Case 6: Proliferative verrucous leukoplakia.
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Diagnosis, Differential↗
Biomedical subjects
L R Eversole
Publications and source records attributed to L R Eversole.
Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients.
Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.
AIDS-Related Opportunistic Infections↗
Cause of oral ulcers in HIV-infected patients: a study of 19 cases.
OBJECTIVES: To study the cause and clinical aspects of oral ulcers in HIV-infected patients. STUDY DESIGN: Forty-one consecutive HIV-positive patients with long-standing oral ulcers were examined; 19 were evaluated by biopsy. From these 19 cases, viral, bacterial, and fungal cultures and biopsies were taken in each patient. When indicated, special microbial stains were undertaken to identify bacteria or fungi. Ten cases without granulomatous bacterial fungal or lymphomatous features were available for in situ hybridization to detect viral DNA of herpes simplex virus 1 and 2, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus. RESULTS: Most of the oral ulcers occurred in patients with severe immunodepression. Median CD4 T-lymphocyte count was 60 cell/mm3 (range, 3 to 335). It was ascertained that nine (47%) patients had nonspecific aphthous-like ulcers, and ulcers caused by herpes group viruses were identified in six (31.5%) patients. One (5%) person was diagnosed with non-Hodgkin's lymphoma; and in one (5%) patient, multiple ulcers were an expression of lues maligna. Two ulcers (10.5%) in the palate harbored mycotic granulomatous foci (cryptococcosis, histoplasmosis). In this population, almost all of these ulcers were found to be large, persistent, and painful. CONCLUSIONS: Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers because either infection or a neoplastic process may be extant. In the absence of infection or neoplasm, such lesions are then designated as ulcers not otherwise specified.
AIDS-Related Opportunistic Infections↗
Effects of an erbium, chromium: yttrium, scandium, gallium, garnet laser on mucocutanous soft tissues.
OBJECTIVES: Lasers are effective tools for soft tissue surgery. The erbium, chromium: yttrium, scandium, gallium, garnet laser is a new system that incorporates an air-water spray. This study evaluates the cutting margins of this laser and compares healing with laser and conventional scalpel and punch biopsy-induced wounds. STUDY DESIGN: New Zealand white rabbits were divided into serial sacrifice groups; the tissues were grossly and microscopically analyzed after laser and convential steel surgical wounding. RESULTS: Wound margins were found to show minimal edge coagulation artifact and were 20 to 40 mm in width. Laser wounds showed minimal to no hemorrhage and re-epithelialization and collagenization were found to occur by day 7 in both laser and conventional groups. CONCLUSIONS: The new laser system is an effective soft tissue surgical device; wound healing is comparable to that associated with surgical steel wounds. The minimal edge artifact observed with this laser system should allow for the procurement of diagnostic biopsy specimens.
Aluminum Silicates↗
Oral lichen planus and its association with squamous cell carcinoma: an update on pathogenesis and treatment implications.
Lichen planus of the oral mucosa (OLP) is characterized by lymphocytic mucositis, basal cell lysis, and lymphocyte transmigration into the epithelial compartment. Some reports have suggested a high incidence of oral squamous cell carcinoma (OSCCA) in OLP patients and have implicated OLP as a premalignant lesion. We describe five cases of OSCCA arising in patients with preexisting OLP. At our institution, the incidence of OSCCA in patients with OLP approximates that reported in other series. The immunopathologic basis for OLP, its potential association with malignancy, and the variable clinical picture of OSCCA in patients with OLP are reviewed. Specific recommendations are given for treatment and follow-up of lesions, including the role of future testing with viral and oncogene markers.
Aged↗
Histopathology of idiopathic chronic recurrent vertigo.
Vestibular neuritis is a degenerative neuropathy of the peripheral vestibular system. The etiology of this condition is uncertain, although it is generally believed to be viral. A small percentage of patients with vestibular neuritis have chronic recurrent episodes of vertigo. Detailed cytologic descriptions of acute or chronic vestibular neuritis are lacking, and no previous studies have reported evidence of chronic inflammation in human temporal bone specimens. The authors of this study examined temporal bone specimens from three patients with a history of chronic recurrent vertigo of unknown cause. Varying degrees of inflammation and destruction were seen in the vestibular system, and mild involvement of the cochlear system was noted. These findings are consistent with postinfectious inflammatory changes of the cochlear-vestibular system analogous to a postinfectious syndrome involving the central nervous system.
Cochlear Nerve↗
Adhesion molecules and oral mucosal diseases.
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Acantholysis↗
Clear cell odontogenic carcinoma. A clinicopathologic analysis.
Clear cell odontogenic tumor is a rare neoplasm of the jaws that histologically may be confused with metastatic renal cell carcinoma. A review of 17 cases revealed that these tumors are aggressive, with a tendency to recur locally after surgery; they also may metastasize both regionally and distantly. There is a marked female predilection, and most cases are discovered during the fifth to seventh decades of life. Seventy percent occur in the mandible, appearing as poorly marginated radiolucencies. We conclude that this tumor is malignant and should be referred to as clear cell odontogenic carcinoma; it requires an aggressive surgical approach.
Adenocarcinoma, Clear Cell↗
Preliminary investigations on the utility of an erbium, chromium YSGG laser.
A variety of laser systems are under investigation as potential tools in dentistry. Most of these systems have been shown to be efficacious for soft tissue surgery of the mucous membranes; however, cutting bone and dental hard tissues has only recently been possible. In this report from the University of California at Los Angeles School of Dentistry, a review of laser applications in dentistry is discussed. The utility of a new laser system using an erbium YSGG medium with air water spray to cut soft tissues, bone, enamel and dentin is under investigation and preliminary research findings are presented.
Animals↗
Immunopathology of oral mucosal ulcerative, desquamative, and bullous diseases. Selective review of the literature.
Cell/cell and cell/matrix adhesion proteins are responsible for maintaining the integrity of the mucosal lining of the oral cavity. Disease processes that destroy keratinocytes or adversely affect their adhesion to one another or to the subjacent basement membrane will result in erosions, ulcerations, and desquamations. Immunologic processes that have a deleterious effect on the integrity of the epithelial/basement membrane/submucosa complex are reviewed, and current research findings with respect to pathogenesis are discussed. In particular, T-cell-mediated hypersensitivity is involved in recurrent aphthous stomatitis and lichen planus; humoral-mediated immunity to cadherin intercellular adhesion molecules is important in the process of acantholysis in pemphigus vulgaris, and genetic defects and antibody-mediated processes give rise to junctional separation in epidermolysis bullosa and mucous membrane pemphigoid, respectively. An immune complex mechanism appears to underlie the pathogenesis of erythema multiforme.
Autoantibodies↗
The effects of human immunodeficiency virus infection on macrophage phagocytosis of Candida.
The effects of infection by human immunodeficiency virus (HIV) on phagocytic function towards Candida pseudotropicalis were tested using monocytotropic and nonmonocytotropic HIV strains on peripheral blood monocytes. There were no differences in either quantitative phagocytic activity or efficacy between the two infected and control mock-infected monocytes. Immunofluorescence for cytoplasmic p24 antigen and in situ hybridization for detection of HIV-specific RNA sequences revealed that very few cells (10(-4)) exhibit productive infection. Occasional cells with active infection as defined by microscopically detectable fluorescence labelling contained phagocytized yeasts.
AIDS-Related Opportunistic Infections↗
Leukocyte adhesion molecules in oral lichen planus: a T cell-mediated immunopathologic process.
Oral lichen planus exhibits features of a mucosal type IV immunopathologic process. Adhesion molecules involved in the trafficking and homing of T lymphocytes to the subepithelial compartment were assessed by immunohistochemical methods. Laminin, type IV collagen and type VII collagen extracellular matrix components at the epithelial-connective tissue junction are significantly increased and serve as ligands for beta 1 integrins on lymphocyte membranes. Endothelial-associated intercellular adhesion molecule 1 and extracellular matrix basement membrane components are also significantly increased in the submucosa. Keratinocyte expression of major histocompatibility complex class II molecules and intercellular adhesion molecule 1 may serve as ligands for lymphocyte T cell receptor complex and beta 2 integrins, respectively. These adhesion molecules are probably involved in the trafficking of lymphocytes to the epithelial connective tissue interface in response to as of yet undefined antigens.
Analysis of Variance↗
Papillary squamous neoplasms of the head and neck.
Papillary squamous neoplasms of the upper respiratory tract are rare variants of squamous cell carcinoma and are related temporally to proliferative verrucous leukoplakia. Fifty-two cases of papillary squamous neoplasms were selected from 2366 cases of squamous cell carcinoma. This is the first study to characterize the biological behavior of papillary squamous neoplasms. Papillary squamous neoplasms exhibit two distinct, yet sometimes overlapping, histologic patterns including an exophytic papillary and an inverting verrucous morphologic appearance. A high rate of synchronous or metachronous lesions were found, especially with the inverting-type of papillary squamous neoplasm. Stage T3 and T4 lesions had a high rate of neck metastasis. Early surgical intervention and close long-term follow-up is mandatory.
Adult↗
Inflammatory diseases of the mucous membranes. Part 1. Viral and fungal infections.
With the advent of modern molecular biology and advances in immunology, the pathogenesis of oral mucosal disease processes has become significantly more clear, allowing reliable diagnostic criteria and more precisely targeted management strategies. This paper reviews current findings relative to pathogenesis, diagnosis and treatment of viral and fungal infections of the oral mucous membranes.
Candidiasis, Oral↗
Inflammatory diseases of the mucous membranes. Part 2. Immunopathologic ulcerative and desquamative diseases.
Bullous and desquamative diseases of the oral mucosa are not common, with the exception of ulcerative lichen planus. All produce mild to severe mucosal pain and some can be life-threatening. Recent studies have helped elucidate the pathogenesis of immunopathologic diseases, although the precise etiology for most of them remains unknown. Minor and major aphthae, lichen planus, pemphigoid, pemphigus and erythema multiforme are discussed.
Diagnosis, Differential↗
Immunohistochemical mapping of epidermal growth-factor receptors in normal human oral soft tissue.
Epidermal growth-factor receptor (EGF-r) has been identified on basilar cells of stratified squamous epithelia and skin adnexa in man. Recent studies have mapped EGF-r to various oral cells in animals; however, complete mapping of EGF-r in normal human oral mucosa has not been done. Normal tissues from eight sites in human oral mucosa were examined for their expression of EGF-r using avidin-biotin peroxidase complex with mouse anti-EGF-r monoclonal antibody. Immunoreactivity was detected in palatal gingiva, buccal gingiva, soft palate, lateral tongue, dorsal tongue and floor of the mouth. The connective tissues of the periodontal ligament and dental pulp were non-reactive. EGF is known to exist in most body fluids, particularly saliva. In normal human mucosa, EGF is localized to connective tissue subjacent to epithelium. With the receptor in the overlying epithelium, a possible epithelial-mesenchymal interaction may exist between the receptor and ligand. A paracrine mode of action may be postulated, functioning to regulate the complex biological functions of the human oral tissues.
Antibodies, Monoclonal↗
White lichenoid lesions of the buccal mucosa in patients with HIV infection.
We report on eight patients who developed white lichenoid lesions of the buccal mucosa during the course of human immunodeficiency virus infection. In five patients the lesions appeared after the administration of zidovudine, in two after the intake of both zidovudine and ketoconazole, and in one after ketoconazole. In the majority of cases, lesions presented as bilateral reticular keratosis or atrophic changes of the buccal mucosa. Three patients manifested lichenoid atrophic changes of the dorsum of the tongue. The histopathologic features were hyperkeratosis, epithelial atrophy, basal cell liquefaction, and the presence in the lamina propria of either a patchy or diffuse lymphocytic infiltrate. All specimens tested negative for Epstein-Barr virus and human papillomavirus. Our study suggests that lichenoid lesions of the buccal mucosa, similar to what has been described as lichenoid drug reactions or idiopathic lichen planus, can be observed during human immunodeficiency virus infection and that administration of zidovudine and ketoconazole should be considered as a possible cause.
Adult↗