Gingival ulceration in patient with history of alcohol and tobacco use

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Extranodal natural killer T-cell lymphoma
Source: NEJM

Extranodal natural killer T-cell lymphoma

Ulcerations are defects in the epithelium, connective tissue or both. The diagnosis of oral ulcers may be quite challenging because of the diverse causative factors and presenting features. In case ulcerative lesions last for 2 weeks or more, it is referred to as chronic. Otherwise it is an acute ulcer. This article describes the case of a 50-year-old who presented to the dental clinic with fever, nasal congestion and an enlarging ulcer between the upper incisors, with a history of 1 month. Doctors diagnosed the patient with extranodal natural killer T-cell lymphoma.

Examination and diagnosis

Oral examination was significant for gingival recession, alveolar bone exposure, gap between the two front teeth and yellowing of the teeth. The ulcer had an irregular border and was seen extending to the hard palate. Doctors advised a complete blood count which showed lymphopenia (1000 lymphocytes per cubic millimeter; reference range, 1100 to 3200). Histopathological analysis of a biopsy specimen confirmed the diagnosis of extranodal natural killer T-cell lymphoma (nasal type), whereas in situ hybridisation was consistent with Epstein-Barr virus. The patient was referred to the oncology department. For further evaluation a positron-emission tomographic (PET) scan was advised which showed involvement of the maxillary sinuses, nasopharynx, cervical lymph nodes, upper right lung, and spleen.

The patient was advised treatment with asparaginase-based chemotherapy. A follow-up PET scan showed that the disease had progressed, therefore, palliative radiation therapy was recommended. Extranodal natural killer T-cell lymphoma is an aggressive non-Hodgkin’s lymphoma more commonly seen in the Pacific rim countries. The most common site of presentation is the nasopharynx, however, it can also affect the skin, intestine and central nervous system.

In case of recurrent ulcers, the ulcers present with a history of similar episodes and intermittent healing. For this reason, to arrive at a definitive diagnosis it is essential for clinicians to consider differential diagnoses.

Source: NEJM

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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