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

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.

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.

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.

The technique was found to be safe and of definitive diagnostic value in detecting gingival infiltration in acute leukemia patients.