by biopsy and immunohistochemical staining. Bone marrow aspiration was normal. Five months later leukemic infiltration of the bone marrow was detected and systemic chemotherapy was reintroduced. This case report highlights the relevance of dental care during and after chemotherapy, not only to treat lesions in the oral cavity resulting from the disease itself or from treatment side effects, but also to detect unusual sites of ALL relapse.
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Sasaki M, Yamazaki H, Aoki T, Ota Y, Sekiya R, Kaneko A. Bilateral numb chin syndrome leading to a diagnosis of Burkitt's cell acute lymphocytic leukemia: a case report and literature review. ACTA ACUST UNITED AC 2011; 111:e11-6. [DOI: 10.1016/j.tripleo.2010.09.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/07/2010] [Accepted: 09/11/2010] [Indexed: 10/18/2022]
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Bakathir AA, Al-Hamdani AS. Relapse of acute lymphoblastic leukemia in the jaw. ACTA ACUST UNITED AC 2009; 107:e14-6. [DOI: 10.1016/j.tripleo.2009.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Revised: 01/21/2009] [Accepted: 01/21/2009] [Indexed: 10/20/2022]
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