Hematologic Diseases

Question 1

Lymphoid Hyperplasia

Answer 1

• May affect lymph nodes, Waldeyer’s ring or oral lymphoid aggregates
• Oropharynx, soft palate, lateral tongue and floor of the mouth
• Moveable (how we differentiate from cancer)
• Important to achieve final diagnosis and rule out a lymphoma
• Completely benign process
• Once diagnosis is established, no treatment required

Question 2

Iron deficiency anemia

Answer 2

• Most common cause of anemia
• Causes
  
  • Excessive blood loss
  • Increased demands
  • Decreased intake
  • Decreased absorption of Fe
• Oral findings
  
  • •“Burning Tongue”
• Erythema of oral mucosa
• Atrophy of filiform papillae
• Taste alteration
• Angular cheilitis
• Similar oral findings to acute erythematous candidiasis in differential dx
• Lab Findings:
  
  • Reduced hematorit and hemoglobin level
  • Serum iron level is low
  • Total iron-binding capacity elevated
• Treatment
  
  • Recognition and treatment of underlying cause
  • Supplements elevate hemoglobin levels and iron stores

Question 3

Plummer-Vinson Syndrome

Answer 3

• Rare condition characterized by:
  
  • Iron deficiency anemia
  • Dysphagia: difficulty swallowing
  • Esophageal webs: abnormal bands of tissue in esophagus
  • Koilonychia: spoon-shaped configuration of the nails
  • High frequency of oral and esophageal SCC

Question 4

Pernicious Anemia

Answer 4

• Cause: Vitamine B12 deficiency
• Oral manifestations
  
  • Burning sensation of tongue & other mucosal sites
  • Diffuse thinning & erythema of oral mucosa, seen most easily on the dorsum of the tongue

Question 5

Mucosal Soreness or Burning Systemic Factors

Answer 5

• Anemia
• Nutritional deficiencies

Question 6

Mucosal Soreness or Burning Local factors

Answer 6

• Candidiasis

Question 7

What is the most common cause for burning tongue?

Answer 7

Candidiasis is significantly more common than anemia

Question 8

What is the radiographic phenomenon “hair on end” appearance characteristic of?

Answer 8

• Sickle cell anemia
• Thalessemia

Question 9

What causes the radiographic phenomenon “hair on end” appearance?

Answer 9

Body responding to sickle cell anemia/thalessemia by making more RBCs to carry more O2, therefore making more bone marrow, at somee point it starts to push the periosteum out. Periosteum responds by laying down bone as it’s getting dragged out. Osteoblasts produce more bone coming outwards.

• Reduced fcn of RBCs = marrow hyperplasia
• Leads to a periosteal rxn leading to interspersed trabeculae
  
  • Normally you’re supposed to have a tight trabecular pattern anteriorly and superiorly

Question 10

Sickle cell anemia

Answer 10

• Genetic disorder of hemoglobin synthesis
• Leads to deformed red blood cell
• Normal biconcave disk changed to rigid and curve (sickle) shape
• Less oxygen carrying capacity

Question 11

Leukemia

Answer 11

WBC neoplasm cells arise in the bone marrow and spread to peripheral blood

Malignant

Question 12

Lymphoma

Answer 12

WBC neoplasm cells arise in lymph nodes and other solid lymphoid tissue

Malignant

Question 13

Clinical features of leukemia

Answer 13

• Clinical features are due to replacement of normal bone marrow with malignant leukemic cells
• Anemia: reduced blood cells
  
  • Fatigue, shortness of breath, tachycardia and other features
• Leukopenia: reduced white blood cells
  
  • Increased infection
• Thrombocytopenia: reduced platelets
• Petechiae and pupura of oral mucosa
• Spontaneous gingival bleeding
• Prolonged bleeding after dental treatment

Question 14

Oral features of leukemia

Answer 14

• Oral ulcers, especially extensive gingival ulceration
• Candidosis
• Herpetic infections both keratinized and nonkeratizined mucosa
• Gingival enlargement, usually diffuse
• Due to an infiltration of leukemic cells

Question 15

Oral features of acute leukemia

Answer 15

children

gingival ulceration, necrosis, enlargement

Question 16

Hodgkin’s lymphoma

Answer 16

• Cancer of young adults (peak = 15-35)
• Almost always begins in lymph nodes
• Most common = head and neck is initial presenting site
• 70-75% of all cases first show enlargement of cervical and supraclavicular lymph nodes
• Malignant cells (Reed-Sternberg) correspond to only 1-3% of all cells
• Reed-Sternberg: B-lymphocyte origin
• Epstein-Barr virus linked to a significant number of cases

Question 17

Burkitt’s lymphoma

Answer 17

• EBV+
• Predilection for the jaws
• Starry sky appearance
• If untreated, results in the death of the patient in 4-6 weeks
• Treatment consists of intensive chemotherapy

Question 18

What is the most common lymphoma in the oral cavity

Answer 18

NHL

Question 19

Multiple myeloma

Answer 19

• Multicentric malignancy of plasma cell origin
• Bone pain
• Pathological fractures
• Fatigue (anemia)
• Fever (neutropenia)
• Well-defined punched out RL lesions
• Screening of the serum or urine for M-protein (Bence-Jones protein)

Question 20

Langerhans cell disease

Answer 20

• Eosinophilic granuloma of bone
  
  • One or more bone lesions
• Chronic disseminated histiocytosis
  
  • Aka Hand-Schuller Christianson
  • Disease of bone, skin, and viscera
  • Bone lesions (eosinophilic granulomas), exophthalmos, diabetes insipidus
    
    • ​ulcer or ST proliferation over bone lesion
• Acute disseminated histiocytosis
• Atypical perio

Question 21

Oral features of Langerhans cell disease

Answer 21

• Jaw lesions may be well-circumscribed or poorly defined
• Jaw lesions sometimes resemble severe or atypical periodontitis with alveolar bone loss, mobility of teeth and gingival proliferation
  
  • “Scooped out” bone loss
  • Teeth floating in air