Zoon's (plasma-cell) balanitis: treatment by circumcision.
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Aged↗
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Studies on pure red cell aplasia. Maintenance therapy with immunosuppressive drugs.
Two patients with pure red cell aplasia, whose marrow cells were capable of increasing their rate of haem synthesis when incubated in vitro with erythropoietin concentrate, had a complete remission associated with the administration of cyclophosphamide and prednisone. Both patients relapsed when the drugs were withdrawn. The patients again went into remission when therapy was reinstituted. Maintenance of normal erythropoiesis was dependent on the continued administration of these drugs. This study provides additional evidence for a causal relationship between immunosuppressive therapy and the resumption of erythropoiesis in patients with this disease and demonstrates the value of this therapy for the maintenance of a remission.
Adult↗
Balanitis of Zoon.
A patient with an eruption of clinical and histologic features typical of plasma cell orificial mucositis of the glans penis is reported. Immunohistologically, IgE and IgG are found to be major immunoglobulin classes in the plasma cellular infiltrate. Although specific allergen has not been identified yet, the present findings suggest that this condition is not a nonspecific inflammatory response but is related to immediate hypersensitivity.
Aged↗
Skin tumor conference number 5. Erythematous plaque of the penis.
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Erythroplasia↗
Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization.
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Adolescent↗
A national epidemiological survey of oral mucosal lesions in Malaysia.
The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11,707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication, was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92%. The age in the sample ranged from 25 to 115 years with a mean of 44.5+/-14.0. The sample comprised 40.2% males and 59.8% females; 55.8% were Malays, 29.4% Chinese, 10.0% Indians and 1.2% other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7%) subjects, 5 (0.04%) had oral cancer, 165 (1.4%) had lesions or conditions that may be precancerous (leukoplakia, erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6%) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0%) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5%) while the lowest prevalence was amongst the Chinese (0.5%).
Adult↗
Thymidine kinase activity in human bone marrow cells.
The thymidine kinase activity per 10(6) DNA-synthesising marrow cells and the rate of incorporation of tritiated thymidine into the DNA of 10(3) DNA-synthesising marrow cells were estimated in 9 haematologically normal patients and 49 patients suffering from a variety of haematological disorders. Slight increases in thymidine kinase activity were found in 6 of the 31 patients with haematological diseases associated with normoblastic erythropoiesis and greater increases were found in 3 of the 18 patients with megaloblastic haemopoiesis due to vitamin B12 or folate deficiency. In the latter group, there was a statistically significant inverse correlation between haemoglobin levels and thymidine kinase activity. No correlation was found between thymidine kinase activity and the rate of incorporation of tritiated thymidine in either the normoblastic or megaloblastic group, suggesting that the level of thymidine kinase activity does not limit the rate of incorporation of exogenously supplied thymidine into the DNA of human bone marrow cells.
Anemia, Hypochromic↗
Correlative clinico-pathological evaluation of oral premalignancy.
In 1972, the World Health Organization's "Meeting of Investigators on the Histological Definitions in Precancerous Lesions" defined a precancerous lesion as a "morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counter part" (Pindborg 1980). There are two generally accepted precancerous lesions in the oral cavity, leukoplakia and erythroplakia (Pindborg 1980). Leukoplakia is currently defined as "a white patch or plaque that cannot be characterized clinically or pathologically as any other disease" (WHO 1978). This definition has no histological connotation and is used in a strictly clinical sense (Pindborg 1980, Banoczy 1977). Erythroplakia is defined as a "bright red velvety plaque which cannot be characterized clinically or pathologically as being due to any other condition" (Pindborg 1980).
Diagnosis, Differential↗
Malignant development of lichen planus-affected oral mucosa.
The present report describes malignant development in oral lichen planus (OLP) among 611 patients (409 F, 202 M) followed for periods from 1-26 years (mean: 7.5). During follow-up, 9 patients (1.5%), 8 women (1.9%) and 1 man (0.5%) developed oral squamous cell carcinomas (SCC) in areas of lichen planus lesions. The age of the patients at diagnosis of carcinoma ranged from 56-79 years (mean: 70.4) and the length of follow-up before malignant development ranged from 4.9-24 years (mean: 10.1). The estimated number expected to develop oral cancer in a sample of the general Danish population of similar size, age distribution and follow-up was 0.18 (0.11 F, 0.07 M) i.e., OLP cases showed a 50-fold increase (F = 70- M = 14-fold). The observed number of cancer cases was significantly higher than the estimated number (p less than 0.00001). Therefore, oral lichen planus fulfils the WHO criterion of a premalignant condition.
Aged↗
Expression of mucin type carbohydrates may supplement histologic diagnosis in oral premalignant lesions.
Recent studies have shown that changes within membrane bound carbohydrates may be essential for cellular differentiation and malignant transformation. We have therefore, by means of immunohistochemistry, studied the expression of T/Tn related (Thomsen-Friedenrich) carbohydrates in 13 oral lesions with squamous cell dysplasia. The epithelial grade of dysplasia was graded as mild, moderate or severe. The following carbohydrate structures were studied: Tn, T, mucintype 3 chain H, and the sialylated derivates, sialosyl-Tn and sialosyl-T. In general, short structures were detected on the basal cells and longer structures on the more mature spinous cells. In many cases, this sequential expression was more disturbed with increasing grade of epithelial dysplasia. However, our results also showed that some lesions with the same grade of epithelial dysplasia showed different carbohydrate expression. These findings indicate that expression of carbohydrates may supplement histologic diagnosis in the evaluation of the prognosis of premalignant lesions.
Antigens, Surface↗
Oral white lesions with special reference to precancerous and tobacco- related lesions: conclusions of an international symposium held in Uppsala, Sweden, May 18-21 1994. International Collaborative Group on Oral White Lesions.
An international group of epidemiologists, clinicians and pathologists with a special interest in oral white lesions and their precancerous significance has reviewed earlier work on this topic and identified some of the problems associated with previous definitions, descriptions and classifications. Modifications to these definitions, descriptions and classifications have been proposed, accompanied by explanations of the reasons for identifying the need for changes to be made. Leukoplakia may be a provisional or definitive diagnosis dependent upon the circumstances of oral examination and the availability of other information. Guidelines are provided to assist in the application of the definitions of oral leukoplakia and illustrations depict the homogeneous and non-homogeneous clinical variants. Consideration is also given to the importance of a red component in a white lesion, or a lesion that is entirely red (erythroplakia). A new clinical staging procedure for oral leukoplakia is also proposed.
Erythroplasia↗
Sensitivity and specificity of OraScan (R) toluidine blue mouthrinse in the detection of oral cancer and precancer.
The efficacy of 1% toluidine blue in the identification of oral malignancies and potentially malignant oral lesions was evaluated among a group of Asian patients (n = 102) with undiagnosed oral mucosal lesions and conditions (n = 145). The trial, utilising a ready-to-use kit, was controlled by histopathologic evaluation of a total of 87 dye-retained or dye-negative lesions. Eighteen oral carcinomas all retained the dye and there were no false negatives, yielding a test sensitivity of 100%. Eight of 39 oral epithelial dysplasias were toluidine blue-negative, giving a false negative rate of 20.5% and a sensitivity of 79.5% for oral epithelial dysplasias. The specificity of the technique was low (62%). Five dysplastic lesions were detected solely by the kit and this suggests that the method is valuable for surveillance of high-risk subjects in addition to its remarkable sensitivity in the detection of invasive carcinoma.
Asia↗
Cytologic and DNA-cytometric very early diagnosis of oral cancer.
BACKGROUND: The aim of this study was to evaluate the diagnostic accuracy of exfoliative cytology (EC) and DNA-image cytometry applied to suspicious oral lesions compared with synchronous histology. METHODS: Brush- and scalpel biopsies were obtained from 98 patients with suspicious oral lesions. In cases, in which EC revealed malignant or suspicious cells, nuclear DNA-contents were measured using a TV image analysis system. RESULTS: Among 98 oral lesions both cytological and histological diagnosis showed no sign of malignancy or dysplasia in 75. In 23 cases cytology yielded tumor cell-positive (15), suspicious (four) or doubtful (four) results. DNA-cytometry showed aneuploidy in 19 of these. The comparison between cytological diagnosis combined with DNA-cytometry and biopsy-histology resulted in a sensitivity of 100% and a specificity of 97.4%. CONCLUSION: In conclusion, cytology with DNA-cytometry is a highly sensitive, specific and non-invasive method for the early diagnosis of oral epithelial neoplasia, showing excellent compliance among patients.
Adult↗
Oral precancerous disorders associated with areca quid chewing, smoking, and alcohol drinking in southern Taiwan.
OBJECTIVE: To investigate the prevalence and the associated risk factors of oral precancerous disorders in southern Taiwan. METHODS: We conducted a cross-sectional community survey interviewing 1075 adult subjects, 15 years of age and over, gathered from randomly selected 591 households, and spanning five villages in southern Taiwan. The study protocol included a visual oral soft tissue examination and a questionnaire-based interview. The chi-square test was used to test the differences in prevalence of oral precancerous lesions and conditions by different "life styles" relating to current risk habits of current areca quid chewing, smoking, and alcohol drinking. To control for possible confounding, a logistic regression model was used to estimate the Odds Ratios (OR) for leukoplakia and oral submucous fibrosis (OSF). RESULTS: 136 precancerous lesions and conditions were detected among 1075 subjects (12.7%). The analysis of the spectrum of oral precancerous disorders detected, leukoplakia (n = 80), OSF (n = 17) and verrucous lesions (n = 9), demonstrated an association with gender (P < 0.001). There were statistically significant associations among leukoplakia (P < 0.01), OSF (P < 0.0001), and verrucous lesions (P < 0.0001) and the life style of current areca quid chewing, smoking, and alcohol drinking. The synergistic effect of smoking and areca quid chewing habit on leukoplakia and OSF was demonstrated. CONCLUSION: This study reinforces the association of current areca quid chewing without tobacco, cigarette smoking, and alcohol drinking to leukoplakia, OSF, and verrucous lesions in Taiwan.
Adolescent↗
Very early cytological and DNA-cytometric diagnosis of in situ carcinoma in an immunosuppressed liver transplant recipient.
BACKGROUND: We describe a patient with an in situ carcinoma with the clinical presentation of an erythroplakia of the tongue in an area where DNA-aneuploidy was detected by means of exfoliative cytology (EC) and DNA-image-cytometry 32 months before. METHODS: Brush- and scalpel biopsies were obtained from a suspicious lesion of the right border of the tongue prior to scalpel biopsy. After Feulgen restaining of the specimens on glass slides, nuclear DNA-contents were measured using a TV image analysis system. RESULTS: A small reddish lesion of the tongue was diagnosed as malignant through EC and DNA-image-cytometry, whereas the synchronous histology from the same area showed only mild dysplasia. A subsequent scalpel biopsy 32 months after the first examination showed an in situ carcinoma. CONCLUSIONS: Non-invasive brush biopsies are of great importance for the very early identification of mucosal areas with a high risk for malignant transformation through cytological and DNA-cytometric examination.
Aneuploidy↗
Oral cancer and pre-cancer in Myanmar: a short review.
Cancer in Myanmar is one of the 10 leading causes of morbidity and mortality. In 1974, the Yangon Cancer Registry was established. From 1974 to 2001 a total of 85 298 cancer cases were registered. From 1963 to 1972 the average annual incidence rate of oral cancer was calculated to be 363 per 100 000 population. The tongue was mostly affected (31.2%). In one study, the prevalence of oral leukoplakia was 1.7%, erythroplakia 0.1%, and submucous fibrosis 0.1%. No epidemiologic studies of the prevalence of betel quid chewing (BQC) in Myanmar have been performed. One study showed that among 773 individuals over the age of 6 years, 46.4% were habitual smokers. A recent symposium on oral health stressed the necessity to introduce concepts of prevention, focusing on BQC habits and smoking as high-risk factors for oral cancer and pre-cancer in Myanmar.
Areca↗
Effective management of smoking in an oral dysplasia clinic in London.
BACKGROUND: Precancerous lesions precede the development of oral cancer; of several clinical types the most common is leukoplakia. The risk factors include tobacco and excess alcohol use and diets low in antioxidants. Studies concerning the management of risk factors related to oral precancer are meager. OBJECTIVES: We investigated the effectiveness of smoking cessation at a dysplasia clinic among patients followed up for at least for 12 months. METHODS: Data from case notes relating to 180 patients with white and red patches of oral mucosa (excluding other benign disorders confirmed by biopsy findings) attending a dysplasia clinic at a teaching hospital in London and seen by one consultant between 1993 and 2003 were transcribed. Effect of referring to a smoker's clinic to receive specialist help was evaluated against brief advice given at the dysplasia clinic +/- medications. RESULTS: The mean age at the first visit was 48.5 years (+/-12.5), 65% were male, and 88% were white European. One hundred and sixty-two patients (90%) had used tobacco and 83% were current smokers. Of the smokers 95% had smoked over 10 years, the majority smoking over 10 cigarettes per day. Nine were alcohol misusers including two binge drinkers. One hundred and forty-six were diagnosed with oral leukoplakia, 16 with non-homogeneous types (speckled or nodular). Three patients were diagnosed with an erythroplakia. Nineteen per cent exhibited the presence of dysplasia and one subject had in situ carcinoma. Five patients in the sample quit smoking prior to arrival in the dysplasia clinic. Twenty-seven cases (20%) with oral leukoplakia quit smoking while registered as a patient at the dysplasia clinic: 17 of 100 subjects quit with brief advice +/- medications and 10 of 30 following referral to the smoker's clinic. The difference between the two groups was significant for point prevalence abstinence at the last visit to the clinic (minimum 12 months follow up). Out of a total of 180 precancer cases managed in the dysplasia clinic (mean follow up 4.2 years) three patients subsequently developed invasive carcinoma during follow up. CONCLUSIONS: Smoking cessation needs to be an integral component of management of cases attending a dysplasia clinic and referring to smoker's clinics could help to improve the effectiveness of managing patients with oral precancer to quit smoking.
Cancer Care Facilities↗
Staining patterns of human pre-malignant oral epithelium and squamous cell carcinomas by monoclonal anti-keratin antibodies.
Formalin-fixed, paraffin-embedded biopsies of metaplastic keratinized oral mucosa (fibromas and leukoplakias), oral mucosa with epithelial dysplasia and oral squamous cell carcinomas were stained with two monoclonal anti-keratin antibodies (AE1 and AE2). Intense suprabasal staining was seen with AE1 in metaplastic keratinized epithelium, whereas staining of adjacent normal unkeratinized epithelium generally was restricted to basal cells. In dysplastic epithelium and squamous cell carcinomas, staining with AE1 revealed a highly disturbed anti-keratin staining pattern. AE2 stained metaplastic keratinized epithelium in a suprabasal pattern but adjacent unkeratinized epithelium did not stain. In dysplastic epithelium and squamous cell carcinomas, AE2 staining was variable and sometimes absent. Further studies are indicated to clarify whether changes in anti-keratin staining patterns can be used for diagnostic and prognostic purposes.
Antibodies, Monoclonal↗