Tongue disease in advanced AIDS

OBJECTIVE: This study describes the involvement and the histological alterations found in the tongues of 92 autopsied patients who died with AIDS. MATERIALS AND METHODS: Sex, age, CD4 cell count and clinical history were obtained from the files of 92 patients who died with AIDS. All the tongues were examined for macroscopical alterations and stained using H&E, Gomori-Grocott, Ziehl-Neelsen, PAS, Brow-Hopps and Mucicarmine. Histological autopsy findings were grouped based on a protocol that was designed following the World Health Organization recommendations. RESULTS: The mean age of the patients who died of AIDS and CD4 cell count were 36 years and 82 cells microL(-1), respectively. Histological alterations of the tongues were found in 75% of the cadavers. The most common lesions were hairy leukoplakia (HL) (42 cases), candidosis (31 cases) and non-specific chronic glossitis (29 cases), followed by concomitant lesions (28 cases), non-specific chronic ulceration (17 cases), melanotic pigmentation (13 cases), herpes simplex (10 cases), lymphoepithelial cysts (two cases), cryptococcosis (two cases), mycobacteriosis (one case), histoplasmosis (one case), cytomegalovirus infection (one case) and non-Hodgkin Lymphoma (one case). HL with oral candidosis (n = 13) were the most common concomitant lesions. CONCLUSION: These findings indicate that the tongue is a favorite site to occurrence of reactive, infectious and concurrent lesions in the end-stage of AIDS patients.     

Oral findings in Mexican AIDS patients with cancer

Oral findings of 42 Mexican AIDS patients with cancer were reviewed. Kaposi's sarcoma (KS) was the most frequent malignancy (81%) followed by non-Hodgkin's lymphoma (NHL) (12%). All cases of NHL were of high or intermediate grade and most of them were extranodal. Out of the 34 individuals with KS, 22 (65%) showed oral KS and in 21 of them the palate was involved. The clinical features of oral KS including site, appearance and size are described. Pseudo-membranous candidosis (PC), hairy leukoplakia (HL) and exfoliative cheilitis (ECh) were also found in these patients. There was no association of these lesions with any type of cancer. A strong association of oral candidosis and history of this infection was found, RR = 7.0 (1.3–4.1). There was evidence of severe immunosuppression in most patients, with mean average CD4 counts of 116 mm³ (range 4–841 /mm³). Oral KS, ECh, PC and HL were more common in patients with lower CD4 counts. Our findings illustrate the most frequent oral lesions associated with HIV-1 infection in patients with AIDS and cancer, and further support the importance of oral examination in HIV infected patients.     

Oral candidosis in non-Hodgkin's lymphoma: a case report

Though oral candidosis is an opportunistic fungal infection that commonly affects immunocompromised patients, little is known of its occurrence as a complication of Non-Hodgkin's lymphoma. This paper reports a case of oral candidosis in a 20-year-old Indonesian woman with this lymphoproliferative disease. She presented with acute pseudomembranous candidosis on the dorsum and lateral borders of the tongue, bilateral angular cheilitis and cheilocandidosis. The latter is a rare clinical variant of oral candidosis, and the lesions affecting the vermilion borders presented as an admixture of superficial erosions, ulcers and white plaques. Clinical findings were confirmed with oral smears and swabs that demonstrated the presence of hyphae, pseudohyphae and blastospores, and colonies identified as Candida albicans. A culture from a saline rinse was also positive for multiple candidal colonies. Lip and oral lesions were managed with Nystatin. The lesions regressed with subsequent crusting on the lips, and overall reduction in oral thrush. As Non-Hodgkin's lymphoma is a neoplastic disease that produces a chronic immunosuppressive state, management of its oral complications, including those due to oral candidosis, is considered a long-term indication.     

Risk factors for oral soft tissue lesions in an adult Spanish population

OBJECTIVES: The aims of this study were (i) to determine the prevalence of oral lesions in adults over 30 years old in the city of Oviedo (Spain), and (ii) to analyze the relationship between the prevalence of oral lesions, toxic habits (tobacco and alcohol) and denture wearers in these patients. METHODS: A representative sample of the adult population in Oviedo (Spain) was obtained through randomized sampling (n = 753); a total of 308 (41%) subjects were finally included in the study. The observed oral pathology was classified according to the WHO criteria and earlier epidemiological studies. RESULTS: A little over half of all patients (51.1%) had oral lesions. The most frequent lesions were frictional lesion (7.5%), traumatic ulcer (7.1%), denture stomatitis and pseudomembranous candidosis (6.5%), followed by melanin pigmentation (5.8%) and denture-induced hyperplasia (5.2%), plicated tongue (3.9%), lichen planus and hemangioma (3.2%), angular cheilitis and cheek biting (2.9%), fibrous hyperplasia and coated tongue (2.6%), recurrent aphthae (1.9%) and oral leukoplakia (1.6%). In relation to leukoplakia, the odds ratio (OR) of heavy drinkers was 15.98 and the OR of heavy smokers was 12.37. The OR of heavy smokers or heavy drinkers diagnosed of frictional lesion was four times greater than that of nonsmokers or nondrinkers. The OR of heavy smokers with melanic pigmentations was 4.08. The OR of complete denture wearers with candidosis was 11.38. The OR of partial removable denture wearers with hemangioma was 5.01. CONCLUSIONS: This study shows the relation of heavy tobacco and heavy alcohol to traumatic keratosis and leukoplakia, and of complete dentures to pseudomembranous candidosis, fibrous hyperplasia and stomatitis. Programs designed to eradicate toxic factors (alcohol and tobacco) should, therefore, be implemented with adequate maintenance of dentures.     

二期梅毒40例口腔表现及病理分析

目的分析40例二期梅毒患者的口腔临床特征及病理表现。方法收集北京大学口腔医学院1994至2004年间以口腔黏膜损害首诊的40例梅毒患者，对经实验室检查确诊的临床病理资料加以分析。结果40例二期梅毒患者中32例口腔表现为相似的黏膜斑，最好发的部位是舌。疼痛症状不明显或伴有轻微疼痛。对8例最初被误诊为口腔念珠菌病和扁平苔藓的患者，组织病理学检查显示为非特异性炎症，主要表现为上皮微脓肿，固有层血管周围有密集的淋巴细胞和浆细胞浸润。16例梅毒患者经苄星青霉素治疗后症状明显好转。结论以口腔黏膜损害为首发症状的梅毒患者有其特殊的临床病理学表现，但常易被口腔医务工作者忽视。口腔科医师应认识梅毒的口腔病损，及时诊断早期梅毒。     

Oral manifestations of AIDS in a heterosexual population in a Zaire hospital

Oral lesions associated with HIV infection as classified by the WHO Collaborative Centre for Oral manifestation of HIV were studied in 83 heterosexual AIDS patients in Kinshasa, Zaire. One or more lesions were fungal (94%), bacterial (33%) and viral (23%). Neoplasm was found in 12% of cases while lesions of unknown etiology in 14%. As location of those lesions, the palate, lips, tongue and the buccal mucosae mostly predominate as sites. The findings from this study were clinically similar to those reported in AIDS in other areas.     

Oral Mucosal Conditions in Chronic Hepatitis C Brazilian Patients: A Cross-Sectional Study

Objective: Our purpose was to carry out an epidemiological study to assess the prevalence of oral mucosal conditions in Brazilian patients with chronic hepatitis C. Methods: A cross-sectional survey was carried out on 215 patients with chronic hepatitis C who were examined for oral mucosal conditions, including oral mucosal lesions and variations of normality. Results: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent (207 patients). Oral mucosal lesions were present in 147 patients (68.4 percent), whereas variations of normality were observed in 173 patients (80.5 percent). The most common lesions included cheek biting in 42 cases (19.5 percent), candidiasis in 39 cases (18.1 percent), and leukoplakia in 28 cases (13.0 percent). The association of oral lichen planus with hepatitis C virus (HCV) infection proved to be statistically significant ( P =  0.002). The most frequent variations of normality included Fordyce's spots in 96 cases (44.7 percent), lingual varicosities in 67 cases (31.2 percent), and fissured tongue in 60 cases (27.9 percent). Conclusion: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent. Despite this high prevalence, only the association between oral lichen planus and hepatitis C showed statistical significance. Considering that HCV infection may be associated with extrahepatic disorders, such as oral manifestations, efforts should be made to clarify the possible relation between oral conditions and HCV infection. This may be helpful in the earlier diagnosis of the infection mainly in asymptomatic patients.     

Oral candidosis by Candida albicans in normal and xerostomic mice

The aim of this study was to analyze the effect of sialoadenectomy on the development of oral candidosis after one or four inoculations of Candida albicans. Initially, a suspension containing 10(8) cells/ml of C. albicans ATCC 36801 was prepared. Seventy-eight sialoadenectomized mice and a similar amount of mice with normal salivary flow received a single inoculation of C. albicans suspension. Another group with a similar number of mice received 4 inoculations. The control group consisted of 6 sialoadenectomized mice and 6 mice with normal salivary flow that were not inoculated with C. albicans. Candidosis development was studied histologically in the tongue of the animals 1, 2, 3, 5, and 8 days after inoculation and at 15-day intervals up to 165 days. According to the results obtained, it could be concluded that sialoadenectomy and a higher frequency of yeast inoculation influenced the presence and extension of candidosis lesions.     

In situ hybridization analysis of human papillomavirus DNA in oral mucosal lesions.

Commercial biotinylated DNA probes specific for human papillomavirus (HPV) types 6 and 11; 16 and 18; and 31, 33, and 35 were used for in situ hybridization analysis of 105 oral mucosal specimens from 5 cases of verruca vulgaris, 15 cases of condyloma acuminatum, 30 cases of squamous papilloma, 20 cases of hyperkeratosis/acanthosis, 15 cases of epithelial dysplasia, 5 cases of carcinoma in situ, and 15 cases of squamous cell carcinoma. Positive hybridization signals were found in 26 specimens (24.8%). Only HPV-6/11 was detected. HPV DNA occurred significantly more often (p less than 0.005, chi-square analysis) in condyloma acuminatum (100%) and verruca vulgaris (100%) than squamous papilloma (13.3%), hyperkeratotic/acanthotic lesions (10%), and malignant and premalignant lesions (0%). The tongue (19.1%) and labial epithelium (17.1%) were infected most frequently. Nuclear reaction products indicating HPV infection were associated primarily with koilocytes. These results demonstrate the usefulness of commercial biotinylated probes for HPV DNA analysis in routine paraffin-embedded lesion specimens. They confirm HPV involvement in benign lesions of the oral mucosa but fail to associate HPV infection with oral cancer and precancer.     

Human papillomavirus in carcinomas of the tongue: clinical and prognostic implications

It is not clear whether the presence of human papillomavirus (HPV) in squamous cell carcinomas of the tongue (SCCT) is of etiopathogenic and clinical significance. This study was designed to establish the incidence of HPV in SCCT and to determine the influence of HPV detection on clinical parameters and the prognosis. Clinical and histopathological data of 64 patients with SCCT were collected. Thirty benign lesions of the tongue were analyzed in parallel, in order to compare the HPV incidence and genotypes in these lesions with those of SCCT. Paraffin blocks of all cases were collected and PCR was carried out using SPF10 primers and the INNO-LiPA genotyping methodology. HPV was detected in 26.2% of the patients. Hybridization results showed that all patients except one had high-risk (HR)-HPV. HPV56 was the most common (42.1%), followed by HPV18 (26.3%), HPV16 (10.5%), HPV66 (10.5%), HPV39 (5.3%), and HPV51 (5.3%). The odds ratio of HR-HPV infection in cases vs. controls was statistically significant (9.45, 95% confidence interval 1.18–75.46). Among the results of the univariate analysis correlating the presence of HR-HPV with different clinical parameters, only mortality showed a statistically significant correlation, being higher in HR-HPV patients (odds ratio 3.97, 95% confidence interval 1.07–14.7).     

舌静脉畸形的DSA分型及治疗—132例临床分析

目的:探讨舌静脉畸形(venous malformations,VM)的数字减影血管造影（digital substraction angiography, DSA）分型及治疗策略。方法:总结2016年2月—2019年2月收治的132例舌VM患者的DSA表现,根据影像学特征将其分为4型,Ⅰ型为无回流型、Ⅱ型为低回流型、Ⅲ型为高回流型、Ⅳ型为广泛型,依据分型选择不同的治疗方案。无回流型单纯采用平阳霉素进行硬化治疗,低回流型单纯采用聚桂醇泡沫硬化剂进行硬化治疗,高回流型采用无水乙醇结合聚桂醇泡沫硬化剂进行硬化治疗,广泛型先按高回流型进行硬化治疗后再结合整形手术切除。统计各组病例的治疗效果及不良反应。结果:本组132例病例获得12~41个月随访,平均15.8个月,所有患者术后舌VM明显缩小甚至消失。Ⅰ型8例,有效率100%;Ⅱ型17例,有效率100 %;Ⅲ型98 例,有效率90.8 %;Ⅳ型 9例,有效率77.8%。不良反应主要为组织溃烂、坏死,Ⅰ型0例;Ⅱ型1例,发生率5.88%; Ⅲ型16例,发生率16.33%;Ⅳ型7例,发生率77.78%。结论:基于DSA的舌VM分型对临床治疗具有重要指导意义。舌VM中大部分为Ⅲ型病例,Ⅰ型比例最小。经黏膜注射无水乙醇是治疗高回流型和广泛型舌VM的有效方法。     

口腔念珠菌混合带菌及感染的研究

目的 调查不同人群口腔念珠菌混合带菌及感染状况；研究不同菌株对氟康唑的敏感性。方法 收集222例正常人及84例口腔念珠菌病患者的混合唾液，用Sabouraud和CHROMagar两种培养基进行念珠菌培养，根据菌落形态和生化反应鉴定菌株，并对部分菌株进行体外药敏试验。结果 正常个体中带念珠菌者71例(32％)，其中混合带菌8例(11．3％)；口腔念珠菌感染者中混合念殊菌感染20例(23．8％)。从其中8例混合感染患者中分离出16株念珠菌，1／16(6．3％)菌株对氟康唑耐药。结论 本研究表明正常人群和感染患者口腔均有不同程度的念珠菌混合带菌或感染；感染患者中有耐药菌株出现，提示必要时需要对部分菌株进行药敏实验。     

口腔颌面部结节病14例临床分析

目的：总结分析14例口腔颌面部结节病的诊治经验。方法：回顾分析1993年至2005年期间收治的14例结节病患者的病例资料，所有患者均行手术治疗，术后经病理诊断证实。8例口腔及颌面部单发病变行完整切除，术后予以随访观察。4例病变位于腮腺者，行肿块及腮腺浅叶切除术，保留面神经，术后随访观察。2例多发病变者，先予试验性激素治疗，病变缩小后再行大部切除，术后继续接受激素治疗。随访1个月～10a。结果：14例患者中，男5例．女9例：年龄30～66岁，中位年龄49岁、病变位于唇部5例，腮腺4例（1例双侧腮腺受累），颏部1例，下颌下1例，舌1例，颧部及下颌下1例．同时累及腮腺、下颌下、颏部1例．手术治疗效果良好，1例有上唇结节病患者．术后1年复发，再次手术治疗；1例舌结节病行部分切除，病变持续存在（8a），仍感不适。2例病变广泛者，术后辅以激素治疗．预后良好，无病变复发或进展。结论：口腔颌面部结节病临床少见，多属局部性病变，手术治疗可获良好疗效。对病变广泛者．术后需配合正规激素治疗，并严密随访观察。     

The prevalence of tongue lesions in Malaysian dental outpatients from the Klang Valley area

Oral Diseases (2011) 17 , 210–216 Objectives: To determine the prevalence of tongue lesions in Malaysian dental outpatients from the Klang Valley area. Subjects and Methods: A cross sectional study was conducted on 600 Malaysian outpatients (257 men, 343 women, mean age, 37.7 years) attending the Primary Dental Care Unit at the Faculty of Dentistry, University of Malaya. Demographic and medical data were recorded for all respondents. Results: One hundred eighty‐one patients (30.2%) (81 men, 100 women, mean age 42.0 years) were diagnosed with at least one tongue lesion (n = 207) at the time of examination. Of these, 24 patients (4%) had two or more tongue lesions present synchronously. Seven different lesions were diagnosed: fissured tongue (13.8%), crenated tongue (7.8%), pigmented tongue (6.2%), geographic tongue (2.2%), ankyloglossia (1.7%), hairy tongue (1.0%) and median rhomboid glossitis (0.2%). Their racial prevalences were Malays (n = 65, 10.8%), Indians (n = 62, 10.3%), Chinese (n = 53, 8.8%) and other race (n = 1, 0.2%). A significant relationship was observed between crenated tongue and race; between four types of tongue lesions (fissured tongue, geographic tongue, crenated tongue and pigmented tongue) and age; and between fissured tongue and gender (P < 0.05). Conclusions: Distribution characteristics of tongue lesions in Malaysians are important as local reference data in the daily clinical practice.     

Prevalence of tongue lesions in Hungarian children

OBJECTIVE: The aim of this study was to investigate the prevalence of tongue lesions in Hungarian children in relation to age, sex, systemic diseases and allergies. MATERIAL AND METHODS: A total of 1017 preschool and school children aged 1-14 years were examined. The age, sex and tongue lesions diagnosed were recorded together with any history of systemic diseases and allergies. RESULTS: Tongue lesions were found in 35.11% of all the children examined. Fissured tongue was the most frequent lesion (29.2%), apparently associated with age and sex. It occurred more commonly in boys, and in older children, than in girls and younger children. Geographic tongue was found in 5.7%, occurred more often in boys, and a relationship existed between fissured and geographic tongue. Among the children with geographic tongue 44.82% also had fissured tongue. These findings agree in general with the epidemiological data reported on population samples elsewhere in the world. Crenated tongue occurred in 0.68%, central papillary atrophy in 0.78%, and partial ankyloglossia in 0.88% of the children examined: confirming the rarity of these lesions. Although there was no obvious correlation with systemic diseases, geographic tongue appeared to be coincident with a history of allergic diathesis in some cases. CONCLUSION: In some cases early recognition of tongue lesions may provide useful diagnostic markers for some diseases.     

Oral signs and symptoms in 160 Greek HIV-infected patients

One hundred and sixty HIV-infected Greek patients were prospectively examined and the oral signs and symptoms were recorded. At the time of oral examination, 76 patients were asymptomatic seropositive, 47 were in ARC stage and 37 had AIDS. One or more oral findings were recorded in 90.6% of the patients while a total of 33 different lesions were observed. The more common oral lesions (highly suspicious) were candidiasis (61%), hairy leukoplakia (24%), periodontitis (19%), necrotizing gingivitis (11%) and Kaposi's sarcoma (12%). In addition some unclassified lesions or symptoms (xerostomia 26%, burning mouth syndrome 19%, patchy depapillated tongue 16%, hairy tongue 10%, exfoliative cheilitis 4%), were common while submandibular and cervical lymph node enlargement were found in 49% of the patients. Interestingly in 16 patients (10%) the suspicion of HIV infection was exclusively based on oral lesions. Our findings show that oral signs and symptoms are common and some times early manifestations of HIV infection and it is in association to those reported in previous studies.     

Unusual clinical aspects of oral non-Hodgkin lymphomas in patients with HIV infection

Patients with HIV infection are at greater risk of developing malignancies. We report two HIV-seropositive patients with primary oral manifestation of a B-cell non-Hodgkin lymphoma (NHL). Localisations of tumours were the palate, with an unusual bifocal origin, and the tongue which is rarely the primary site of NHL. Ulcerations and extensive tissue necrosis were observed. Histologically both cases were high grade malignant lymphomas, immunoblastic. Epstein-Barr virus DNA was detected with in situ hybridisation in 1 patient.     

Prevalence and distribution of oral lesions: a cross-sectional study in Turkey

OBJECTIVES: The purpose of this study was to evaluate the prevalence and distribution of oral lesions (OLs) in Turkish population. SUBJECTS AND METHODS: In this cross-sectional study, 765 residents (F/M: 375/390) were selected by the cluster sampling method and examined according to WHO criteria. RESULTS: Excessive melanin pigmentation (6.9%) was the most common lesion in the study population. The tongue lesions observed in this study were as follows: fissured tongue (5.2%), varices (4.1%), hairy tongue (3.8%), geographic tongue (1.0%), atrophic tongue papillae (0.7%) and ankyloglossia (0.3%). The denture-related lesions were denture stomatitis (4.3%), suction irritation (0.8%), denture hyperplasia and torus palatinus as bony lesion (0.5%) and traumatic ulcers (0.3%). In regression analysis, being 65 years old and over was found as a statistically significant risk factor for the occurrence of pigmentation, fissured tongue, varices, hairy tongue, denture stomatitis and petechiae (P < 0.05). CONCLUSIONS: Pigmentation, fissured tongue and denture stomatitis were observed to be the most common lesions in Turkish population. Elderly population was a significant risk factor for occurrence of some OLs.     

Herpes Simplex Virus Type 1 infection: overview on relevant clinico‐pathological features*

Herpes Simplex Virus Type 1 (HSV‐1) is a nuclear replicating enveloped virus, usually acquired through direct contact with infected lesions or body fluids (typically saliva). The prevalence of HSV‐1 infection increases progressively from childhood, the seroprevalence being inversely related to socioeconomic background. Primary HSV‐1 infections in children are either asymptomatic or following an incubation period of about 1 week gives rise to mucocutaneous vesicular eruptions. Herpetic gingivostomatitis typically affects the tongue, lips, gingival, buccal mucosa and the hard and soft palate. Most primary oro‐facial HSV infection is caused by HSV‐1, infection by HSV‐2 is increasingly common. Recurrent infections, which occur at variable intervals, typically give rise to vesiculo‐ulcerative lesions at mucocutaneous junctions particularly the lips (herpes labialis). Recurrent HSV‐1 infection within the mouth is uncommon in otherwise healthy patients, although in immunocompromised patients, recurrent infection can be more extensive and/or aggressive. The diagnosis of common herpetic infection can usually be based upon the clinical history and presenting features. Confirmatory laboratory diagnosis is, however, required when patients are, or may be, immunocompromised.     

ALDH1A1在舌癌及淋巴结中的表达及其临床意义

目的:检测乙醛脱氢酶1A1(aldehyde dehydrogenase1A1, ALDH1A1)在舌鳞状细胞癌(tongue squamous cell carcinoma, TSCC)原发灶及颈淋巴结标本中的表达水平,分析其与患者临床病理特征及预后的关系。方法:采用免疫组化SP法检测50例舌鳞状细胞癌原发灶和10例正常舌组织、29例转移淋巴结和9例未转移淋巴结标本中ALDH1A1的表达水平。结果:舌鳞状细胞癌原发灶中ALDH1A1表达高于正常舌组织,差异有统计学意义(P＜0.05);转移淋巴结中ALDH1A1表达高于未转移淋巴结,差异有统计学意义(P＜0.05)。在舌鳞状细胞癌原发灶中,ALDH1A1表达与患者的临床分期、有无淋巴结转移、原发灶大小及组织学分级有关(P＜0.05);在淋巴结中,ALDH1A1表达与患者的临床分期、有无淋巴结转移及原发灶大小有关(P＜0.05)。Kaplan-Meier分析表明舌鳞状细胞癌原发灶ALDH1A1高表达提示不良预后。结论:ALDH1A1的表达与舌鳞状细胞癌的生物学行为及预后密切相关,有望作为舌鳞状细胞癌预后相关因子,可能为舌鳞状细胞癌提供新的治疗靶点。