Oral leukemic infiltration is the presence of localized or generalized tissue hyperplasia of the mouth caused by collections of malignant white blood cells or their precursors. The demographic features follow that of the particular leukemia. However, the most common presentation is leukemic infiltration of the gingiva in acute monocytic or acute myelomonocytic leukemia, a disease of adults. Lesions are generally not painful, although they may bleed. Because of immunosuppression secondary to the leukemia, lesions may also exhibit secondary infection by viral or fungal agents.
Patients report weight loss, fatigue, loss of appetite, and easy bruisability. The infiltrate often develops over weeks and months.
Oral leukemic infiltration - Oral Mucosal Lesion
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Synopsis
Codes
ICD10CM:
C95.90 – Leukemia, unspecified not having achieved remission
SNOMEDCT:
404156009 – Leukemic infiltration of skin
C95.90 – Leukemia, unspecified not having achieved remission
SNOMEDCT:
404156009 – Leukemic infiltration of skin
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Differential Diagnosis & Pitfalls
- Gingival hyperplasia caused by poor oral hygiene is associated with a healthy individual with no change in health status (unless it is pregnancy or puberty associated).
- Gingival hyperplasia caused by ingestion of medications is seen in patients with specific medical histories such as seizure disorders, organ transplantation, and hypertension. Hereditary gingival hyperplasia has an associated family history of this disorder, and the gingival growth is present from childhood. It has a pink or fibrotic appearance with a firm texture.
- Juvenile hyaline fibromatosis is associated with skin lesions.
- Orofacial granulomatosis exhibits gingival hyperplasia that tends to be somewhat firm and fibrotic and is associated with recurrent or concomitant orofacial swelling.
- Granulomatosis with polyangiitis may have a similar gingival appearance, and the patient may also have upper respiratory signs, evidence of kidney disease, or elevated p-ANCA and c-ANCA levels.
- Kaposi sarcoma is purplish/blue/red and has typical biopsy findings.
- Ligneous gingivitis has typical biopsy findings and a history of plasminogen deficiency.
- Scurvy (vitamin C deficiency)
- Langerhans cell histiocytosis
- Oral exostoses
- Pregnancy
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Last Updated:09/26/2017
Oral leukemic infiltration - Oral Mucosal Lesion