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PERIO - Periodontal Practice Today
PERIO - Periodontal Practice Today 4 (2007), No. 1     9. Mar. 2007
PERIO - Periodontal Practice Today 4 (2007), No. 1  (09.03.2007)

Page 37-40

Necrotising gingivitis as a manifestation of Richter syndrome
Rudralingam, Meenakshi / McCracken, Giles I. / Nolan, Anita / Heasman, Peter A.
Methods: Histological staining with haematoxylin and eosin of a gingival biopsy of the intra-oral lesion revealed diffuse sheets of malignant cells, which were confirmed as being lymphoid cells of B cell lineage Newcastle University using immunostain with CD20 marker. The Ki67 proliferation fraction was about 50%, which supported a diagnosis of a high-grade lymphoma, and the overall features confirmed a diagnosis of a diffuse, large B-cell lymphoma.
Results: Periodontal treatment was largely ineffective but the introduction of a CHOP-R chemotherapy regime resulted in dramatic and instantaneous resolution of the oral ulceration and associated symptoms.
Conclusions: The report demonstrates that the clinical signs of gingival ulceration and necrosis can, albeit rarely, represent a manifestation of an underlying, insidious general pathology which in this instance, transformed into a diffuse, large B-cell lymphoma.

Keywords: necrotising gingivitis, Richter syndrome