Leukemia is a type of blood cancer that begins in the bone marrow and is characterized by an abnormal increase in white blood cells. The exact cause is unknown but genetic factors, infections, and environmental exposures are associated with increased risk. Leukemia is classified as either acute or chronic and as affecting myeloid or lymphoid cells. Common symptoms include fatigue, fever, easy bruising and bleeding. Treatment involves chemotherapy, radiation therapy, stem cell transplants or splenectomy depending on the classification and severity.

1. LEUKEMIA
JAHNAVI YADAV
Dept of Oral Pathology

2. CONTENTS
Introduction And Definition
Etiology and Risk Factors
Classification
Treatment
Reference

3. INTRODUCTION
• Leukemia is a type of blood cancer
that begins in the bone marrow.
Leukemia is a malignant disorders
of hematopoietic stem cells
characteristically associated with increase
number of white cells in bone
marrow/peripheral blood.
{Davidson’s Principles and
Practice of Medicine, 21st edition}

4. ETIOLOGY AND RISK FACTORS
The exact cause is unknown.
Several factors are associated with leukemia
Include:
1. Genetic factors
2. Infections
3. Environmental factors

5. CLASSIFICATION
ACUTE CHRONIC
AML
(Acute
Myeloblastic
Leukemia)
ALL
(Acute
Lymphoblastic
Leukemia)
CML
(Chronic
Myelocytic
Leukemia)
CLL
(Chronic
Lymphocytic
Leukemia)
LEUKEMIA
• AML with certain genetic
abnormalities.
• AML with multilineage
dysplasia
• AML related to previous
chemotherapy or radiation
• AML otherwise not specified
M0- AML minimally differentiated
M1- AML w/o Maturation
M2-AML with Maturation
M3- Acute promyelocytic leukemia
M4- Acute myelomonocytic leukemia
M5- Acute monocytic leukemia
M6- Acute erythroid leukemia
M7-Acute megakaryoblastic leukemia
• L1- Small
Homogenous
Cells
(childhood
ALL)
• L2- Large
Heterogenou
s Cells (seen
in Adults)
• L3- Burkitt’s
lymphoma
• Common
B Cell
• Rare T
Cell
• Philadelphia
chromosome positive
• Philadelphia
chromosome negative
• Eosinophilic Leukemia

6. ACUTE LEUKEMIA
Differentiation
Self Renewal is maintained
or increased
Apoptosis Proliferation is
increased
Proliferation
and survival of
cells leads to
accumulation of
undifferentiated
cells.

7. ACUTE MYELOID LEUKEMIA
• Most common in adults.
• Peak incidence after 60 years.
• Minor fraction of leukemia in childhood(10-15%)
• Blast cells and Auer Rods seen in peripheral
blood smear.
• Periodic Acid Schiff Stain (PAS) – positive
• Peroxidase and Sudan Black B - negative

8. ACUTE LYMPHOID LEUKEMIA
• Acute Lymphoblastic Leukemia are neoplasm composed of immature B or T
cells.
• Occurs primarily in children between age group of 2-10 years.
• Blasts cells on peripheral blood smear.
• Auer rods absent.
• PAS -negative.
• Peroxidase and Sudan black B –positive.

9. CHRONIC MYELOCYTIC LEUKEMIA
• By WHO definition, CML is established by identification of the clone of
hematopoietic stem cell that possesses the balanced reciprocal translocation
between chromosomes 9 and 22, forming Philadelphia chromosomes.
Ref. Harsh Mohan Textbook Of Pathology, 7th Edition
• Commonly seen in Elderly Population and has male predominance of 2:1
• Etiology is unknown.

10. CHRONIC LYMPHOCYTIC LEUKEMIA
• Neoplastic disorder characterized by monoclonal proliferation of
immunologically incompetent, slowly dividing, mature B-lymphocytes.
Ref. Harsh Mohan Textbook Of Pathology, 7th Edition
• CLL is the most common form of leukemia of adults in Europe and the USA.
• Male: Female= 2:1

11. SYMPTOMS

12. ORAL MANIFESTATIONS
• Gingival Bleeding
• Gingival Hypertrophy
• Jaw Pain
• Exudation from gingivae
• Spontaneous hemorrhage
• Nonspecific ulcerations
• Loose teeth
• Halitosis
• Lymphadenopathy

13. LAB DIAGNOSIS
• Haemoglobin– Low (Anemia-Normocytic)
• Platelet- Low (Thrombocytopenia-below 50,000/ul)
• WBC- Markedly HIGH (50,000-1,00,000/cmm)
• Blood film shows large no of blast cells
• Bone Marrow- Reduced erythropoiesis & hypercellularity
• Periodic acid-Schiff stain is positive in AML.
• Sudan Black B and Myeloperoxidase is positive in ALL.

14. TREATMENT
Chemotherapy Radiation
therapy
Stem Cell
Transplant
Splenectomy

15. REFERENCE
• Harsh Mohan Textbook Of Pathology, 7th Edition
• Shafer's Textbook of Oral Pathology, 8th Edition
• Textbook of Clinical Medicine, 4th Edition
• Davidson’s Principles and Practice of Medicine, 21st edition