GINGIVAL ULCERATIONS IN A PATIENT WITH ACUTE MYELOID LEUKEMIA: A case report and literature review.

A 40-year-old female patient was admitted to the Department of Oral Medicine due to oral ulcerations. Oral ulcerations were present on vestibular mucosa above teeth 21, 22, 25 and 26 and were 1 cm in diameter, and also around teeth 45 and 46. The patient had prolonged neutropenia due to therapy-related myelodysplastic syndrome that progressed to therapy-related acute myeloid leukemia. Initially, the patient was successfully treated with polychemotherapy for non-Hodgkin lymphoma. Unfortunately, many toxic complications ensued, such as peripheral neuropathy, dilated cardiomyopathy and therapy-related myelodysplastic syndrome/therapy-related acute myeloid leukemia. The onset of therapy-related myelodysplastic syndrome was less than six months after initiation of chemotherapy treatment, which was rather early, but cytogenetic changes (monosomy 5 and 7) were consistent with the diagnosis. Upon admission to our Department, microbiological swabs were obtained and were all negative, while x-ray finding showed that ulcerations did not have dental cause. Biopsy was not obtained as the patient had severe neutropenia and thrombocytopenia. While viral and fungal swabs were negative, Stenotrophomonas maltophilia was cultured from the oral cavity. Thus, differential diagnoses are listed in this report. Neutropenic ulcerations did not heal albeit extensive medicamentous oral and systemic treatments were applied and the patient died.

Survival time and prognostic factors of oral cancer in Ubon Ratchathani Cancer Center.

OBJECTIVE: To characterize the survival time and prognostic factors of oral cancer in Ubon Ratchathani, Thailand. MATERIAL AND METHOD: A total of 519 patients with oral cancer in the Ubon Ratchathani Cancer Center were recruited retrospectively over 5 years, from January 1, 2002 to December 31, 2006. The survival status of the patients was followed until December 31, 2007. Survival times were estimated and compared using the product-limit (Kaplan-Meier) method Cox Proportional Hazards models were used to examine prognostic factors. RESULTS: At the end of the study, 384 patients (74.0%) had died. The mean age of the patients at diagnosis was 64.15 years, with a male to female ratio of 1:1.56. Location of cancer were found at tongue (25.2%), buccal mucosa (22.4%), gum (21.1%), lip (17.5%) and others (13.7%). Squamous cell carcinoma was the most common cell type (92.7%). The median survival time was 337 days and the survival probability at 1, 3 and 5-years were 46.7%, 26.4% and 18.2%, respectively. In multivariable analysis, patients at the greatest risk of death were those having cancer of the tongue (HR 1.93, 1.20, 3.11) compared to cancer of the lip and being in stage IV at diagnosis (HR 3.57, 95% CI = 1.79, 7.13) as compared to stage I. CONCLUSION: Patients with advanced tumors had the worst prognosis, underscoring the importance of improved early detection for early treatment.

Highly virulent strains of herpes simplex virus fail to kill mice following infection via gingival route.

Virulence of herpes simplex virus (HSV) in mice has been demonstrated to be dependent on the site of infection. In this experiment, pathogenesis of HSV was studied in 2 different routes of infection in a mouse model system. When BALB/c mice were infected with 5 x 10(3) plaque-forming units (PFU) of virulent HSV type 1 Miyama GC+ strain (HSV-1-GC+) intraperitoneally, all mice were dead in 6 to 9 days. HSV-1-GC+ was recovered from organs such as the cerebrum, cerebellum, brainstem, and spleen 2 to 5 days after infection, but not from other organs such as trigeminal ganglia. However, if mice were infected in the maxillary gingiva with 1.0 x 10(7) PFU of HSV-1-GC+, all mice survived. HSV-1-GC+ was recovered from the trigeminal ganglia and brainstem 2 to 5 days after infection, but not from other organs tested. When mice were infected in maxillary gingiva with HSV-1-GC+, followed by the intraperitoneal injection of 6 mg of cyclophosphamide 72 hrs after virus infection, all mice were dead within days. Immunofluorescent and hematoxylin-eosin staining of gingival tissue sections revealed that when mice were infected in maxillary gingiva with HSV-1-GC+, 3 times as many gamma delta T-cells and 5 times as many polymorphonuclear cells can be detected in sections of maxillary gingiva when compared with non-infected mice. These data show that the gingiva of mice is considerably more resistant to infection with HSV, compared with the peritoneal cavity, and suggest the possible presence of an oral defense mechanism which might be different from that in the peritoneal cavity.