Presentation

A 17-year-old female presented to a dental school clinic with a chief complaint of a sudden, painless swelling of her gingivae (figures 1 and 2). She had previously gone to a local emergency room. There, her condition was dismissed as a lack of oral hygiene, and she was told to go to a dental provider. The patient had social concerns as she was being ridiculed at school for her condition. She was not pregnant and took no medications. The staff periodontist submitted a large tissue sample to a university pathology lab, and then he performed a gingivectomy on the swollen tissues (figure 3).

In two weeks, the patient returned for a follow-up appointment. The tissue had grown back almost to the original levels (figures 4 and 5). Note the intense red color of the maxillary gingivae.

At this follow-up, the biopsy report was available. Here is a quote from that report: The histomorphology when combined with the clinical presentation and positive staining with MPO and high proliferation index is highly suggestive of acute myeloid or promyelocytic leukemia. The patient should be quickly evaluated by hemo-oncology with this in mind.

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The patient was referred to the University of Floridas Childrens Hospital, where she was treated and went into subsequent remission with chemotherapy. With a timely diagnosis and swift treatment, young people typically respond quickly and favorably. Treatment programs may include chemotherapy, radiation, stem-cell transplant, immunotherapy, or bone marrow transplant.

Myeloid leukemia involves the rapid growth of myeloid blood cells that build up in the bone marrow and prevent the normal production and maturation process. Promyelocytic leukemia is a more aggressive form of myeloid leukemia. In young individuals, these conditions are most often associated with several chromosomal abnormalities. Sudden gingival enlargement is not an uncommon symptom.1 It may occur in patients with non-Hodgkins lymphoma.2

Certain medications may initiate gingival hyperplasia. It is common in renal transplant patients who are treated with cyclosporine and a calcium channel blocker.3 Other medications such as carbamazepine, phenytoin, topiramate, and valproic acid are all possible triggering agents.4 Finally, certain immunosuppressants have the potential to trigger gingival hyperplasia.

Editors note:This article first appeared inThrough the Loupesnewsletter, a publication of the Endeavor Business Media Dental Group.Read more articlesandsubscribetoThrough the Loupes.

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Oral symptoms of systemic pathology in a 17-year-old female - DentistryIQ

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