Gum hypertrophy - an unusual presenting feature in a case of precursor T-cell acute lymphoblastic leukemia

Acute lymphoblastic leukemia/lymphoma, the malignant transformation of T-cell or B-cell precursors, is the most common diagnosis in pediatric oncology. Precursor T-cell acute lymphoblastic leukemia/lymphoma commonly affects adolescents, and is associated with mediastinal mass in over half of the cases, with early dissemination to bone marrow, gonads and the central nervous system. We present a rare case of precursor T-cell acute lymphoblastic leukemia/lymphoma with initial oral manifestation, presenting with the unusual features of gum hypertrophy and involvement of upper jaw and palate in a 10-year-old boy. This report discusses the clinical presentation, histopathologic and immunologic features, and diagnosis of this malignancy.