Oral & dental consideration in leukemia

1. Dentist may be the first clinician to

suspect the disease
2. Oral complications are common
throughout the disease
3. The dental management is complex & the
mouth is potential source of morbidity
and mortality
4. Head & neck signs results from leukemic
infiltrates or marrow failure. These
include cervical lymphadenopathy, oral
bleeding, gingival infiltrates, oral
infection & oral ulcers
Prominent reversal & resting lines
 Hyperparathyroidism
Histologic Features:

 increased osteoclastic
activity
 thinning of the trabecular bone
 wide zones of osteoid rimmed
with activated osteoblasts

 multinucleated giant cells

 fibrous connective tissue stroma
 SUNRAY APPEARANCE
• SMALL STREAKS OF
BONE RADIATING
OUTWARD
 CODMAN’S TRIANGLE
• IN LONG BONES,
PERIOSTEUM IS
ELEVATED OVER THE
EXPANDING TUMOR
MASS IN A TENT LIKE
FASHION. AT THE
POINT ON THE BONE
WHERE THE
PRIOSTEUM BEGINS
TO MERGE, AN ACUTE
ANGLE IS FORMED
KNOWN AS
CODMAN’S TRIANGLE
 Macroscopic appearance

• Chondrosarcoma arising from the vertebral column.

It appears as a large lobulated destructive mass with
a characteristic translucent whitish appearance due
to the chondroid stroma
ODONTOGENIC KERATOCYST

CONNECTIVE TISSUE
COLUMNAR CELLS WITH
REVERSE POLARISATION
SATELLITE CYSTS

EPITHELIAL RESTS

CORRUGATION OF SURFACE
EPITHELIUM
SEPERATION OF EPITHELUM
FROM CONNECTIVE TISSUE
Odontogenic keratocyst. The epithelial lining is 6 to 8
cells thick (arrow), with a hyperchromatic and palisaded
basal cell layer. Note the corrugated parakeratotic surface.
• Odontogenic keratocyst. The characteristic
microscopic features have been lost in the central
area of this portion of the cystic lining because of the
heavy chronic inflammatory cell infiltrate. ( arrow)
 Odontogenic Keratocyst
(‘primordial cyst’, ‘benign cystic tumor’)
Screening for Gorlin-Goltz syndrome:
multiple jaw cyst,
bifid rib, multiple naevi and
basal cell carcinomas of the skin

Management & Prognosis: vigorous enucleation followed

by prolonged follow-up as recurrence rate is high
compared to other jaw cysts.
 Histological Features

Dentigerous cyst: formation of

Dentigerous cyst: low power view the lining by splitting of the
shows attachment of the cyst wall reduced enamel epithelium.
to the neck of the tooth (arrow ) Remnants of the latter were
attached to the enamel surface
DENTIGEROUS CYST

CYSTIC LINING WITH FLATENDED

EPITHELIAL CELLS

CYSTIC LUMEN

CONNECTIVE TISSUE

BLOOD CAPILLARY

FIBROBLAST
Dentigerous cyst. This inflamed dentigerous cyst shows a
thicker epithelial lining with hyperplastic rete ridges. (Arrow )
The fibrous cyst capsule shows a diffuse chronic
inflammatory infiltrate.
Dentigerous cyst. This noninflamed dentigerous cyst
shows a thin, nonkeratinized epithelial lining.
( arrow)
Dentigerous cyst. Scattered mucous cells can be
seen within the epithelial lining. ( Arrow)
CALCIFYING ODONTOGENIC
CYST
CONNECTIVE TISSUE

FIBROBLAST

GHOST CELLS

CYSTIC LUMEN

STELLATE RETICULUM LIKE CELLS

AMELOBLAST LIKE CELLS

CALCIFICATIONS

BLOOD CAPILLARY
• ‘cracked-mud’,
‘corrugated’
Nodular (‘speckled
Hyperkeratosis Acanthosis
NBCCS
SATELLITE CYSTS
Cholesterol clefts