DEPARTMENT OF ORAL AND MAXILLOFACIAL

PATHOLOGY

PRESENTED BY: SOUNDARYA V III BDS

CHRONIC LEUKEMIAS

REFERENCESTextbook of Oral Pathology - Shafers

Textbook of Oral and Maxillofacial Pathology - Neville

Robbins Textbook of Pathology

Textbook of Clinical Medicine - Chugh

Textbook of Pathology-Harsh mohan

www.wikipedia.com

Google Images

Practical Haematology – Ramnik sood

INTRODUCTION Leukemias are tumors of the white blood cells(leucocytes)

Haematologic malignancies

They are classified into:

1. Chronic myeloid leukemia

2. Chronic lymphocytic leukemia

CHRONIC MYELOID LEUKEMIASynonyms: Chronic granulocytic

leukemia Chronic myelocytic leukemia

• CML is cancer of WBCs

Characterized by increased growth of predominantly myeloid cells in bone marrow

Proliferation of mature granulocytes

Myeloproliferative disease associated with

chromosomal translocation [Philadelphia chromosome]

GENETIC ABNORMALITY: Chromosomal translocation know as

philadelphia chromosome. - parts of 2 chromosomes(9th & 22nd)switch

places - As a result,part of BCRgene from

chromosome 22 is fused with ABLgene on chromosome9

RECENTLY: Abnormally ↑ tyrosinekinase activity

PATHOPHYSIOLOGY

CLINICAL FEATURES

Peak incidence - 3rd and 4th decades

Male = Female

Variant seen in children Juvenile CML

Onset is insidious

SYMPTOMS COMMON : - Anaemia - Splenomegaly - Fatigue - Weight loss - Weakness - Dyspnea - purplish spots - Rashes

MODERATELY COMMON : - Hypermetabolism - Bleeding tendencies - Malaise - Retinal haemorrhage OCCASIONAL : - Joint pain - Bone pain - Amenorrhea - Priapism - Fever

ORAL MANIFESTATION Gingival hyperplasia : most commonest feature - Primary clinical manifestation : Gingivitis

Haemorrhage Petechia Ulceration - Severe : Generalized & teeth completely

hidden - Oedematous & deep red - Bleed easily - Purpuric lesion

Gingival haemorrhage Ulceration

Noma like condition Necrosis

Rapid loosening of teeth

Osseous changes in the jaws like destruction of lamina dura & displacement of teeth

Oral melanosis

LAB DIAGNOSIS

BLOOD PICTURE

BONE MARROW EXAMINATION

CYTOCHEMISTRY

Other investigations

BLOOD PICTUREAnaemia Normocytic and Normochromic type

is seenWhite blood cells Marked leucocytosis

CML consists of 3 phases: 1. chronic 2. Accelerate 3. Blastic

CHRONIC : - Excessive proliferation of myeliod cells

ACCELERATED : - Leucocytosis associated with

thrombocytopenia and splenomegaly

BLASTIC : - Lymphoid blast crisis seen - Development of Chloroma

CHRONIC• 5-6yrs• Platelets ↑• Bonemarro

w:Myeloid hyperplasia

ACCELERATE• 6-9mnts• Platelets↑or

↓• Bone

marrow: Myeloid hyperplasia

BLAST3-6mnts• Platelets↓• Myeliod

hyperplasia

BONEMARROW EXAMINATION1. Hypercellularity

2. Myeloid cells Increased myeloid – erythroid ratio

3. Erythropoiesis

4. Megakaryocytes

5. Cytogenetics – philadelphia chromosome

OTHER INVESTIGATIONS Elevated serum B12

Elevated VitB12 binding capacity

Elevated serum uric acid

DIFFERENTIAL DIAGNOSIS Benign neutrophilia

Splenomegaly

Polycythaemia vera

Idiopathic myelofibrosis

TREATMENTIn past : - Antimetabolites -Alkylating agents -Steroids Treated with inhibitors of Tyrosine kinase - first – Imatinib mesylate -Nilotinib & Dasatanib

Bone marrow transplantation rarely used.

SIDE EFFECTS OF TKIs

• Nausea ,Diarrhoea• Skin rash, EdemaImatinib

• Edema, Pleural effusion

• ThrombocytopeniaDasatinib

• Myelosuppression• Hepatic impairementNilotinib

PROGNOSIS

Overall survival rate - 95.2%

Only 1% patients died of leukemia progression.

THANK YOU