PMC5674499_01
(a) Intraoral view of the patient after extraction of teeth with severe mobility, prior to initiation of chemotherapy. Extensive gingival lesions are observed on the palatal surface of the maxilla. (b) Intraoral view of the patient after extraction of teeth with severe mobility, prior to initiation of chemotherapy. Diffuse, erythematous, and ulcerated gingival hyperplasia is observed in the mandible. (c) Panoramic radiograph of the patient at initial presentation. Generalized alveolar bone loss is observed. (d) Axial sections of the computed tomography scan obtained at initial presentation. Diffuse involvement of both maxilla and the mandible is observed.
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Intraoral examination revealed generalized gingival hyperplasia with a greater severity in the palatal region (Figure 1(a)). The gingival enlargement was sessile, soft in consistency, and red in colour with ulcerated surfaces covered by a necrotic slough (Figure 1(b)). Widespread alveolar bone loss consistent with severe teeth mobility was detected on the orthopantomogram (Figure 1(c)). Further radiological examination of the patient with computed tomography scan revealed multiple alveolar lesions with poorly defined and invasive margins (Figure 1(d)).
Infiltration of the edematous stroma by polygonal cells with eosinophilic cytoplasm, oval nuclei with longitudinal grooves resembling coffee beans named as Langerhans cells, and eosinophils are observed. (a) Haematoxylin and eosin, x200 magnification. (b) Haematoxylin and eosin, x400 magnification. (c) Langerhans cells were highlighted immunohistochemically by S-100, x200 magnification. (d) Langerhans cells were highlighted immunohistochemically by CD1a, x200 magnification.
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Langerhans cells with nuclear grooves accompanied by eosinophils and lymphocytic infiltration (Figures 2(a) and 2(b)). LCs were immunopositive with S-100 and CD1a (Figures 2(c) and 2(d)).
(a) Intraoral view of the patient 12 months after initiation of chemotherapy. Significant regression of gingival lesions is observed on the palatal surface of the maxilla. (b) Intraoral view of the patient 12 months after initiation of chemotherapy. Significant regression of gingival lesions is observed in the mandible. (c) Panoramic radiograph of the patient 12 months after initiation of chemotherapy. Periradicular bone levels of the remaining teeth are maintained except for mandibular left premolar and molar teeth, around which minimal progression of the alveolar bone loss is observed.
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Regression of gingival lesions, significant decrease in mobility of the remaining teeth, and severity of pain were noted at 12-month follow-up after initiation of chemotherapy (Figures 3(a) and 3(b)). Radiological examination revealed no progression in alveolar bone loss, except for mandibular left premolar and molar teeth, around which periradicular bone loss minimally progressed since the initial presentation (Figure 3(c)).