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We present a case of a 50-year-old patient suffering from anemia (Hb 8.6 g/dL), thrombocytopenia (PLT 99000 U/uL) and leukocytosis (WBC 71200 U / uL, with neutrophils 16530 U/L and monocytes 28050 U/uL), reporting recent onset of fever, fatigue and general malaise. Marrow aspiration is performed, where immunophenotypic test found the presence of two cell clusters: a component of 35.9% of cells CD13+, CD38+, CD33+, CD45RA±, HLA-DR+, CD123±, CD200+, MPO+, CD34+, CD117+ and the other monocyte component equal to 24.2% with phenotype CD4+, CD14+, CD33+, CD36+, CD38+, HLA-DR+, CD45RA+, MPO± and Lys+, but CD34 and CD117-. There was FLT-3 ITD mutation (allelic ratio 0.6), while NPM1 was not mutated. Acute myelomonocytic leukemia (formerly known as AML-M4, according to the FAB classification) was diagnosed. On general physical examination, a peculiar and highly developed gingival hypertrophy was found, as seen in Figure 1. This is a very interesting finding, due to tissue infiltration by the disease, that can rarely characterize this type of acute leukemia and could guide the physician in clinical suspicion.