A clinical and fine needle aspiration cytology study of gingiva in acute leukemia

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.
Key Words: Acute leukemia, fine needle aspiration cytology, gingiva