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LEUKAEMIA Under the Guidance of: Dr. KIRAN HOLIKATTI SIR PRESENTED BY: DEPT. OF ORAL & MAXILLOFACIAL PATHOLOGY SHUBHANGI MISHRA
CONTENTS ?DEFINITION ?TYPES ?CLASSIFICATION ?ETIOLOGY ?ACUTE LEUKAEMIA ?CHRONIC LEUKAEMIA ?DENTAL CONSIDERATIONS
LEUKAEMIA(LEUCOSIS) DEFINITION: “LEUKAEMIA ARE A GROUP OF NEOPLASTIC DISEASES THAT LEAD TO EXCESSIVE PRODUCTION OF LEUKOCYTES IN BONE MARROW, USUALLY PRESENT IN THE CIRCULATION IN AN IMMATURE FORM”
LEUKAEMIA ?PRESENCE OF LEUKAEMIC CELLS IN BONE MARROW RESULTS IN IMPAIRMENT OF NORMAL HAEMOPOIESIS RESULTING IN “ANAEMIA, GRANULOCYTOPENIA, & THROMBOCYTOPENIA”. ?IT IS A PROGRESSIVE & FATAL CONDITION CAUSING DEATH FROM HAEMORRHAGE & INFECTION.
TYPES: 1. “STEM” OR “BLAST CELL” LEUKAEMIA 2. SUBLEUKAEMIA 3. ALEUKAEMIA 4. LEUKAEMOID REACTION
CLASSIFICATION According to types of WBC lines involved: 1.LYMPHOID(LYMPHOBLASTIC, LYMPHOCYTIC) LEUKEMIAS 2.MYELOID LEUKAEMIAS According to Progression of untreated disease : 1.ACUTE LEUKAEMIAS 2. CHRONIC LEUKAEMIAS
leukemia new jiojvgijjgfyuijjfddiiij.pptx
ETIOLOGY: EXTERNAL FACTORS 1. VIRUS(EBV, HTLV, HERPES-LIKE VIRUS) 2. RADIATION & ATOMIC ENERGY 3. CHEMICAL AGENTS(ANILINE DYES, BENZENE) 4. ANTI-CANCER DRUGS(MELPHALAN, CHLORAMBUCIL) INTERNAL FACTORS 1. GENETIC & CHROMOSOMAL FACTORS(PHILADELPHIA CHROMOSOME) 2. IMMUNOLOGICALLY DEFICIENCY SYNDROME:- Down syndrome, Fanconi syndrome, Klinefelter syndrome
ACUTE LEUKAEMIA ?IT IS A DISORDER IN WHICH THERE IS FAILURE OF MATURATION OF LEUCOCYTE. ?THERE IS AN ACCUMULATION OF IMMATURE CELLS WITHIN THE BONE MARROW AND LATER IN BLOOD
CLINICAL FEATURES: ?AGE: Children& young adults b/w 15 to 39 yrs of age. ? SEX: MALE>FEMALE; MALE:FEMALE RATIO =3:2 ? ONSET: Abrupt stormy onset with PYREXIA & SPLENOMEGALY
CLINICAL FEATURES : SYMPTOMS: 1. WEAKNESS, FEVER, HEADACHE 2. GENERALIZED SWELLING OF LYMPH NODES 3. BONE PAIN 4. PETECHIAE OR HAEMORRHAGE IN SKIN & MUCOUS MEMBRANE 5. CNS manifestation (Headache, vomiting, nerve palsies) result from meningeal spread. ALL>AML
CLINICAL FEATURES: SIGNS: Due to Anemia& Thrombocytopenia 1. Pallor, dyspnoea, fatigue 2. Petechiae, ecchymosis, epistaxis, melena 3. Increased susceptibility to infection 4. Cervical lymphadenopathy 5. Hepatosplenomegaly 6. Intracranial & subarachnoid haemorrhage 7. Recurrent infections of lungs, Urinary tract, skin, mouth.
CLINICAL FEATURES: CHLOROMA: Foci of leukaemic cells present as mass which may behave like “A LOCALIZED MALIGNANT TUMOR” Surface turns green when exposed to light due to presence of MYELOPEROXIDASE Usually associated with AML
ORAL MANIFESTATION SIGNS: Oral mucous membrane shows: 1. Pallor, ulceration with necrosis 2. Petechiae, ecchymosis, bleeding tendency 3. Recurrent infections such as candidiasis 4. Massive necrosis of lingual mucosa with sloughing SYMPTOMS: 1.Paresthesia of lower lip & chin 2. Toothache 3. Rapid loosening of teeth
ORAL MANIFESTATION LYMPH NODES ? SUBMENTAL, CERVICAL, PRE-&POST- AURICULAR LYMPH NODES may be ENLARGED & TENDER TEETH & LIP ?TEETH- TOOTH MOBILITY ?LIP-CRUSTING OF LIP
GINGIVA May be the 1st sign of AML in ~5% of cases Gingival Hypertrophy:Due to leukaemic infiltration in areas of mild chronic irritation. (Most common with AML of monocytic differentiation) Gingival hyperplasia :Seen in 20-30% cases. ? Cyanotic discolouration ? Gingivitis
GINGIVAL HYPERPLASIA ? BOGGY ? OEDEMATOUS ? SOFT TO TOUCH ? DEEP RED IN COLOUR ? TENDER TO TOUCH ? TENDENCY TO BLEED
CHRONIC LEUKEMIAS CHRONIC MYELOID LEUKEMIA ? AGE: >65 yrs ? SEX: Male > Female ? C/F: 1. Insidious course 2. Splenomegaly 3. Mild to moderate anemia 4. Increased fatigability 5. Weakness, Weight loss, Loss of appetite 6. Hepatomegaly 7. Petechiae, Ecchymosis, Hemmorhage of skin & mucous membrane 8. Enlargememt of salivary gland and tonsils 9. Xerostomia CHRONIC LYMPHATIC LEUKEMIA ? AGE:>45 yrs ? SEX: Male >Female ? C/F: 1. Insidious onset 2. Anemia, Thrombocytopenia 3. Pallor, Weakness, Dyspnoea, Purpura 4. Enlarged lymph nodes:Cervical, Axillary, Inguinal 5. Hepatosplenomegaly 6. Increased susceptibility to infection 7. Leukaemids:Papules, pustules, bullae, areas of pigmentation, Herpes zoster, itching & burning sensation 8. Nodules due to leukaemic infiltration 9. Intestinal malabsorption, Pulmonary obstruction, Compression of CNS/PNS
LEUKAEMID
ORAL MANIFESTATION CHRONIC MYELOID LEUKEMIA ? SIGNS OF LOCAL INFECTION(Candidal, Bacterial, Viral) ? Pathologic fracture ? Osteomyelitis CHRONIC LYMPHATIC LEUKEMIA ? GINGIVA:Gingival Hypertrophy with ulceration, gangrenous degeneration, brown exudate and fetor oris ? TONGUE:Swollen and dark ? LYMPH NODES:Regional lymphadenopathy ? TEETH:Rapid loosening of teeth due to necrosis of PDL & alveolar bone
GINGIVAL HYPERTROPHY (CHRONIC LEUKEMIAS)
PANORAMIC RADIOGRAPH ILL-DEFINED PATCHY RADIOLUCENCY MOTH-EATEN APPEARANCE ONION-PEEL APPEARANCE
leukemia new jiojvgijjgfyuijjfddiiij.pptx
DIAGNOSIS 1. CLINICAL DIAGNOSIS:C/O sudden Gingival bleeding or Gingival hyperplasia with symptoms of anemia & Thrombocytopenia may suspect leukemia
LAB DIAGNOSIS: 1.COMPLETE BLOOD COUNT:Abnormal WBC’s 2. LEUKEMIA TYPING 3. NEEDLE BIOPSY ASPIRATION OF BONE MARROW 4. DNA MARKERS 5. CHROMOSOME CHANGES
ACUTE LEUKEMIA 1.WBC COUNT:Subnormal(Early stage); Increased to ~100000 cells/cu.mm(Terminal stage) 2. DIFFERENTIAL WBC COUNT: Increased proportion of blast cells 3. PBS: 1.Large thrombocytes 2. Macrocytes 3.Poikilocytes 4.Neutrophils with reduced no. of lobes 5.Absolute or relative MONOCYTOSIS 6.NEUTROPENIA(AML) 7.THROMBOCYTOPENIA(40%) 4. BONE MARROW SMEARS :HYPERCELLULAR Diagnostic feature :ABNORMAL DIFFERENTIATION OF THE MYELOID SERIES
ACUTE MYELOID LEUKAEMIA SHOWING MYELOBLASTS
CHRONIC LEUKEMIAS 1.WBC COUNT: LEUKOCYTOSIS(>100,000 CELLS/cu.mm) 2. WBC’s PRESENT: NEUTROPHILS, BAND FORMS, METAMYELOCYTES, MYELOCYTES, EOSINOPHILS, BASOPHILS BASOPHILIA-*char.feature of CML 3. BONE MARROW SMEARS:HYPERCELLULAR “SEA-BLUE HISTIOCYTES” /MACROPHAGES WITH ABUNDANT GREEN-BLUE CYTOPLASM“- Charac. Feature of CML DIAGNOSTIC FEATURE: PHILADELPHIA CHROMOSOME MUTATION(95%) IN CML
MONOCYTIC LEUKEMIA ATYPICAL, PLEOMORPHIC MONOCYTES
MANAGEMENT ? CHEMOTHERAPY(1ST LINE TREATMENT) ? STEM CELL TRANSPLANT(REMISSION PT.) ? RADIATION THERAPY ? LEUKAPHERESIS ? TARGETED THERAPY WITH TYROSINE KINASE INHIBITORS-IMATINIB&NILOTINIB(1ST LINE THERAPY IN CML) ? BIOLOGICAL TREATMENT(INTERFERON ALPHA, BUSULFAN, HYDROXYUREA, RADIATION THERAPY, SPLENECTOMY)
DENTAL CONSIDERATIONS ? C/O periodontal lesions with unusual appearance & severity, sudden Gingival bleeding or gingivitis should suggest possibility of leukemia ? Check blood indices of Pt. With leukemia and disease and treatment status need to be considered ? Cancellation of procedures accompanied by risk of infection or procedures to be carried out under prophylactic antibiotic cover ? Topical treatment:To stop bleeding, remove local irritants, direct pressure & use of absorbable microfibrillar collagen ? Platelet transfusion:If platelet count is extremely low and to be considered pre and 24 hrs post-operatively
BIBLIOGRAPHY ? SHAFER’S TEXTBOOK OF ORAL PATHOLOGY(8TH EDITION) ? GHOM’S TEXTBOOK OF ORAL MEDICINE(4th EDITION)
leukemia new jiojvgijjgfyuijjfddiiij.pptx

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leukemia new jiojvgijjgfyuijjfddiiij.pptx

  • 1. LEUKAEMIA Under the Guidance of: Dr. KIRAN HOLIKATTI SIR PRESENTED BY: DEPT. OF ORAL & MAXILLOFACIAL PATHOLOGY SHUBHANGI MISHRA
  • 3. LEUKAEMIA(LEUCOSIS) DEFINITION: “LEUKAEMIA ARE A GROUP OF NEOPLASTIC DISEASES THAT LEAD TO EXCESSIVE PRODUCTION OF LEUKOCYTES IN BONE MARROW, USUALLY PRESENT IN THE CIRCULATION IN AN IMMATURE FORM”
  • 4. LEUKAEMIA ?PRESENCE OF LEUKAEMIC CELLS IN BONE MARROW RESULTS IN IMPAIRMENT OF NORMAL HAEMOPOIESIS RESULTING IN “ANAEMIA, GRANULOCYTOPENIA, & THROMBOCYTOPENIA”. ?IT IS A PROGRESSIVE & FATAL CONDITION CAUSING DEATH FROM HAEMORRHAGE & INFECTION.
  • 5. TYPES: 1. “STEM” OR “BLAST CELL” LEUKAEMIA 2. SUBLEUKAEMIA 3. ALEUKAEMIA 4. LEUKAEMOID REACTION
  • 6. CLASSIFICATION According to types of WBC lines involved: 1.LYMPHOID(LYMPHOBLASTIC, LYMPHOCYTIC) LEUKEMIAS 2.MYELOID LEUKAEMIAS According to Progression of untreated disease : 1.ACUTE LEUKAEMIAS 2. CHRONIC LEUKAEMIAS
  • 8. ETIOLOGY: EXTERNAL FACTORS 1. VIRUS(EBV, HTLV, HERPES-LIKE VIRUS) 2. RADIATION & ATOMIC ENERGY 3. CHEMICAL AGENTS(ANILINE DYES, BENZENE) 4. ANTI-CANCER DRUGS(MELPHALAN, CHLORAMBUCIL) INTERNAL FACTORS 1. GENETIC & CHROMOSOMAL FACTORS(PHILADELPHIA CHROMOSOME) 2. IMMUNOLOGICALLY DEFICIENCY SYNDROME:- Down syndrome, Fanconi syndrome, Klinefelter syndrome
  • 9. ACUTE LEUKAEMIA ?IT IS A DISORDER IN WHICH THERE IS FAILURE OF MATURATION OF LEUCOCYTE. ?THERE IS AN ACCUMULATION OF IMMATURE CELLS WITHIN THE BONE MARROW AND LATER IN BLOOD
  • 10. CLINICAL FEATURES: ?AGE: Children& young adults b/w 15 to 39 yrs of age. ? SEX: MALE>FEMALE; MALE:FEMALE RATIO =3:2 ? ONSET: Abrupt stormy onset with PYREXIA & SPLENOMEGALY
  • 11. CLINICAL FEATURES : SYMPTOMS: 1. WEAKNESS, FEVER, HEADACHE 2. GENERALIZED SWELLING OF LYMPH NODES 3. BONE PAIN 4. PETECHIAE OR HAEMORRHAGE IN SKIN & MUCOUS MEMBRANE 5. CNS manifestation (Headache, vomiting, nerve palsies) result from meningeal spread. ALL>AML
  • 12. CLINICAL FEATURES: SIGNS: Due to Anemia& Thrombocytopenia 1. Pallor, dyspnoea, fatigue 2. Petechiae, ecchymosis, epistaxis, melena 3. Increased susceptibility to infection 4. Cervical lymphadenopathy 5. Hepatosplenomegaly 6. Intracranial & subarachnoid haemorrhage 7. Recurrent infections of lungs, Urinary tract, skin, mouth.
  • 13. CLINICAL FEATURES: CHLOROMA: Foci of leukaemic cells present as mass which may behave like “A LOCALIZED MALIGNANT TUMOR” Surface turns green when exposed to light due to presence of MYELOPEROXIDASE Usually associated with AML
  • 14. ORAL MANIFESTATION SIGNS: Oral mucous membrane shows: 1. Pallor, ulceration with necrosis 2. Petechiae, ecchymosis, bleeding tendency 3. Recurrent infections such as candidiasis 4. Massive necrosis of lingual mucosa with sloughing SYMPTOMS: 1.Paresthesia of lower lip & chin 2. Toothache 3. Rapid loosening of teeth
  • 15. ORAL MANIFESTATION LYMPH NODES ? SUBMENTAL, CERVICAL, PRE-&POST- AURICULAR LYMPH NODES may be ENLARGED & TENDER TEETH & LIP ?TEETH- TOOTH MOBILITY ?LIP-CRUSTING OF LIP
  • 16. GINGIVA May be the 1st sign of AML in ~5% of cases Gingival Hypertrophy:Due to leukaemic infiltration in areas of mild chronic irritation. (Most common with AML of monocytic differentiation) Gingival hyperplasia :Seen in 20-30% cases. ? Cyanotic discolouration ? Gingivitis
  • 17. GINGIVAL HYPERPLASIA ? BOGGY ? OEDEMATOUS ? SOFT TO TOUCH ? DEEP RED IN COLOUR ? TENDER TO TOUCH ? TENDENCY TO BLEED
  • 18. CHRONIC LEUKEMIAS CHRONIC MYELOID LEUKEMIA ? AGE: >65 yrs ? SEX: Male > Female ? C/F: 1. Insidious course 2. Splenomegaly 3. Mild to moderate anemia 4. Increased fatigability 5. Weakness, Weight loss, Loss of appetite 6. Hepatomegaly 7. Petechiae, Ecchymosis, Hemmorhage of skin & mucous membrane 8. Enlargememt of salivary gland and tonsils 9. Xerostomia CHRONIC LYMPHATIC LEUKEMIA ? AGE:>45 yrs ? SEX: Male >Female ? C/F: 1. Insidious onset 2. Anemia, Thrombocytopenia 3. Pallor, Weakness, Dyspnoea, Purpura 4. Enlarged lymph nodes:Cervical, Axillary, Inguinal 5. Hepatosplenomegaly 6. Increased susceptibility to infection 7. Leukaemids:Papules, pustules, bullae, areas of pigmentation, Herpes zoster, itching & burning sensation 8. Nodules due to leukaemic infiltration 9. Intestinal malabsorption, Pulmonary obstruction, Compression of CNS/PNS
  • 20. ORAL MANIFESTATION CHRONIC MYELOID LEUKEMIA ? SIGNS OF LOCAL INFECTION(Candidal, Bacterial, Viral) ? Pathologic fracture ? Osteomyelitis CHRONIC LYMPHATIC LEUKEMIA ? GINGIVA:Gingival Hypertrophy with ulceration, gangrenous degeneration, brown exudate and fetor oris ? TONGUE:Swollen and dark ? LYMPH NODES:Regional lymphadenopathy ? TEETH:Rapid loosening of teeth due to necrosis of PDL & alveolar bone
  • 22. PANORAMIC RADIOGRAPH ILL-DEFINED PATCHY RADIOLUCENCY MOTH-EATEN APPEARANCE ONION-PEEL APPEARANCE
  • 24. DIAGNOSIS 1. CLINICAL DIAGNOSIS:C/O sudden Gingival bleeding or Gingival hyperplasia with symptoms of anemia & Thrombocytopenia may suspect leukemia
  • 25. LAB DIAGNOSIS: 1.COMPLETE BLOOD COUNT:Abnormal WBC’s 2. LEUKEMIA TYPING 3. NEEDLE BIOPSY ASPIRATION OF BONE MARROW 4. DNA MARKERS 5. CHROMOSOME CHANGES
  • 26. ACUTE LEUKEMIA 1.WBC COUNT:Subnormal(Early stage); Increased to ~100000 cells/cu.mm(Terminal stage) 2. DIFFERENTIAL WBC COUNT: Increased proportion of blast cells 3. PBS: 1.Large thrombocytes 2. Macrocytes 3.Poikilocytes 4.Neutrophils with reduced no. of lobes 5.Absolute or relative MONOCYTOSIS 6.NEUTROPENIA(AML) 7.THROMBOCYTOPENIA(40%) 4. BONE MARROW SMEARS :HYPERCELLULAR Diagnostic feature :ABNORMAL DIFFERENTIATION OF THE MYELOID SERIES
  • 27. ACUTE MYELOID LEUKAEMIA SHOWING MYELOBLASTS
  • 28. CHRONIC LEUKEMIAS 1.WBC COUNT: LEUKOCYTOSIS(>100,000 CELLS/cu.mm) 2. WBC’s PRESENT: NEUTROPHILS, BAND FORMS, METAMYELOCYTES, MYELOCYTES, EOSINOPHILS, BASOPHILS BASOPHILIA-*char.feature of CML 3. BONE MARROW SMEARS:HYPERCELLULAR “SEA-BLUE HISTIOCYTES” /MACROPHAGES WITH ABUNDANT GREEN-BLUE CYTOPLASM“- Charac. Feature of CML DIAGNOSTIC FEATURE: PHILADELPHIA CHROMOSOME MUTATION(95%) IN CML
  • 30. MANAGEMENT ? CHEMOTHERAPY(1ST LINE TREATMENT) ? STEM CELL TRANSPLANT(REMISSION PT.) ? RADIATION THERAPY ? LEUKAPHERESIS ? TARGETED THERAPY WITH TYROSINE KINASE INHIBITORS-IMATINIB&NILOTINIB(1ST LINE THERAPY IN CML) ? BIOLOGICAL TREATMENT(INTERFERON ALPHA, BUSULFAN, HYDROXYUREA, RADIATION THERAPY, SPLENECTOMY)
  • 31. DENTAL CONSIDERATIONS ? C/O periodontal lesions with unusual appearance & severity, sudden Gingival bleeding or gingivitis should suggest possibility of leukemia ? Check blood indices of Pt. With leukemia and disease and treatment status need to be considered ? Cancellation of procedures accompanied by risk of infection or procedures to be carried out under prophylactic antibiotic cover ? Topical treatment:To stop bleeding, remove local irritants, direct pressure & use of absorbable microfibrillar collagen ? Platelet transfusion:If platelet count is extremely low and to be considered pre and 24 hrs post-operatively
  • 32. BIBLIOGRAPHY ? SHAFER’S TEXTBOOK OF ORAL PATHOLOGY(8TH EDITION) ? GHOM’S TEXTBOOK OF ORAL MEDICINE(4th EDITION)