Gingival ulcer after tooth extraction as a initital symptom of T cell chronic lymphocytic leukemia(T-CLL).

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A case of T cell chronic lymphocytic leukemia (T-CLL) present in a gingival ulcer is reported. A 59 year old man was first seen at our clinic on May 24, 1985. The chief complaint was a gingival ulcer after tooth extraction. WBC was 17, 200/mm3 with 88% lymphoid cells. Bone marrow analysis showed 71.6% lymphoid cells. Lymphoid cells did not have convoluted nuclei typical in ATL and had surface markers of OKT 3+, OKT 4-, OKT 8+, OKT 11+, B 3/25-, Tac-. Cytochemical analysis of these lymphoid cell revealed negative peroxidase, negative esterase, negative acid phosphatase. The cells also lacked natural killer function and blast formation activity stimulated by PHA. The patient had negative anti-ATLA antibodies. Biopsy of the gingival lesion and the cervical lymph node showed infiltration of leukemic cells which also had the surface markers of OKT 4-, and OKT 8+. The gingival lesion grew in a deep ulcer with severe bleeding from the mandibular canal. Chemotherapy combined with cyclophosphamide and predonisolone proved effective and the oral lesion was soon reduced. Maintenance chemotherapy with cyclophosphamide, vindesine and OK-432 has been continued and he is still under remission