Evaluation on Malignant Transformation of Oral Lichen Planus

目的：口腔扁平苔藓（oral lichen planus,OLP)是否属于癌前病变，至今仍存在较大的争论。本文的目的在于评估OLP的癌变性质。方法：报告1995－2002年之间9例OLP的癌变病例。结果：5例OLP患者同时或继发为口腔鳞状细胞癌，1例为疣状癌，3例为上皮异常增生。其中7例发生在原OLP存在的部位，1例发生在其它部位，1例在同一部位同时存在OLP和鳞状细胞癌。OLP的癌变常发生在糜烂型和萎缩型，发生于颊粘膜，舌或牙龈。根据所制定的OLP的诊断及癌变标准，4例OLP患者发生了癌变。结论：OLP具有一定的癌变潜力，对OLP患者应每年随访2－4次，尤其是对发生在颊粘膜，舌或牙龈的糜烂型和萎缩型的患者。     

端粒酶逆转录酶mRNA在口腔扁平苔藓中的表达

目的 探讨端粒酶逆转录酶(TERT)mRNA在口腔扁平苔藓(OLP)中的表达及临床意义。方法 采用原位杂交(ISH)的方法,检测了20例糜烂型扁平苔藓(erosive oral lichen planus,eOLP)、20例非糜烂型扁平苔藓(non-erosive oral lichen planus,neOLP)和12例正常口腔黏膜TERT mRNA的表达。结果 糜烂型OLP的TERT mRNA阳性率明显高于非糜烂型OLP的TERT mRNA阳性率(P<0.05)。糜烂型OLP与非糜烂型OLP染色强度相比有统计学意义(P<0.05)。结论 糜烂型OLP的上皮细胞可能比非糜烂型OLP的上皮细胞处于更高的增殖状态。     

DNA ploidy in oral lichen planus,determined by image cytometry

J Oral Pathol Med (2010) 39 : 206–211 Background: The objective of this study was to use image cytometry to determine the degree and frequency of DNA ploidy in biopsies of reticular and atrophic‐erosive oral lichen planus and to analyze 14 karyometric measurements of the nuclei of epithelial cells from each specimen. Methods: A total of 40 slides were analyzed, each of them representing one biopsy of one oral lichen planus (OLP) lesion from each one of the 40 patients (cases) studied. Specimens were embedded in paraffin and comprised 20 slides of reticular oral lichen planus (group R) and 20 slides of atrophic‐erosive oral lichen planus (group AE). Results: Group R, the reticular lichen samples, had 18 diploid cases and two aneuploid cases. Group AE, the atrophic‐erosive lichen samples, had 10 diploid cases, one tetraploid case, and nine aneuploid cases. Of the 14 karyometric measurements of the nuclei of OLP epithelial cells analyzed, the group R mean values for mean density and minimum density were significantly greater than the group AE mean values, and mean roundness in group AE was significantly greater than in group R (t‐test: P < 0.05). Conclusions: The most common degree of DNA ploidy in OLP lesions was diploidy. Comparing the two groups (chi‐square test of association P = 0.021) demonstrated that diploidy was associated with the reticular clinical form of OLP, while aneuploidy was associated with the atrophic‐erosive clinical form of oral lichen planus.     

A clinical study of 674 patients with oral lichen planus in China

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular, atrophic or erosive. Although OLP is a relatively common disorder, the reports comprising large numbers of OLP patients with specific character are lacking in the literature. The purpose of this paper was to describe the clinical characteristics of OLP in 674 Chinese patients. METHODS: A total of 674 charts of patients with histologically confirmed OLP were collected from Stomatological Hospital of Wuhan University between 1963 and 2003. RESULTS: Of the 674 patients, 65.9% were women and 34.1% were men. The most common clinical presentation was the reticular type (51.3%), and symptomatic OLP was noted in 67.5% of the patients, mainly in those with the erosive form. The erosive presentations showed significantly longer duration, more sites affected and a much greater old patients predominance than reticular or atrophic ones. About 90.9% of the patients had multiple oral sites of involvement and isolated lower lip lichen planus were observed in 60 cases (8.9%) and isolated gingiva lichen in only one case (0.2%). Skin involvement of lichen planus was found in 11.4% of patients. No statistically significant differences could be identified between OLP and diabetes, cardiovascular disease, smoking or alcohol use. Precipitating factors that resulted in an exacerbation of the disease were frequently noted and included foods, stress, dental cusp and poor oral hygiene. The transformation of OLP into malignancy was observed in four patients at sites previously diagnosed by clinical examination as erosive or atrophic lichen planus. CONCLUSIONS: Patients with OLP in China usually present with distinctive clinical morphology and characteristic distribution and few may display lesions with a confusing array of forms mimicking other diseases. A long time follow up is of utmost importance to detect its malignant transformation.     

端粒酶逆转录酶mRNA在OLP和OSCC中的表达

目的：探讨端粒酶逆转录酶（TERT）mRNA在口腔扁平苔藓（OLP）和口腔鳞状细胞癌（OSCC）中的表达以及在OLP癌变过程中的作用。方法：应用mRNA原位杂交法对正常口腔黏膜12例,非糜烂型OLP20例,糜烂型OLP20例及OSCC20例,进行hTERTmRNA的检测。结果：正常口腔黏膜、非糜烂型OLP、糜烂型OLP及OSCC中hTERTmRNA阳性表达率分别为8.33％（1／12）、15％（3／20）、45％（9／20）、80％（16／20）。其中,除正常口腔黏膜与非糜烂型OLP中hTERT mRNA阳性率无显著性差异外,其余各组间均有显著性差异（P〈0.05）。而且,正常口腔黏膜与非糜烂型OLP的hTERT mRNA染色强度明显低于糜烂型OLP及OSCC（P〈0.05）。结论：hTERT mRNA可能在糜烂型OLP的癌变过程起着一定的作用。     

口腔白斑、扁平苔藓细胞凋亡相关蛋白Bax表达的研究

目的 :探讨口腔白斑、扁平苔藓的癌变机理及发病机制。方法 :采用免疫组化法检测 10例正常口腔黏膜上皮 ,18例扁平苔藓 ,2 3例白斑 ,2 2例口腔鳞癌上皮组织中凋亡相关蛋白Bax的表达水平。结果 :白斑中上皮单纯增生、轻度、中度不典型增生和低分化鳞癌及糜烂型扁平苔藓的Bax蛋白显过度表达 ,与正常口腔黏膜上皮相比有显著性差异。结论 :Bax参与了口腔白斑癌变的早期过程 ,Bax的表达水平可作为临床监测白斑癌变倾向的参考指标。扁平苔藓的发病机制可能与细胞免疫亢进刺激Bax过度表达诱导角朊细胞凋亡有关 ,扁平苔藓的癌变机理有待进一步研究     

口腔扁平苔藓人乳头瘤病毒的检测

目的 探讨口腔扁平苔藓（OLP）和人乳头瘤病毒（HPV）的关系，从而为确定OLP的原因，诱因和发病机理提供理论依据。方法 应用通用引物（General Primer,GP)介导的PCR技术检测OLP和正常口腔黏膜的HPVDNA，并对HPV－16DNA进行特异性检测。结果 30例OLP检测到25例HPV－6，11，33DNA阳性，而对照组检测到5例，两者相比有显著性差异（P＜0．05）；OLP组检测到3例HPV－16，18DNA阳性，对照组1例，两者相比无显著性差异（P＞0．05）。结论 OLP是以低危型HPV感染为主，其中糜烂型OLP可检测到较高高危HPV16 DNA。因此，对OLP尤其是糜烂型OLP要进行HPV的检测，从而进行有效治疗。     

Serum antioxidant micronutrient levels in oral lichen planus

The aim of this study was to elucidate any association between oral lichen planus (OLP) and serum antioxidant micronutrients by a population-based case-control study. A total of 9536 subjects were examined, and 62 (58 reticular, 4 atrophic and erosive) diagnosed with OLP at referral facilities were compared with four controls per case (n=248) selected among disease-free subjects matched for age and sex. Serum levels of micronutrients (retinol, alpha-tocopherol, zeaxanthin/lutein and cryptoxanthin, lycopene, alpha-carotene and beta-carotene) were estimated by the high performance liquid chromatography (HPLC) method. Among cases, mean serum retinol level (2.820+/-0.849 micromol/l) was significantly higher compared with that of controls (2.562+/-0.735 micromol/l) (P<0.05). No significant differences were noted in carotenoid levels examined in this study, except for a lower level of lycopene found in atrophic/erosive OLP cases. The results of this study suggest that low serum retinol or carotenoid levels are not risk factors for occurrence of lichen planus, and any specific benefits of antioxidant micronutrients cannot be claimed for this inflammatory disorder.     

口腔癌前病变细胞凋亡状况及Bcl-2、Bax表达的研究

目的 :通过对口腔白斑、扁平苔藓病变发展及癌变过程中细胞凋亡状况和凋亡相关蛋白表达水平的研究 ,探讨口腔白斑、扁平苔藓的癌变机理及病变机制。方法 :采用原位末端转移酶标记法及免疫组化法 ,观察分析 10例正常口腔黏膜上皮 ,18例扁平苔藓 ,2 3例白斑 ,2 2例口腔鳞癌上皮组织中细胞凋亡状况及凋亡相关蛋白Bcl- 2、Bax的表达水平。结果 :上皮 (轻 ,中 ,重 )不典型增生 ,鳞癌及糜烂型扁平苔藓的凋亡指数均高于正常 (P <0 .0 1)。Bcl- 2在白斑、扁平苔藓上皮细胞层无异常表达 ,但在扁平苔藓固有层淋巴细胞浸润处过度表达 ,在鳞癌组织中显高表达 (P <0 .0 1)。Bax在上皮单纯增生、轻、中度不典型增生和鳞癌及糜烂型扁平苔藓组织中显过度表达 (P <0 .0 5 )。结论 :白斑、扁平苔藓的病变发展及癌变过程中 ,上皮细胞凋亡状况发生了改变 ,Bax参与了白斑癌变的早期事件。扁平苔藓的发病机制与Bcl- 2、Bax在特定部位的过度表达有关     

Oral lichen planus and hepatitis C virus (HCV) infection: is there a relationship? A report of 10 cases

Ten patients are reported suffering from oral lichen planus (OLP) associated with chronic liver diseases linked to HCV. All patients were affected by varieties of erosive oral lichen planus. In six of these 10 patients the diagnosis of HCV was made as a result of the OLP diagnosis and four of them had unknown, but severe, chronic liver disease. These preliminary data support the possible existence of a relationship between oral erosive lichen planus and HCV infection.     

口腔扁平苔藓组织中表皮生长因子及其受体表达变化的研究

目的探讨表皮生长因子(EGF)、表皮生长因子受体(EGFR)及两种原癌基因c-fos、c-jun,在口腔扁平苔藓中的基因表达、蛋白含量变化及其生物学意义。方法选择新鲜组织标本31例,包括糜烂型扁平苔藓10例、网状型扁平苔藓12例和正常口腔黏膜9例,使用逆转录聚合酶链反应技术(RT-PCR)检测EGF、EGFR、c-fos和c-jun基因在不同组织中的表达;同时使用免疫组化方法比较这4种蛋白在不同组织中的定位和表达量的变化。结果糜烂型扁平苔藓EGFR基因的mRNA和蛋白含量分别为(55.9±23.1)%、(71.1±10.1)%,均明显高于网状型扁平苔藓及正常口腔黏膜组织(P<0.05)。糜烂型扁平苔藓中的c-fos和c-jun基因表达呈相同的变化规律,两种基因的mRNA含量均显著高于正常口腔黏膜。糜烂型扁平苔藓的C-fos、C-jun蛋白的阳性细胞率分别是正常黏膜的1.3和1.5倍,蛋白含量明显高于正常口腔黏膜(P<0.01)。结论糜烂型扁平苔藓的癌变率可能大于网状型扁平苔藓,其中EGF及其受体引导的信号传导通路可能起着十分重要的作用。     

Oral lichen planus: Malignant potential and diagnosis

Oral lichen planus (OLP) is one of the most common diseases of the oral mucosa. Clinically, it has specific and clearly identifiable features; bilateral symmetric presentation showing a lace-like network of fine white lines (known as Wickham's striae) is an essential element of OLP even if the lesion exhibits a mainly atrophic and erosive pattern. There are various lesions that resemble OLP clinically and histologically. These lesions are widely referred to as lichenoid reactions or lichenoid lesions (OLLs). OLLs include contact hypersensitivity to dental materials, drug-induced lichenoid lesions, lichenoid reactions in chronic graft-versus-host disease, and other lesions that resemble OLP. The risk of malignant transformation of OLP is the subject of ongoing debate in the literature. Some authors have suggested that only OLLs, but not OLP, are of a premalignant nature and thus, should be categorized as “other dysplastic conditions.” Contrary to this suggestion, many cases of oral squamous cell carcinoma (OSCC) developing in patients with OLP presenting with no epithelial dysplasia have been reported. In addition, it has been reported that multiple events including multifocal dysplasia and/or OSCC subsequently occurred in some patients with OLP, suggesting possible field cancerization in OLP. In this paper, differential diagnosis between OLP and OLLs and their malignant potential are reviewed.     

热休克蛋白60、70在口腔扁平苔藓中表达的研究

目的　探讨热休克蛋白 (heatshockprotein ,HSP) 60和HSP70在口腔扁平苔藓病变中的作用。方法　对 62例口腔扁平苔藓、1 0例正常口腔粘膜、2 1例慢性盘状红斑狼疮、1 0例粘膜良性淋巴组织增生病 ,46例白斑进行免疫组织化学SP法染色 ,分析HSP60、HSP70在口腔扁平苔藓中的表达 ;对 1 2例口腔扁平苔藓和 5例正常粘膜进行逆转录PCR实验 ,观察HSP60、HSP70mRNA的变化。结果　HSP60在口腔扁平苔藓病损区的表达较其他各组显著增强 ,差异有显著性 (P <0 0 0 1 )。HSP70在糜烂型口腔扁平苔藓病损区的表达下调。RT PCR结果显示 ,HSP60、HSP70mRNA表达增强。结论　HSP60及HSP70在口腔扁平苔藓的发病中起重要作用     

Oral lichen planus and dental hygiene: a case report

To cite this article:
Int J Dent Hygiene 9 , 2011; 163–166
DOI: 10.1111/j.1601‐5037.2010.00454.x
Scattarella A, Petruzzi M, Ballini A, Grassi FR, Nardi GM. Oral lichen planus and dental hygiene: a case report. Abstract: Background: The presence of atrophic‐erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease. Case report: A patient suffering from a mixed atrophic‐erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance. Discussion: The management of the patient suffering from gingival atrophic‐erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.     

血管内皮生长因子在口腔扁平苔藓及鳞癌组织中的表达

目的探讨血管内皮生长因子在口腔扁平苔藓癌变及发病机制中的作用。方法采用免疫组化法,检测10例正常口腔黏膜、25例口腔扁平苔藓、11例口腔扁平苔藓伴不典型增生及14例口腔鳞癌,上皮组织中血管内皮生长因子的表达水平。结果血管内皮生长因子在24例口腔扁平苔藓标本中阳性表达2例,阴性表达22例,阳性表达率明显低于其它3组（P〈0.05）。扁平苔藓伴不典型增生及口腔鳞癌中血管内皮生长因子的阳性表达率均高于正常黏膜（P〈0.05）。结论血管内皮生长因子的表达异常可能在口腔扁平苔藓的发生发展及癌变的过程中起作用。     

表皮生长因子受体在口腔扁平苔藓组织中的表达

目的探讨口腔扁平苔藓(OLP)癌变及发病机制。方法采用免疫组化法检测10例正常口腔黏膜,16例扁平苔藓,10例扁平苔藓伴不典型增生,14例口腔鳞癌上皮组织中表皮生长因子受体(EGFR)的表达水平。结果OLP伴不典型增生组织中EGFR的表达高于正常黏膜(P<0.05)。口腔鳞癌中EGFR的表达高于正常黏膜及OLP(P<0.01)。结论EGFR的过表达在OLP的发生、发展过程中可能起着重要的作用。     

OLP组织中Smad7蛋白的表达研究

目的:检测Smad7蛋白在口腔扁平苔藓(OLP)组织中的表达及分布,探讨其在OLP发病机制中的作用。方法:采用免疫组化SABC法,用Smad7兔抗人多克隆抗体检测60例OLP病变组织及10例正常口腔黏膜组织中Smad7蛋白的表达及分布。结果:Smad7在OLP病变组织有明显的阳性表达,而在正常口腔黏膜组织中阴性表达(P<0.05)。结论:Smad7蛋白在OLP病变组织中高表达,其在OLP发病机制中有重要作用。     

Oral lichen planus – retrospective study of 563 Croatian patients

Objectives: To investigate the epidemiological and clinical characteristics of oral lichen planus (OLP) in a group of Croatian patients seen between 2006 and 2012. Study Design: A group of 563 patients with a diagnosis of OLP was retrospectively reviewed in our clinic. Data regarding age, gender, medical history, drugs, smoking, alcohol, chief complaint, clinical type, localization, histology, treatment and malignant transformation were registered. Results: Of the 563 patients, 414 were females and 149 were males. The average age at the diagnosis was 58 (range 11-94). The most common site was buccal mucosa (82.4%). Most of our patients did not smoke (72.5%) or consume alcohol (69.6%). Patients reported oral soreness (43.3%), mucosal roughness (7%), xerostomia (3%), gingival bleeding (2%) and altered taste (0.5%) as the chief complaint, while almost half of them were asymptomatic (44.2%). The most common types of OLP were reticular (64.8%) and erosive (22.9%). Plaque-like (5.7%) atrophic/erythemtous (4.3%) and bullous (2.3%) type were also observed. Malignant transformation rate of 0.7% was recorded. Conclusions: OLP mostly affects non-smoking middle-aged women. Buccal mucosa is the most commonly affected site. In almost half of the cases patients are asymptomatic. In spite of the small risk for malignant transformation all patients should be regularly monitored. Key words:Oral lichen planus, malignant transformation, epidemiology, retrospective study.     

Anti‐angiogenic therapy (bevacizumab) in the management of oral lichen planus

Oral lichen planus (OLP), a mucocutaneous chronic inflammatory disease, is conventionally managed using topical corticosteroid therapy. Given the fact that OLP is strongly linked to angiogenesis, anti‐angiogenic drugs, such as bevacizumab, might be introduced as an alternative treatment for contraindicated, non‐responsive patients. The aim of the present study was to report the short‐term effectiveness and safety of intralesional bevacizumab injection in the management of atrophic/erosive OLP. A case series study was conducted in patients with atrophic/erosive OLP in the buccal mucosa, assigned to receive either 2.5 mg of bevacizumab, by intralesional injection (n = 20, test), or topical 0.1% triamcinolone acetonide ointment (n = 20, control). The size, score, and pain intensity of the lesions were assessed pre‐ and post‐treatment. Tissue biopsies were collected for histopathologic, immunohistochemical, and ultrastructural examination. After 1 wk, the test group had significant reductions both in lesion seize and in pain scores compared with controls. A marked decrease in vascular endothelial growth factor (VEGF) and interleukin‐8 immunoexpression was noted in tissue biopsies from bevacizumab‐treated lesions compared with control lesions. Furthermore, ultrastructural examination of OLP tissue specimens revealed significant healing signs associated with bevacizumab treatment. Short‐term data suggest that intralesional bevacizumab injection effectively and safely achieved resolution of atrophic/erosive OLP lesions without disease exacerbations during a 3‐month follow‐up period.     

Distribution of ABO blood group substances in various types of oral lichen planus

Formalin-fixed, paraffin-embedded tissue sections of fifty oral lichen planus lesions including hypertrophic, atrophic and erosive types, were examined by an immunofluorescent technique for the presence of the ABO blood group antigens. The antigen activity in lichen planus lesions was compared with the reactivity of normal human and Rhesus monkey oral mucosa as controls, and the reactivity of adjacent normal epithelium in the same specimen. A difference in the distribution of the blood group substances was observed in the three different types of oral lichen planus. The hypertrophic showed the strongest staining reaction approaching that of the normal, whereas a decrease in quantity of blood group substances was seen in the atrophic, and a tendency to complete loss in the erosive type. There was a marked tendency for loss of staining to be greater in lesions from older patients; this could be related to the greater frequency of atrophic and erosive lesions in the elderly.