165 GINGIVAL ENLARGEMENT - A CLUE TO THE DIAGNOSIS OF LEUKEMIA? Manoj Kumar * , Vineet Nair † , Lora Mishra ‡ , Surajit Mistry § , Anurag Satpathy * , Abhaya Chandra Das * ABSTRACT: Objective: The acute leukemia's are a group of neoplastic diseases that are characterized by proliferation of immature white cells in the bone marrow and/or blood and are often associated with severe leucopenia, anemia and thrombocytopenia. Oral manifestations are more common in patients with acute leukemia. Oral bleeding, gingival enlargement, ulceration and infection in patients with leukemia have been described. Leukemic infltrates in the gingivae are commonly seen in acute monocytic leukemia. Case Presentation: A case of acute monocytic leukemia in a 25 year old pregnant lady who reported with gingival enlargement is presented here. The role of oral lesions as a diagnostic indicator is discussed. Conclusion: Oral manifestations of leukemias are seen early in the course of disease, thus unwarranted dental procedures that may aggravate the systemic condition should be avoided. AOSR 2012;2(3):165-168. Key Words: Acute Monocytic Leukemia; Gingival Enlargement; Oral Manifestations. * Department of Periodontics, Institute of Dental Sciences, Bhubaneshwar, Orissa, India. † Department of Periodontics, Dr. R. Ahmed Dental College and Hospital, Kolkatta, West Bengal , India. ‡ Department of Conservative Dentistry and Endontics, Institute of Dental Sciences, Bhubaneshwar, Orissa, India. § Department of Dentistry, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India. INTRODUCTION: Gingival enlargement is one of the most important clinical features of gingival diseases with several reported etiologies including poor oral hygiene, medications, serious systemic illness, hematological disorders, genetic conditions and it can be even idiopathic. 1-6 Leukemia is a malignant neoplasm resulting from proliferation of abnormal haemopoietic stem cells with uncoordinated differentiation, regulation and apoptosis resulting in abnormal numbers and forms of immature leukocytes in circulating blood and widespread infltrates in the liver, spleen, lymph nodes and other body tissues like gingiva. 7 Leukemia’s occur in all human races, but are more common in Caucasians. 8 According to the lineage of leukocytes involved, leukemia is classifed as lymphocytic or myelocytic; a subgroup of the myelocytic leukemia is monocytic leukemia, its acute form is rapidly fatal. Gingival enlargements have been associated with leukemias which may be diffuse or marginal and localized or generalized. It may appear as a diffuse enlargement of the gingival mucosa, an oversized extension of marginal gingiva or a discrete tumor like interproximal mass. The gingiva is generally bluish red and has a shiny surface. The consistency is moderately frm, but there is a tendency toward friability and hemorrhage. Here, we are going to present a case of leukemic gingival enlargement. CASE REPORT: A 25 yr old female patient reported to the Department of Periodontia of Dr. R. Ahmed Dental College & Hospital, Kolkata with the chief complaint of generalized gingival swelling since 20 days. She was pregnant and in her second trimester. She also complained of fever, weakness and malaise with associated feature of chest infection since 1 month. Past dental history revealed that the gingival enlargement had occurred following the extraction of lower right posterior frst molar tooth 20 days back. Her general physical examination revealed that the patient was emaciated and weak. Intra oral examination revealed generalized diffused gingival enlargement of marginal, interdental and attached gingiva. The color was pale pink with a shiny surface; moderately frm consistency and Archives of Oral Sciences & Research