[New aspects of the clinical course of dermatoses localized in the mouth mucosa and the lips].
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An algorithm has been derived and a computer program based on it developed, which helps to the dentist to carry out fluorescent cytological investigations and make a tentative rapid diagnosis using a PC. The algorithm is based on a simple standard assessment of the cytological preparation. Efficacy of differential diagnosis of labial and buccal cancer and precancer is 91.9 +/- 3.2%.
Bacteriological smears were taken from various regions of the oral cavities of a total of 100 subjects (patients with carcinoma, non-specific ulcer or leucoplakia, and patients without pathological oral findings). The preparations were stained by the Gram procedure and differentiated according to germ count, morphology and ability to combine with dyes. Gram positive cocci prevailed in all groups. The total germ counts were greater in patients with carcinoma than in those with nonspecific ulcer and in normal subjects.
We report the case history of a 60-year-old male caucasian with lichen ruber planus of the oral cavity. After having this condition for 5 years, a medium-grade differentiated squamous cell carcinoma developed on the same side. Since a history of tobacco and alcohol abuse was negative, the Lichen ruber planus was considered to be a precancerous lesion without any other concomitant condition.
Natural changes in oral mucosa are influenced by disturbances of metabolism and many local injuries with the result of various appearances in the surface of the oral cavity in the elderly. There are less acute inflammations but more diseases with chronic inflammation and more degenerative and tumorous alterations. A special problem comes from psychosomatic diseases with their difficulties in diagnoses and therapeutic management.
Although carcinoma cuniculatum clinically appears to be malignant, histological evaluation often results in a false diagnosis of a benign papillomatous lesion or pseudoepitheliomatous hyperplasia, because the tumor usually displays a well differentiated tissue. In this report morphological and immunohistological features in a rare case of carcinoma cuniculatum of the oral cavity are described. Both clinical features and histomorphological evaluation must be taken into consideration when diagnosing the tumor.
Contrary to common opinion the intraepithelial cancer of the buccal mucosa presents clinical symptoms, but they are discreet and different from those observed in an invasive carcinoma. Usually, there is leucoplakia with an erythema and an irregular keratosis or a punctuated one. There is an erythematous variation (Queyrat's erythroplasia) which is without keratinasation. Only histological evidence can confirm the diagnosis cancer. It should be differentiated against Bowen's disease and the light, intermediated and severe dysplasias.
The paper is concerned with analysis of the 5-year recurrence-free survival in 279 patients with cancer of the oral and tongue mucosa. The site, spread, anatomical shape and a method of the treatment of a primary tumor focus and regional metastases were taken into account. The advantage of the proposed method of moving sectorial irradiation was shown because it permitted the delivery of high focal doses (80-60 Gy) to tumors and metastases. The obtained long-term results of gamma-beam therapy were equal to those of the combined radiation method but radiation reactions were less noticeable and radiation injuries were minimum.
Amalgam tattoos develop as an amalgam deposit often as a result of continuous contact between an amalgam filling and the gingiva or amalgam fragments embedded in the oral tissue during dental filling or surgical operations. Sometimes fragments of amalgam restorations are broken off during extraction and embed in the adjacent soft tissue. In our case a small piece of amalgam had broken off during an extraction after retrograde filling up this tooth some years before following a resection of the dental root. Embedded in the depth of the bony resection cavity the piece of amalgam had produced the amalgam tattoo 13 years later.
The authors proposed a new model of dosimetric design of combined gamma-therapy of patients with oral mucosa tumors on the basis of F. Ellis' modified model with account of a therapeutic volume of tissues to be irradiated, and Henschke's model describing a focal dose optimum value in interstitial gamma-therapy as a function of its volume. The proposed model is based on the concept of relative (partial) tolerance which is equal to a ratio of values of a dose delivered to a therapeutic volume to a tolerance dose and differs from the formula of partial tolerance described by Orton and Ellis.
Morphological investigations under experimental conditions have demonstrated that local UHF-hyperthermia at 42-43 degrees C for 30 min does not cause alterative changes of the oral mucosa in animals. The revealed signs of activization of metabolic processes can probably increase radiosensitivity of tumors and their reparation. A favorable course of radiation mucositis was noted after experimental local hyperthermia and irradiation. Morphological changes of the oral mucosa, determined mainly by exposure to radiation, are characterized in the early period by alternative and dystrophic changes, and later on (in 3 mos.) by atrophy and sclerosis. In patients local UHF-hyperthermia had a radiosensitizing effect on the oral mucosa at 40-41,5 degrees C for 30 and 60 min. However it did not prevent the completion of a radical split course in the regimen of dynamic dose fractionation nor did it increase the number of postradiation complications. Under this temperature-time regimen the time of development and a degree of expression of radiation reactions did not depend on the succession of hyperthermia and irradiation, and the time of heating.
The basaloid-squamous carcinoma (BSC) that was first described in 1986 by Wain et al. for the head and neck region is a rare distinct variant of squamous cell carcinoma (SCC). The cardinal histopathologic feature is a biphasic cellular pattern of basaloid and squamous components. BSC has been confused with solid adenoid cystic carcinoma (ACC). Although the number of reported cases is small, BSC appears biologically virulent, with a propensity to aggressive local behavior, early regional and distant metastasis, and subsequent poor survival. We report the clinicopathological characteristics of 4 new cases and compare their immunohistochemical features with those of solid ACC and conventional SCC. Our results show that BSC, ACC and SCC react to CK 5/6. SCC is CK 10- and CK 13-positive, while BSC and ACC are negative for these markers. BSC and ACC react to CK 8, but in ACC only the luminal cells are CK 8 positive: therefore ACC has a glandular pattern. Our findings indicate that the immunohistochemical differences between BSC and ACC can facilitate their differential diagnosis. Because the biologic behavior of BSC differs from ACC and SCC, distinction among these tumor types is warranted.
The present study evaluates and analyzes anamnestic and clinical findings of 100 consecutively referred patients with oral mucosal lesions. The mean age of the cohort was 50.5 years (range 8-91 years) with a female rate of 60 percent. A total of 9 malignant neoplasia were found among the 100 mucosal lesions, including 7 squamous cell carcinomas and 2 mucoepidermoid carcinomas. In addition, 11 cases presented with leukoplakia and 4 cases with lichen planus, both recognized as possible precancerous conditions. These figures support the essential role of the dentist with respect to initial diagnosis and prevention of oral cancer. In addition, stomatologic follow-up examinations are recommended to be performed by each and every general practitioner. In the near future, the dentist will assess oral mucosal lesions more frequently due to the increasing number of elderly patients and to the fact that elderly people present with more lesions compared to younger patients. consistent to literature data, patients with leukoplasia and squamous cell carcinoma had the highest rates of tobacco and alcohol consumption. Therefore, the dentist may also become active in giving preventive information to the patient. the results of the present study showed, that--by employing a standardized examination--a correct clinical diagnosis was identical to the final diagnosis established by laboratory techniques.
Progressive studies in dogs with skin and oral melanomas were undertaken to determine whether or not the WHO-classification of melanomas, which is based mainly on histological criteria, reflects sufficiently the biological behaviour of these tumours. Furthermore, some prognostic parameters, important in the prognosis of human malignant melanomas were tested with respect to their significance for canine melanomas. The paper deals with progressive studies in 182 dogs with surgically treated benign and malignant skin and oral melanomas. Parameters of the biological behaviour were the 2 years death rate and the median survival time. The melanomas were classified according to the recommendations of the WHO. Within 2 years after the first treatment five (5.7%) of 87 dogs with benign skin melanomas, 29 (65.9%) of 44 dogs with malignant skin melanomas and 44 (86.2%) of 55 dogs with malignant oral melanomas were killed because of recurrence or metastases or both. The median survival time of dogs with benign skin melanomas was more than 24 months, with malignant skin melanomas 8 months and with malignant oral melanomas 3 months. In dogs with large malignant skin melanomas the 2 years death rate was 100% with a median survival time of 4 months, whereas animals with small melanomas had a 2 years death rate of 54.3% and a median survival time of 12 months. The site of skin melanomas, sex and histological type of both skin and oral melanomas, however, had no significant influence on the course of the disease. Also, histological parameters, important in the prognosis of human malignant melanoma (rate of mitosis, size of nucleoli, pigmentation and vascular invasion), had no significant influence on the course of the disease.
BACKGROUND: Normal oral mucosa and invasive squamous cell carcinoma of the oral mucosa and the lips were examined immunoenzymatically for different lectin-binding sites and evaluated semiquantitatively. In 110 patients suffering from invasive squamous cell carcinoma of the oral mucosa or the lips, the course of the disease was examined retrospectively with regard to metastases, recurrence and survival time over a minimum of 60 months and was correlated with cell surface binding to lectins (PNA, WGA, UEA I) of the primary tumor. Normal oral mucosa shows intensive cell surface binding to the lectins PNA, WGA and UEA I, but in more than half of the cases the PNA-defined epitopes are blocked by sialic acid. RESULTS: The comparison of the cumulated survival rates showed a much better prognosis for primary tumors with lectin-binding sites than for those without. Strong and medium WGA-binding pT2 tumors showed significantly better survival rates than those pT2 tumors with poor WGA-binding sites. Carcinomas without lectin binding showed the highest recurrence risk in the course of the disease. In squamous cell carcinomas without WGA and UEA I bindings, the period of time before a relapse occurred was significantly shortened. Carcinomas expressing UEA I-binding sites showed a considerably lower metastasis rate than UEA I-negative tumors. Squamous cell carcinomas with complete sialic acid-blocked PNA-binding sites had the same lymph node metastasis rate as those without expression of PNA-specific disaccharides. A significantly lower metastasis rate than both these groups was exhibited by tumors without or with only partially blocked PNA-binding sites. DISCUSSION: In addition to aiding routine grading, the study of PNA-, WGA- and UEA I-binding patterns can therefore provide further information in cases of oral squamous cell carcinoma regarding the potential for metastasis and tumor prognosis.