口腔颌面部嗜酸性淋巴肉芽肿的临床病理研究

目的：探讨口腔颌面部嗜酸性淋巴肉芽肿（Kimura病）的临床病理学特征。方法：对武汉大学口腔医院诊治的28例口腔颌面部嗜酸性淋巴肉芽肿病例资料。分别从患者性别、发病年龄、临床表现、发病部位、实验室检查及组织病理学等方面进行回顾性分析。应用免疫组织化学方法行同种异体移植炎症因子（allografl inflammatory factor-1，AIF-1）染色。28例患者中，男性19例，女性9例，中位年龄40岁。结果：此28例嗜酸性淋巴肉芽肿患者以腮腺区为多发部位。主要临床表现为皮下单发或多发性结节样肿块。外周血嗜酸性粒细胞计数平均为9％。组织病理学表现为淋巴组织增生并形成淋巴滤泡。内含活跃的生发中心，滤泡间可见大量增生的毛细血管后微静脉型血管；血管周围及滤泡间大量的嗜酸性粒细胞浸润并形成散在的嗜酸性微脓疡。免疫组织化学检测28例标本淋巴滤泡的生发中心AIF-1染色阳性。结论：嗜酸性淋巴肉芽肿是一种具有较明显临床及病理学特征的慢性炎症性疾病，免疫调节异常是其可能发病机制。     

天疱疮治疗的探讨

天疱疮(pemphigus)是一种可以危及生命的自身免疫性皮肤-黏膜疱性疾病。病损表现为薄壁、易破裂的大疱，组织病理为棘层细胞松解所致的表皮内水疱。病损可单发于口腔(56％)或皮肤(12％)，亦可同时发病(32％)。研究表明，在天疱疮患者血循环中存在抗角朊细胞间物质的天疱疮抗体，该抗体与角朊细胞连接蛋白——桥粒中的抗原结合后，使表皮细胞释放纤维蛋白溶酶原激活物，后者使纤维蛋白酶系统激活而导致棘层松解，形成皮内疱。     

11例银屑病患者口腔损害的病理表现

探讨口腔粘膜是否可发生银病。于４５０例有皮损的银屑患者中发现有口腔病得１１例,且口腔病损与皮损间有消长一致的关系。作者对这些口腔病损进行了组织病理学和免疫病理学研究。结果显示：口腔病损上皮不全角化,棘层增厚（棘皮症）角源细胞分裂活性增加,结缔组织乳头延长,钉突亦相应增长,毛细血管扩张,上皮内炎性细胞浸润,上皮浅层有时可见到Ｍｕｎｒｏ’ｓ微脓肿,角层、棘细胞间及基底细胞间和基底膜处有免疫复合物沉积。     

高+Gx环境对猴口腔黏膜上皮c-fos表达的影响

目的:观察模拟空间环境航天应急返回过程中高 Gx对猴口腔黏膜上皮细胞c-fos表达的影响.方法:以9只雄性猕猴为对象,随机分为4组,对照组承受 1 Gx、300 s的超重作用;实验组根据承受过载峰值的大小分为3个亚组,分别承受过载峰值为 15 Gx、200 s; 18 Gx、165 s; 21 Gx、140 s的超重作用.采用常规组织病理学方法,观察猴口腔黏膜上皮细胞的改变;采用免疫组织化学PicTureTM两步法,观察高 Gx对猴口腔黏膜上皮c-fos表达的影响.结果:组织病理学观察显示,对照组和实验组动物口腔黏膜上皮均未见明显病理学改变.免疫组化学观察显示,实验组口腔黏膜上皮基底细胞和棘细胞呈深棕色,为c-fos强阳性表达,对照组口腔黏膜上皮部分基底细胞和少量棘细胞呈浅棕色,为c-fos弱阳性表达.高 Gx实验组之间口腔黏膜上皮c-fos表达无明显差异.结论:高 Gx可引起猴口腔黏膜上皮细胞c-fos表达增强.     

口腔颌面部上皮样血管瘤临床病理研究

目的：探讨口腔颌面部上皮样血管瘤的临床、病理学特征及生物学行为.方法：回顾性分析7例口腔颌面部上皮样血管瘤的临床资料,常规HE染色及弹力纤维染色,光镜观察,全部标本行免疫组织化学染色分析其病理学特点.结果：7例患者中,男性4例女性3例.肿瘤分别位于舌、唇部、鼻根及腭部.5例表现为表浅单发性肿块,3例有创伤史.组织学表现为毛细血管和小血管增生,内皮细胞呈上皮样或组织细胞样改变;病变内有慢性炎性细胞浸润.免疫组织化学检测,全部标本Vimentin、FⅧRAg、UEA-1、CD34及α-SMA阳性,S-100蛋白、广谱CK及GLUT-1染色阴性.手术治疗后2例复发,无转移.结论：上皮样血管瘤是一种良性血管病变,可能与局部创伤有关.     

核转录因子-κB在金地鼠颊囊癌变过程中的表达研究

目的　探讨核转录因子-κB家族成员的重要亚基p65及其抑制蛋白IκBα在金地鼠颊囊鳞癌发生过程中的 表达及意义。方法　建立金地鼠颊囊癌变的动物模型,采用Western blot法检测金地鼠正常颊黏膜、上皮单纯增生 黏膜、上皮异常增生黏膜和鳞癌组织所提取的核蛋白中p65的表达差异;采用SABC免疫组织化学法检测在金地鼠 颊黏膜正常上皮、上皮单纯增生、上皮异常增生、鳞状细胞癌中IκBα的表达变化。结果　正常黏膜和上皮单纯增生 黏膜中,p65表达很弱,但普遍存在IκBα的表达,该表达多局限于黏膜基底层和棘层底部细胞的胞浆中。随着上皮 异常增生的出现,p65表达增强,与正常黏膜和单纯增生黏膜相比有统计学意义(P<0.01),而IκBα表达则显著下 降(P<0.05)。鳞癌组织中p65的表达显著高于正常黏膜和异常增生黏膜(P<0.01),IκBα的表达显著升高,明显 高于上皮异常增生黏膜(P<0.01),甚至超过正常水平(P<0.01)。结论　p65在金地鼠颊囊鳞癌发生、发展过程中 被激活。p65和IκBα在金地鼠颊囊癌变过程中的表达异常,上皮异常增生阶段p65的表达上调而IκBα的表达下调, 可能是口腔黏膜上皮癌变过程中的早期事件,可作为口腔早期癌变监测的生物学指标。     

嗜酸性淋巴肉芽肿

嗜酸性淋巴肉芽肿是一种病因不明的、多累及头颈部浅表淋巴结和软组织的慢性肉芽肿痛变。病理学上表现为淋巴滤泡形成或滤泡样结构增生，存在生发中心。外周血中嗜酸性粒细胞增多。该病变组织对放疗极为敏感，此外，还可采用化疗、手术等方法。虽然本病预后良好，但容易复发，早期患者的确诊较困难，应引起口腔颌面外科医生的高度重视。     

EMS1基因扩增与口腔黏膜癌变的相关研究

目的 了解EMS1基因扩增是否参与口腔黏膜癌变。方法采用显微解剖技术分别获取正常口腔黏膜上皮，口腔白斑患者的单纯增生，轻、中、重度异常增生上皮和原发性口腔鳞癌组织标本78例，应用差示PCR反应检测EMS1基因扩增。结果①分别有20．0％的口腔白斑组织，57．6％的口腔鳞癌组织观察到EMS1扩增；②在口腔黏膜癌变进程中，EMS1扩增开始于中度异常增生黏膜，在伴有淋巴结转移的口腔鳞癌组织中其扩增率有显著增高(P=0．015)。结论EMS1基因扩增与口腔黏膜癌变的演进相平行，似是口腔黏膜癌变的早期分子事件。     

口腔黏膜良性淋巴组织增生病的免疫组化研究

目的　研究口腔黏膜良性淋巴组织增生病与口腔癌的细胞增殖能力、血管密度和细胞凋亡的变化。方法　采用免疫组化SP法检测 15例黏膜良性淋巴组织增生病、9例黏膜良性淋巴组织增生病伴上皮异常增生、15例口腔癌及 10例正常黏膜组织中Ki 6 7的表达、细胞凋亡及微血管密度。结果　口腔黏膜良性淋巴组织增生病伴异常增生及鳞状细胞癌中Ki 6 7的表达明显高于不伴异常增生的口腔黏膜良性淋巴组织增生病及正常黏膜 (P <0 0 5 ) ,在所有的口腔黏膜良性淋巴组织增生病及鳞状细胞癌中微血管密度均明显高于正常组 (P <0 0 5 )。口腔黏膜良性淋巴组织增生病中细胞凋亡明显高于正常黏膜及口腔癌 (P <0 0 5 )。结论　在伴有上皮异常增生的口腔黏膜良性淋巴组织增生病中Ki 6 7表达及微血管密度均介于正常组织和口腔癌之间 ,凋亡细胞数也明显多于正常组织。研究结果提示 :口腔黏膜良性淋巴组织增生病是一种具有癌变潜能的疾患     

人口腔异常增生上皮、正常上皮及鳞癌细胞生物学特性比较

目的：检测体外培养的人口腔黏膜上皮异常增生细胞(Dysplastic Oral Keritinocyte，DOK)，为口腔癌前病变体外细胞模型建立提供试验依据。方法：采用细胞计数，生长曲线，克隆形成率，染色体倍性检测等方法，比较DOK与正常口腔黏膜上皮角化细胞(Oral Keritinocytes，OKC)及Tca8113(舌鳞癌细胞)细胞体外培养的生物学特性。结果：DOK在生长速度，克隆形成率，染色体异倍体率均介于正常细胞与肿瘤细胞之间。结论：DOK细胞属正常细胞向癌转变的中间过渡型细胞，可作为研究口腔癌前病变的细胞模型。     

Pyostomatitis vegetans and its relation to inflammatory bowel disease, pyoderma gangrenosum, pyodermatitis vegetans, and pemphigus

J Oral Pathol Med (2012) 41: 584-588 Pyostomatitis vegetans (PSV) is an intraoral pustular eruption considered by most authors to represent the mucous analogous of cutaneous pyoderma gangrenosum and its vegetating presentations (pyodermatitis vegetans). A strong correlation of PSV with inflammatory bowel disease (IBD) is well documented. The histopathology of PSV lesions usually reveals acanthosis, and neutrophils and/or eosinophils infiltration with intraepithelial or subepithelial abscesses; acantholysis is present in some cases. We studied four patients with IBD that presented oral lesions suggestive of PSV. Two male and two female patients were included. The histopathology of oral lesions of two patients revealed findings typical for PSV. The other two patients showed findings typical for pemphigus vulgaris (PV), although the course of their symptoms paralleled that of the bowel disease. Our findings may suggest that pustular lesions in patients with IBD can be a presentation of both PSV and PV; adequate diagnosis is required because clinical presentation is very similar.     

The differential diagnosis of pyostomatitis vegetans and its relation to bowel disease

Pyostomatitis vegetans is a rare oral disorder that is usually associated with bowel and/or skin disease. The clinical appearance is of soft hyperplastic folds of mucosa characterized by small miliary abscesses with superficial erosions. Upon analysis of the clinical, histologic, and immunofluorescent findings, cases of pyostomatitis vegetans may be classified as the oral manifestation of either pyoderma vegetans of Hallopeau, pemphigus vegetans of Hallopeau, or pemphigus vegetans of Neumann, although the exact definitions and even the existence of these diseases as separate entities are still a matter of controversy.     

Pyostomatitis vegetans. Report of two cases and review of the literature

Pyostomatitis vegetans (PV) is a rare benign chronic mucocutaneous pustular disorder of unknown etiology, though it is usually associated with chronic inflammatory disease of the bowel-particularly ulcerative colitis. At the oral level PV manifests as an exophytic lesion with an erythematous perimeter and a creamy-yellow surface presenting a friable covering membrane which easily disintegrates, giving rise to the development of small ulcers or superficial erosions. The histology shows epithelial acanthosis and superficial ulceration. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. The present study describes 2 cases of PV associated with ulcerative colitis. The differential diagnosis should be established with Neumann type pemphigus vegetans, since in both cases the lesions are clinically similar and the histology reveals an important eosinophil response, acanthosis, and the formation of intraepithelial miliary microabscesses. The treatment of PV focuses on control of the disease. In the event the orofacial lesions persist, topical oral drugs such as corticoids, with additional antibiotherapy, multivitamin complexes, and nutritional supplements, can be provided.     

Pyodermatitis-pyostomatitis vegetans: report of a case and review of the literature

Pyodermatitis-pyostomatitis vegetans is a benign, rare disorder characterized by a pustular eruption in the oral mucosa and vegetating plaques involving the groin and axillary folds. Its association with inflammatory bowel disease is well established. We report the case of a 49-year-old-white man with ulcerative colitis who manifested a vegetating, annular plaque in the left inguinal region of 2 months' duration. Oral examination disclosed an erythematous mucosa with multiple painful pustules involving the labial and gingival mucosa. Histopathologic study demonstrated epidermal hyperplasia and an inflammatory infiltrate composed mostly of neutrophils and eosinophils, grouped into microabscesses within the epidermis and with a bandlike configuration in the upper dermis. Results of direct and indirect immunofluorescence studies were negative. We discuss the differential diagnosis between pyodermatitis-pyostomatitis vegetans and pemphigus vegetans.     

强的松治疗天疱疮起始量的探讨

目的：探讨强的松治疗天疱疮病人合理的起始量范围。方法：收集了1996～2008年我院收治的天疱疮病例85例,（寻常型82例。增殖型2例,红斑型1例）作为研究对象。肾上腺皮质激素起始量的范围由基本量和附加量两个水平确定：分有效（量足）、显效（量够）、无效（量欠）三个标准。将有效和显效计为有效率。结果：结果表明85例患者中77例为有效（量足）,5例显效（为量够）,3例无效（为量欠）,有效率为96.4%。结论：该方案可作为强的松治疗天疱疮的起始量参考。     

Freeze-fracturing of oral epithelial cells in pemphigus

Hietanen, J. & Lounatmaa, K. Freeze-fracturing of oral epithelial cells in pemphigus, Acta Odontol. Scand. 1982, 40, 415–420

Biopsies from the oral mucosa of three patients (two with pemphigus vulgaris and one with pemphigus erythematosus) were taken for both freeze-fracturing and thin-sectioning studies. Oral mucosa from a clinically healthy volunteer was used as control. The samples collected from both the involved and uninvolved oral mucosa of pemphigus patients showed widened intercellular spaces and fewer than normal desmosomes. Thin sections showed a random distribution of tonofi-laments. However, in freeze-fracture replicas tonofilaments were arranged in thick bundles with a slightly coiled orientation. In freeze-fracture replicas of samples from a pemphigus patient in remission no difference was found in the number of particles on both fracture faces.     

Oral epithelial cells as the origin of pemphigus antigen in human saliva

Absorption of pemphigus sera with normal human saliva or with scraped oral epithelial cells abolished the intercellular antibody titres, as revealed by indirect immunofluorescence. No pemphigus antigenic activity was detected on either human or macaque salivary glands, suggesting that the pemphigus antigen in saliva is a product of the epithelial lining of the oral mucosa. Indirect immunofluorescence on primary cultures of normal oral mucosa demonstrated that pemphigus antigen is synthesized by human oral epithelial cells. Salivary pemphigus antigen was isolated by affinity chromatography on Sepharose-linked IgG-fraction from pemphigus sera. Pemphigus antibody-binding material from the isolated fraction was detected in two bands with apparent molecular weights of 30,000 and 12,000 by immuno-blotting of reduced SDS-polyacrylamide gel electrophoretograms.     

Human papillomavirus as a risk factor for oral squamous cell carcinoma: a meta-analysis, 1982-1997

OBJECTIVE: Human papillomavirus (HPV) infection is a significant risk factor for uterine cervical carcinoma. However, the role of HPV infection in oral squamous cell carcinoma (OSCC) is less well defined. To determine the significance of the relationship of this virus in the progressive development of oral cancer, we estimated the risk of HPV detection in normal oral mucosa, precancerous oral tissue, and oral carcinoma using meta-analysis. STUDY DESIGN: Case reports and clinical series published in English-language journals were retrieved by searching MEDLINE (January 1980-August 1998). Review articles were also examined to identify additional studies. Studies that used biochemical, immunologic, microscopic, or molecular analyses to detect HPV in tissue or cells derived from normal oral mucosa (n = 25), benign leukoplakia (n = 21), intraepithelial neoplasia (ie, dysplasia and carcinoma in situ; n = 27), and oral cancer (n = 94) were included in the meta-analysis. Information on sample size, age, sex, method of tissue preservation (ie, fresh, frozen, paraffin-embedded), assay, primer amplification region (early, late), high-risk versus low-risk genotype, and use of tobacco or alcohol was abstracted by one author (C.S.M.). RESULTS: Data from 94 reports that analyzed 4680 samples were included in the meta-analysis. Analyses made by means of a random-effects model with and without adjustments for assay sensitivity showed increased probability of HPV detection in tissue with precancerous and cancerous features compared with normal mucosa. The likelihood of detecting HPV in normal oral mucosa (10.0%; 95% confidence interval [CI], 6.1%-14.6%) was significantly less than of detecting benign leukoplakia (22.2%; 95% CI, 15.7%-29.9%), intraepithelial neoplasia (26.2%; 95% CI, 19.6%-33.6%), verrucous carcinoma (29.5%; 95% CI, 23%-36.8%), and OSCC (46.5%; 95% CI, 37.6%-55.5%). Adjustment of findings for differences in assay sensitivity indicated that these estimates may be conservative. Overall, HPV was between 2 and 3 times more likely to be detected in precancerous oral mucosa and 4.7 times more likely to be detected in oral carcinoma than in normal mucosa. The pooled odds ratio for the subset of studies directly comparing the prevalence of HPV in normal mucosa and OSCC was 5.37, confirming the trend observed in the overall sample. The probability of detecting high-risk HPVs in OSCCs was 2.8 times greater than that of low-risk HPVs. CONCLUSION: This meta-analysis indicates that HPV is detected with increased frequency in oral dysplastic and carcinomatous epithelium in comparison with normal oral mucosa. The findings provide further quantitative evidence that oral infection with HPV, particularly with high-risk genotypes, is a significant independent risk factor for OSCC.     

Oral mucocutaneous diseases: clinicopathologic analysis and malignant transformation

Oral mucocutaneous diseases (MCDs) are a heterogeneous group of disorders that could involve oral mucous membrane frequently. The purpose of this study was analysis of clinicopathologic features and relative frequency of MCDs with emphasize on malignant transformation of oral lichen planus (OLP). In this retrospective study, clinical data regarding to site of involvement, patient's age and sex, and accompanied symptoms were noted, and pathologic slides of OLP were reviewed for the detection of dysplastic changes. Among 309 patients, OLP and pemphigus vulgaris were the first and second most common MCDs. Buccal mucosa was the most frequent affected site. Female predominance (70.23%) and mean age of 45.3 years were seen. Approximately 12.4% of OLPs showed dysplastic and neoplastic changes. In conclusion, MCD with oral manifestation is most probably to be OLP and pemphigus vulgaris rather than other rare disorders. Malignant transformation may occur in all forms of OLP, and hence, regular, exact follow-up of the patient is necessary for enhancing quality of life.     

Possible role of apoptotic cells of the oral epithelium in the pathogenesis of aphthous ulceration

Electron microscopic examination of the normal oral mucosa of patients with recurrent aphthous ulceration or Beh?et's syndrome revealed that the degenerate dark prickle cells are apoptotic cells. Such dark prickle cells showed characteristic findings of apoptosis, such as the shrinkage of nucleus and cytoplasm and the formation of contraction vacuoles. The number of intraepithelial mononuclear cells phagocytosing apoptotic cellular debris increased remarkably at the preulcerative stage of the aphthous lesions. The apoptotic debris also attracted neutrophilic leukocytes in the prickle cell layer at the preulcerative stage but not in the normal oral epithelium. It is speculated that the onset of aphthous ulceration is closely related to phagocytosis of these apoptotic cells by intraepithelial mononuclear cells.