ICDO code99303

Gingival infiltrates occur in 3.5% of patients with acute myeloid leukaemia, predominantly in the monocytic or myelomonocytic subtypes {622}. Clinically, there is diffuse enlargement of the interdental papillae, marginal gingiva and attached gingiva. The swollen gingiva has a spongy to firm consistency, bright red to purple in colour. There is no correlation between gingival leukaemic infiltrate and oral hygiene or peripheral white blood cell count {622}. Rare cases of extramedullary myeloid sarcoma may present as an isolated tumour-forming intraoral mass. The most frequently involved sites are the palate and gingiva {52,761,2189,2614,2618}. While the tumour most often develops while the patient has active disease, it may precede the development of acute myeloid leukaemia, or arise as blastic transformation of an underlying chronic myeloproliferative disease or myelodys-

Fig. 4.52 Extramedullary myeloid sarcoma of the gingiva as the first sign of relapse of acute myeloid leukaemia. Beneath an intact stratified squamous epithelium, there is a diffuse and dense infiltrate of primitive myeloid cells.

Fig. 4.53 Extramedullar myeloid sarcoma of the gingiva as the first sign of relapse of acute myeloid leukaemia. In areas, there is typically an Indian-file pattern of infitration.

plastic syndrome. Histologically, there Is a dense infiltrate of immature myeloid cells in the subepithelial soft tissue of the gingiva. Please refer to the section of 'Other uncommon haematolymphoid tumours' in 'Tumours of the nasal cavity and paranasal sinuses' for further details on extramedullary myeloid sarcoma.

Follicular dendritic cell sarcoma / tumour

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