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“FIRST OF ITS KIND IN THE NATION”
Dedicated Exclusively to Diagnostic and Consultative Pathology of the Oral Cavity, Head and Neck
CLINICAL INFORMATION
35 year old female with diffuse “boggy” gingival enlargement and “peripheral granuloma-like growths”. S/P wisdom teeth extraction three weeks prior. Negative past medical history. Not taking any medication.
SPECIMEN:
Thick mucosa with tan-white, “fleshy” cut surface.
PRELIMINARY HISTOLOGIC DIAGNOSIS:
Diffuse Infiltration With High Grade Malignant Lymphoid Cells.
FINAL DIAGNOSIS: ACUTE MYELOGENOUS LEUKEMIA (AML).
(In correlation with the immunohistochemical phenotype and laboratory results).
DISCUSSION:
The malignant cell in AML is the myeloblast (immature precursor of white blood cells). The leukemic transformation (mutation) can occur at different steps in the process of white blood cell maturation, thereby its heterogeneity. AML is characterized by rapid growth and markedly decreased normal circulating blood cells. It is more common in males than females. Infiltration of the brain, skin and gums with AML (myeloid sarcoma) is infrequent. Early symptoms are non-specific. The diagnosis is based on peripheral blood findings & bone marrow evaluation (routine microscopy, flow cytometry & cytogenetics). The single most important diagnostic and prognostic factor in AML is cytogenetics.
*IMPORTANT:
Diffuse and rapid enlargement of gingival tissues without an identifiable cause can represent a manifestation of serious systemic disease and calls for rapid diagnosis (biopsy) and laboratory work-up.
Note: This case illustrates the importance of close communication with the pathologist prior to biopsy for prompt intervention. Flow cytometry and cytogenetic studies require special tissue handling.
A special thank you to Dr. Charles A. Tomeo for the opportunity of working up this case.
- Diplomate of the American Board of Medical
Pathology.
- Diplomate of the American Board of Oral and
Maxillofacial Pathology.
- Fellowship Training: Soft Tissue Neoplasia and
Immunohistochemistry.
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