Myeloid sarcoma of the Gingiva with myelodysplastic syndrome: A Case Report

Abstract

The purpose of this report is to present a case of myeloid sarcoma of the gingiva with myelodysplastic syndrome.A 52-year-old male diagnosed with myelodysplastic syndrome with skin lesions presented with gingival swelling and gingival redness involving the maxillary left second premolar and the maxillary left first molar. The patient was referred from the Department of Hematology for a biopsy of the lesion. Full-thickness flaps were elevated and inflamed, and neoplastic soft tissue was removed from a lesion and the samples sent for histopathologic analysis.Histopathologic results showed leukemic cell infiltration beneath the oral epithelium, and the specimen was positive for the leukocyte marker. The diagnosis was myeloid sarcoma. Uneventful healing was observed at 2-week follow-up, but relapse of the lesions with the hyperplastic and neoplastic tissue was noted at 4-week follow-up. Further follow-up or treatment could not be performed because the patient did not visit at the next follow-up.In conclusion, myeloid sarcoma should be a diagnosis option for gingival growth because it can involve intraoral lesion. In this report, a biopsy was performed due to referral considering the patient's medical history. Although myeloid sarcoma in the oral cavity is extremely rare, a small biopsy and consultation with a hematologist may be beneficial for patients and may provide a differential diagnosis.

Figure 1

Histopathology and immunohistochemical staining of biopsy from the skin leukemia cutis. (A) Leukemic cell infiltration beneath the epidermis (hematoxylin and eosin stain; original magnification ×40). (B) Magnified view of the leukemic cell infiltration (hematoxylin and eosin stain; original magnification ×400). (C) CD68-positive cells (CD68 staining; original magnification ×400). (D) Myeloperoxidase-positive (MPO) cells (MPO staining; original magnification ×400). MPO cells = myeloperoxidase-positive cells.

Figure 2

Clinical view and radiograph at the first visit. (A) Clinical view indicating gingival swelling with gingival redness involving the maxillary left second premolar and the maxillary left first molar. (B) Periapical radiograph indicating the widening of periodontal ligament space at the maxillary left second premolar. (C) Buccal view showing the removal of inflamed or neoplastic soft tissues. (D) Occlusal view after removal of the tissues.

Figure 3

Histopathology and immunohistochemical staining of biopsy from the gingiva. (A) Leukemic cell infiltration beneath the oral epithelium (hematoxylin and eosin stain; original magnification ×40). (B) Magnified view showing the leukemic cell infiltration (hematoxylin and eosin stain; original magnification ×400). (C) Leukocyte marker (CD45RB)-positive (CD45RB staining; original magnification ×400). (D) MPO-positive cells (MPO staining; original magnification ×400). (E) Some cells were positive for CD34 (CD 34 staining; original magnification ×400). (F) Number of cells were CD117 positive (CD117 staining; original magnification ×400). MPO cells, myeloperoxidase-positive cells.

Figure 4

(A) Clinical photograph at 2 weeks after surgery showing uneventful healing. (B) Occlusal view at 2 weeks after surgery. (C) Relapse of the lesions in the hyperplastic and neoplastic tissue was noted 4 weeks after the surgery. (D) Periapical radiograph showed bone loss between the maxillary left second premolar and the maxillary left first molar.