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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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Al-Sabbagh M, Hawasli A, Almehmadi N, Omami G, Miller CS. Hemorrhagic enlargement of the mandibular gingiva. J Am Dent Assoc 2023; 154:74-78. [PMID: 34836620 DOI: 10.1016/j.adaj.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 01/11/2023]
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KRAS-related long noncoding RNAs in human cancers. Cancer Gene Ther 2022; 29:418-427. [PMID: 34489556 PMCID: PMC9113938 DOI: 10.1038/s41417-021-00381-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/29/2021] [Accepted: 08/11/2021] [Indexed: 02/08/2023]
Abstract
KRAS is one of the most widely prevalent proto-oncogenes in human cancers. The constitutively active KRAS oncoprotein contributes to both tumor onset and cancer development by promoting cell proliferation and anchorage-independent growth in a MAPK pathway-dependent manner. The expression of microRNAs (miRNAs) and the KRAS oncogene are known to be dysregulated in various cancers, while long noncoding RNAs (lncRNAs) can act as regulators of the miRNAs targeting KRAS oncogene in different cancers and have gradually become a focus of research in recent years. In this review article, we summarize recent advances in the research on lncRNAs that have sponging effects on KRAS-targeting miRNAs as crucial mediators of KRAS expression in different cell types and organs. A deeper understanding of lncRNA function in KRAS-driven cancers is of major fundamental importance and will provide a valuable clinical tool for the diagnosis, prognosis, and eventual treatment of cancers.
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Cammarata-Scalisi F, Girardi K, Strocchio L, Merli P, Bernardin AG, Galeotti A, Magliarditi F, Inserra A, Callea M. Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia. Cancers (Basel) 2020; 12:cancers12061634. [PMID: 32575613 PMCID: PMC7352340 DOI: 10.3390/cancers12061634] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.
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Affiliation(s)
- Francisco Cammarata-Scalisi
- Pediatrics Service, Regional Hospital of Antofagasta, Antofagasta 12440, Chile
- Correspondence: (F.C.-S.); (M.C.)
| | - Katia Girardi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | - Luisa Strocchio
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | | | - Angela Galeotti
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
| | - Fabio Magliarditi
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
| | | | - Michele Callea
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
- Correspondence: (F.C.-S.); (M.C.)
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5
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Lee Y, Hong J, Kim I, Choi Y, Park H. Prospective evaluation of clinical symptoms of chemotherapy-induced oral mucositis in adult patients with acute leukemia: A preliminary study. Clin Exp Dent Res 2020; 6:90-99. [PMID: 32067405 PMCID: PMC7025998 DOI: 10.1002/cre2.253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to prospectively evaluate the clinical features of chemotherapy-induced oral mucositis (CIOM) in adult patients with acute leukemia and the aggravating factors for such symptoms. SUBJECTS Thirty-seven prospective patients aged ≥19 years with acute leukemia undergoing chemotherapy were enrolled. Oral and clinical investigations were performed at baseline and on Day 14 after starting chemotherapy. The presence and severity of cancer-induced oral mucositis were demonstrated using the World Health Organization (WHO) scoring system. RESULTS On Day 14, we found that oral mucositis had developed in eight patients (21.6%). Hematopoietic stem cell transplantation (HSCT) in patients was a predictor of increased WHO scores (β = 1.937, p < .001). Regarding oral sites, ventral tongue (β = 1.670), soft palate (β = 1.242), and buccal mucosa (β = 0.593) were predictors for increased scores. In addition, the increase in WHO scores was positively correlated with the number of oral lesions (r = .521), the difficulty in eating (r = .250), and the overall oral health (r = .534; all p < .05). CONCLUSION The main factors affecting the severity of CIOM symptoms were the treatment with HSCT and the location of oral lesions. The incidence of CIOM and WHO scores were not significantly different between the subgroups of disease. Our findings will help clinicians investigate the oral findings after chemotherapy in adult patients with acute leukemia.
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Affiliation(s)
- Yeon‐Hee Lee
- Department of Orofacial Pain and Oral MedicineKyung Hee University Dental HospitalSeoulKorea
| | - Junshik Hong
- Department of Internal MedicineSeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
- Cancer Research InstituteSeoul National UniversitySeoulKorea
| | - Inho Kim
- Department of Internal MedicineSeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
- Cancer Research InstituteSeoul National UniversitySeoulKorea
| | - Youngnim Choi
- Department of Immunology and Molecular Microbiology, School of Dentistry and Dental Research InstituteSeoul National UniversitySeoulKorea
| | - Hee‐Kyung Park
- Department of Oral Medicine and Oral Diagnosis, Dental Research InstituteSeoul National University Dental Hospital, Seoul National University School of DentistrySeoulKorea
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Gholman RR, Felemban EH, El Meligy OAES. Dental Rehabilitation of a Child with Acute Lymphocytic Leukemia: A Case Report. Int J Clin Pediatr Dent 2019; 12:582-586. [PMID: 32440080 PMCID: PMC7229377 DOI: 10.5005/jp-journals-10005-1664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Leukemia is the cancer of blood cells and bone marrow and it is the most common cancer in children. The cause of acute lymphocytic leukemia is unknown, but many predisposing risk factors could be associated, such as an exposure to radiation, chemical or viral infections. A six-year-old boy was presented with multiple carious teeth and severe pain related to his lower left teeth. Regarding medical history, the child was diagnosed with acute lymphocytic leukemia and after consultation with patient's physician; dental treatment was planned to be accomplished under general anesthesia. The aim of treatment was to eliminate sources of infections, restore carious teeth, relief pain, and improve oral hygiene and patient's parents' education regarding general and oral health. Full-mouth rehabilitation was accomplished after preparing the patient with pediatric hematology/oncology team under general anesthesia. During recall visits, good oral hygiene and caries-free teeth were obtained. It is important to have solid knowledge regarding the medical conditions, the necessary consultations with medical subspecialties and the appropriate timings for treatment. HOW TO CITE THIS ARTICLE Gholman RR, Felemban EH, El Meligy OAES. Dental Rehabilitation of a Child with Acute Lymphocytic Leukemia: A Case Report. Int J Clin Pediatr Dent 2019;12(6):582-586.
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Affiliation(s)
- Raed R Gholman
- Dental Department, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia
| | - Emtenan H Felemban
- Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Omar AES El Meligy
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Brierley DJ, Crane H, Hunter KD. Lumps and Bumps of the Gingiva: A Pathological Miscellany. Head Neck Pathol 2019; 13:103-113. [PMID: 30693455 PMCID: PMC6404662 DOI: 10.1007/s12105-019-01000-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
Abstract
Lesions of the gingivae are amongst the commonest lesions seen in patients and the vast majority are reactive hyperplasias, related to a number of chronic irritant stimuli. However, there are a number of entities that have a predilection for the gingivae, which are much less common in other parts of the oral cavity. The purpose of this paper is to discuss the clinical and histological differential diagnoses when presented with a lump on the gingivae, including the approach to diagnosis and diagnostic pitfalls.
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Affiliation(s)
- Daniel J. Brierley
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA UK
| | - Hannah Crane
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA UK
| | - Keith D. Hunter
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA UK ,Department of Oral Pathology and Biology, University of Pretoria, Pretoria, South Africa
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8
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Mester A, Irimie A, Oprita L, Dima D, Petrushev B, Lucaciu O, Campian RS, Tanase A. Oral manifestations in stem cell transplantation for acute myeloid leukemia. Med Hypotheses 2018; 121:191-194. [PMID: 30396479 DOI: 10.1016/j.mehy.2018.06.015] [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: 04/07/2018] [Accepted: 06/15/2018] [Indexed: 12/16/2022]
Abstract
Acute myeloid leukemia is a highly aggressive malignancy with a high morbidity rate, for which an accurate and rapid diagnostic is essential. Acute myeloid leukemia manifestations frequently include oral abnormalities. Still, there is a limited number of studies reporting the incidence of oral manifestations in acute leukemia, the prevalence of periodontal status and periodontal parameters in these patients. Our aim was to emphasize the importance of early recognition by the dental practitioners of oral cavity manifestations as signs of acute myeloid leukemia, so that prompt referral to the hematologists is being done, and appropriate treatment is offered.
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Affiliation(s)
- Alexandru Mester
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alexandra Irimie
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Liana Oprita
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Bobe Petrushev
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania.
| | - Ondine Lucaciu
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Radu-Septimiu Campian
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alina Tanase
- Department of Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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9
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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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10
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Myeloid sarcoma of the nasal septum following invasive fungal sinusitis: report of a case and review of the relevant literature. J Hematop 2018. [DOI: 10.1007/s12308-018-0319-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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11
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Chowdhri K, Tandon S, Lamba AK, Faraz F. Leukemic gingival enlargement: A case report and review of literature. J Oral Maxillofac Pathol 2018; 22:S77-S81. [PMID: 29491612 PMCID: PMC5824525 DOI: 10.4103/jomfp.jomfp_205_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The oral cavity manifests signs of various systemic diseases. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Occasionally, oral signs can be an expression of systemic conditions such as endocrine imbalance, nutritional deficiencies and blood disorders. Leukemia is a malignancy of white blood cells, which may result in significant morbidity and mortality. Oral changes maybe the first and only presenting features in leukemia patients, making it imperative for the dentist to diagnose the disease accurately.
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Affiliation(s)
- Kanika Chowdhri
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shruti Tandon
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Arundeep Kaur Lamba
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Farrukh Faraz
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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12
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Li AW, Yin ES, Stahl M, Kim TK, Panse G, Zeidan AM, Leventhal JS. The skin as a window to the blood: Cutaneous manifestations of myeloid malignancies. Blood Rev 2017; 31:370-388. [DOI: 10.1016/j.blre.2017.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022]
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13
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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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14
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Busjan R, Hasenkamp J, Schmalz G, Haak R, Trümper L, Ziebolz D. Oral health status in adult patients with newly diagnosed acute leukemia. Clin Oral Investig 2017; 22:411-418. [PMID: 28536781 DOI: 10.1007/s00784-017-2127-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this cross-sectional study was to evaluate the oral health of adult patients with newly diagnosed acute leukemia. METHODS Patients with initially diagnosed acute myeloid (AML) or lymphocytic (ALL) leukemia and a matched healthy control (HC) group were included. The oral investigation comprised inspection of the oral mucosa; the decayed (D), missing (M), and filled (F) teeth (DMF-T) index; and a detailed periodontal status. Subgingival biofilm samples were analyzed (polymerase chain reaction) for the presence of selected potentially periodontal pathogenic bacteria. Statistical analysis was performed using Fisher's exact test, chi-squared test, and Mann-Whitney U test (significance level α = 5%). RESULTS Thirty-nine patients with leukemia (AML 26, ALL 13) and 38 HCs were included. Oral mucosal findings were present in 62% of L compared to 0% of HC patients, whereby gingival hyperplasia was the most detected finding. Furthermore, a higher caries prevalence in leukemia patients was shown (D value 3.64 ± 3.98 vs. 0.72 ± 1.72, p < 0.01). The periodontal parameters were poorer in leukemia patients. No substantial differences in microbiological findings of selected bacteria were detected within L group and between L and HC patients. CONCLUSION The high prevalence of oral diseases supports the demand of an early and consequent dental treatment of leukemia patients, especially considering subsequent therapy.
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Affiliation(s)
- Rilana Busjan
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
| | - Justin Hasenkamp
- Clinic for Hematology and Medical Oncology, University of Goettingen, Goettingen, Germany
| | - Gerhard Schmalz
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
| | - Rainer Haak
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
| | - Lorenz Trümper
- Clinic for Hematology and Medical Oncology, University of Goettingen, Goettingen, Germany
| | - Dirk Ziebolz
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.
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15
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Yassin A, Dixon DR, Oda D, London RM. Diagnosis and Clinical Management of Human Papilloma Virus-Related Gingival Squamous Cell Carcinoma in a Patient With Leukemia: A Case Report. Clin Adv Periodontics 2016; 6:50-56. [PMID: 29593935 DOI: 10.1902/cap.2015.150038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Close clinical inspection for intraoral lesions in patients with leukemia that develop chronic graft-versus-host disease (cGVHD) is critical. Additionally, neoplasias developing in bone marrow transplant patients after treatment for leukemia represent a significant obstacle for long-term patient survival, necessitating lifetime follow-up by health care providers. This case report describes the identification, diagnosis, and treatment of gingival squamous cell carcinoma (SCC) in a patient with leukemia who was treated previously with a stem cell transplant and referred for routine periodontal care. Case Presentation A 53-year-old male was referred to the Department of Periodontics for an assessment of tooth #10 with 2+ mobility and associated cross-bite occlusion. The patient was diagnosed with acute myeloid leukemia at age 39 years, received hematopoietic stem cell transplantation (HSCT), and later developed cGVHD followed by human papilloma virus (HPV) infections. During the periodontal evaluation, a large, non-painful, exophytic, alveolar gingival mass was identified and later diagnosed as SCC. It is unusual that oral SCC presents as an exophytic, gingival swelling. The patient received comprehensive periodontal management in coordination with his otolaryngology team before and during the diagnosis of SCC secondary to cGVHD and HPV infection. Conclusions Patients with a history of HSCT treatment for leukemia and subsequent cGVHD are at a high risk of developing second primary oral malignancies, including SCC. Exposure to oncogenic HPV infection may compound this risk. Therefore, it is important for dentists to be aware of special treatment concerns and to frequently screen these patients to achieve early diagnosis and treatment of these neoplasms.
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Affiliation(s)
- Alaa Yassin
- Department of Periodontics, University of Washington, Seattle, WA
| | - Douglas R Dixon
- Department of Periodontics, University of Washington, Seattle, WA
| | - Dolphine Oda
- Department of Oral Pathology, University of Washington
| | - Robert M London
- Department of Periodontics, University of Washington, Seattle, WA
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16
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Sabharwal A, Ganapathi K, Hatton MN, Aguirre A. Swollen and ulcerated maxillary gingivae. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:1-4. [PMID: 26337221 DOI: 10.1016/j.oooo.2015.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 07/03/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Amarpreet Sabharwal
- Research Associate, Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York, Buffalo, NY, USA
| | - Karthik Ganapathi
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Michael N Hatton
- Clinical Associate Professor, Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York, Buffalo, NY, USA
| | - Alfredo Aguirre
- Program Director, Advanced Oral and Maxillofacial Pathology and Professor, Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York, Buffalo, NY, USA.
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17
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Guan G, Firth N. Oral manifestations as an early clinical sign of acute myeloid leukaemia: a case report. Aust Dent J 2015; 60:123-7. [DOI: 10.1111/adj.12272] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/22/2022]
Affiliation(s)
- G Guan
- Department of Oral Diagnostic and Surgical Sciences; School of Dentistry; The University of Otago; Dunedin New Zealand
| | - N Firth
- Department of Oral Diagnostic and Surgical Sciences; School of Dentistry; The University of Otago; Dunedin New Zealand
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18
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Lim HC, Kim CS. Oral signs of acute leukemia for early detection. J Periodontal Implant Sci 2014; 44:293-9. [PMID: 25568810 PMCID: PMC4284378 DOI: 10.5051/jpis.2014.44.6.293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/11/2014] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Systemic disease can manifest oral signs at an early phase, which may be crucial for the diagnosis and timing of treatment. This report describes two patients who presented with gingival enlargement as an early sign of acute leukemia. METHODS Two patients presented with oral symptoms including severe gingival enlargement. The progress of their symptoms was associated with underlying systemic disease. RESULTS The patients were transferred to the Department of Hematology and diagnosed with acute myelomonocytic leukemia. They received appropriate treatment and survived. CONCLUSIONS Gingival enlargement can be caused by underlying systemic diseases. Accurate diagnosis and timely referral are important for preventing a fatal situation. It must be emphasized that some oral signs and symptoms may be closely correlated with systemic diseases.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Chang-Sung Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea. ; Department of Applied Life Science, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
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19
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Babu SPKK, Kashyap V, Sivaranjani P, Agila S. An undiagnosed case of acute myeloid leukemia. J Indian Soc Periodontol 2014; 18:95-7. [PMID: 24744555 PMCID: PMC3988656 DOI: 10.4103/0972-124x.128257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 09/11/2013] [Indexed: 01/17/2023] Open
Abstract
Leukemia is a neoplastic disease characterized by an excessive proliferation of immature white blood cells and their precursors. Oral lesions may be the presenting feature of acute leukemia, which can be rapidly fatal if left untreated. Although many cases of gingival enlargement in patients with acute myeloid leukemia's have been reported in the literature, cases diagnosed by the oral manifestations in India are very few. This report describes the case of a 43-year-old female who presented with gingival bleeding and gingival enlargement. Within a month she developed signs and symptoms of systemic disease such as, and splenomegaly, and upon further investigation, she was diagnosed with acute myeloid leukemia to which she succumbed within 10 days after diagnosis. The need for early diagnosis and referral of this fatal disease are also underline.
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Affiliation(s)
- S P K Kennedy Babu
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
| | - Vineet Kashyap
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
| | - P Sivaranjani
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
| | - S Agila
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
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20
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Reenesh M, Munishwar S, Rath SK. Generalised leukaemic gingival enlargement: a case report. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2012; 3:e5. [PMID: 24422017 PMCID: PMC3886083 DOI: 10.5037/jomr.2012.3305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/25/2012] [Indexed: 11/16/2022]
Abstract
Background Acute myeloblastic leukaemia is a malignant bone marrow neoplasm of myeloid
precursors of white blood cells. Due to its high morbidity rate, early
diagnosis and appropriate medical therapy is essential. Methods The article highlights normal blood alterations like anaemia,
thrombocytopenia, leukocytosis and advanced diagnostic aids like flow
cytometry, special staining as a diagnostic modality as well as for
prognostic information in acute leukaemia, particularly as a tool for
assigning lineage and facilitating further pathologic classification which
may be helpful in influencing treatment strategies. Results On clinical examination the case presented with features of inflammatory
gingival enlargement with presence of local deposits and calculus. Routine
blood examination anaemia, thrombocytopenia, leukocytosis with haemoglobin
5.6 gm% and total leukocyte count of 1,12,000 / cu mm suggestive of
leukaemia. Myeloperoxidase and leukocyte nonspecific esterase (NSE) special
stain were used which showed presence of myeloblasts in the peripheral smear
suggestive of acute myelocytic leukaemia. Flow cytometry were done which
further helped in interpretation of these cells which showed to be strongly
positive for CD45, CD13, CD14, and anti HLADR and moderately positive for
CD4, CD34 and Anti MPO confirming to be case of AML-M4 with 57.73%
gating. Conclusions Fact that gingival alterations are sometimes the first manifestations of the
disease implies that dental professionals must be sufficiently familiarized
with the clinical manifestations of systemic diseases. The timely referral
by the general dentist for a suspicious lesion provided an early diagnosis
and early intervention reducing the patient morbidity.
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Affiliation(s)
- Mechery Reenesh
- Division of Periodontology, Armed Forces Medical College Pune India
| | - Singh Munishwar
- Division of Periodontology, Armed Forces Medical College Pune India
| | - Saroj Kumar Rath
- Department of Dental Surgery, Armed Forces Medical College Pune India
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21
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22
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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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23
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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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24
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Sonoi N, Soga Y, Maeda H, Ichimura K, Yoshino T, Aoyama K, Fujii N, Maeda Y, Tanimoto M, Logan R, Raber-Durlacher J, Takashiba S. Histological and immunohistochemical features of gingival enlargement in a patient with AML. Odontology 2011; 100:254-7. [PMID: 22075755 DOI: 10.1007/s10266-011-0051-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 10/30/2011] [Indexed: 11/26/2022]
Abstract
Here, we discuss the pathophysiology of leukemia-associated gingival enlargement based on a case of acute myelomonocytic leukemia (AML-M4) with typical gingival enlargement. Uniquely, this patient was well enough to allow full periodontal examination and incisional gingival biopsy to be performed both before and after chemotherapy. The patient was a 39-year-old Japanese woman with AML-M4 showing gingival enlargement. Histological and immunohistochemical features of gingiva and bacterial counts in the periodontal pockets were examined before and after chemotherapy. The results were as follows: (1) infiltration of myelomonocytic blasts in enlarged gingiva; (2) resolution of gingival enlargement with complete remission of AML by anticancer chemotherapy; and (3) the numbers of bacteria in the periodontal pockets were not high and were not altered before or after chemotherapy. In patients with AML-M4, remarkable mucosal enlargement is not generally observed in the body except in the gingiva. We hypothesized that antigens derived from periodontal bacteria, even if they are not present in large numbers, could act as chemoattractants for myelomonocytic leukemic cells.
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Affiliation(s)
- Norihiro Sonoi
- Department of Patho-physiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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da Silva Santos PS, Fontes A, de Andrade F, de Sousa SCOM. Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia. Otolaryngol Head Neck Surg 2010; 143:465-6. [PMID: 20723792 DOI: 10.1016/j.otohns.2010.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 03/16/2010] [Accepted: 04/12/2010] [Indexed: 10/19/2022]
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Santos FA, Pochapski MT, Pilatti GL, Kozlowski Jr VA, Goiris FAJ, Groppo FC. Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemia. Aust Dent J 2009; 54:262-5. [DOI: 10.1111/j.1834-7819.2009.01129.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Fatahzadeh M, Krakow AM. Manifestation of acute monocytic leukemia in the oral cavity: a case report. SPECIAL CARE IN DENTISTRY 2008; 28:190-4. [DOI: 10.1111/j.1754-4505.2008.00039.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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28
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Brennan MT, Woo SB, Lockhart PB. Dental treatment planning and management in the patient who has cancer. Dent Clin North Am 2008; 52:19-vii. [PMID: 18154863 DOI: 10.1016/j.cden.2007.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The oral cavity has the potential to be a major source of short-term and long-term complications from cancer therapy. Appropriate evaluation and elimination of potential sources of oral infection before cancer therapy is vital because oral bacteria are a known source of bacteremia and septicemia during cancer therapy. Cancer diagnosis with previous and planned treatment, past medical history, past dental history, current medications, drug allergies, social history, family history, laboratory values, extraoral findings, intraoral findings, and radiographic findings must all be evaluated in planning dental treatment for these complex cases.
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Affiliation(s)
- Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA.
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Affiliation(s)
- Gary C Armitage
- Department of Stomatology, School of Dentistry, University of California, San Francisco, California, USA
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