Acquired bullous diseases of the oral mucosa

Bullous diseases of the oral cavity cause painful erosion. They must be distinguished from aphthae and vesicles which may have a similar presentation. Acute, chronic and congenital conditions are recognized. Acute lesions may involve a polymorphous oral erhythema which has an polymorphous erythematous presentation or toxidermia (Stevens-Johnson syndrome, Lyell syndrome, fixed pigmented erythema). Examination of the skin and history taking are the keys to diagnosis. Patients with chronic bullous diseases may have a congenital condition (bullous epidermolysis or lymphangioma) suggested by the age at onset and the clinical presentation. Acquired chronic bullous diseases include lichen planus and autoimmune bullous diseases. Careful examination is essential to identify mucosal or cutaneous involvement and to obtain a biopsy for histological examination. Search for antibodies deposited in the perilesional mucosa is necessary. Chronic erosive gingivitis is a frequent presentation. Most of the patients have cicatricial pemphigoid, lichen planus, and more rarely pemphigus. The pinch sign is highly discriminative to differentiate the cause of this syndrome. Symptomatic treatment of bullous lesions of the oral cavity include adapted diet and correct and early use of antalgesics.     

Melanoma of the oral mucosa

INTRODUCTION: The oral melanoma (OM) account for 1% of all melanomas. The prognosis is poor despite an adequate locoregional control of the disease. CLINICAL CASE: A 45-year-old woman presented with submandibular lymph nodes, having metastised from a melanoma. Oral cavity examination revealed a pigmented lesion of the gingiva in front of tooth 12, with satellite spots. Surgical treatment, radiotherapy, chemotherapy, and immunotherapy failed and the patient died 16 months after diagnosis. DISCUSSION: Oral melanomas have a poor prognosis probably because they are generally detected late. The most common sites for oral melanomas are the palate and maxillary gingiva. About 30% of OM is preceded by areas of oral pigmentation for several months or years. The prognosis is poor with a 5% to 20% five-year survival rate.     

The value of a cytologic examination in the diagnosis of various diseases of the oral mucosa]

The use of cytological examination in the diagnosis of different conditions of the buccal mucosa is of increasing interest in all branches of medicine. Collection of a specimen is very simple, painless and may always be repeated. Although not having an absolute value, cytological examination may contribute to the diagnosis of a group of inflammatory disorders of the buccal mucosa.     

Cellular schwannoma in the oral mucosa

A case of cellular schwannoma of the oral mucosa in a 34-year-old Japanese man is described. Cellular schwannoma commonly affects soft tissues such as the retroperitoneum and posterior mediastinum, and also bone, but is extremely rare in the oral region. To our knowledge, this is only the second report of oral cellular schwannoma. Histologically, the tumor parenchyma consisted of hypercellular spindle cells with nuclear and cytoplasmic pleomorphism and nuclear palisading resembling Antoni A-type conventional schwannoma, without evidence of Verocay bodies. These features were indicative of cellular schwannoma. Immunohistochemically, the tumor cells were positive for S-100, S-100alpha, S-100beta and vimentin, suggesting that they were of peripheral nervous origin. Furthermore, it is speculated that the tumor was intermediate between a benign and a malignant state, based on the histological features and positivity for S-100alpha.     

Verrucous carcinoma of the oral mucosa]

Verrucous carcinoma is a distinct variant of differentiated squamous cell carcinoma with low-grade malignancy, slow growth and no metastatic potential. Although it has been reported at extraoral sites, the tumor is mostly found in the oral mucosa. Clinically warty tumours with a grey-white, deeply cleaved surface are detected. The special feature of this tumour type is that it appears macroscopically malignant but histologically benign. The diagnosis of verrucous carcinoma may be difficult, since it is often lumped with verrucous hyperplasia or epidermoid carcinoma. In our study the clinical and histological characteristics of 32 cases of verrucous carcinoma of the oral cavity were investigated. The most common site was the mandibular buccal sulcus. The average age amount to 69 years. Adequate surgical excision is considered the treatment of choice. Because of the lack of metastatic spread a systematic treatment of the regional lymph nodes ist not mandatory. The prognosis of verrucous carcinoma is fairly good.     

Clinicopathological discordance for lesions of the oral mucosa

BACKGROUND: The oral cavity is the site of various oral mucosal lesions. The physical examination must be completed by a pathology examination in order to establish a final diagnosis. The objective of our study was to investigate the discordance between clinical and pathological findings concerning lesions oral mucosa. MATERIAL AND METHOD: This study was a cross-sectional epidemiological investigation involving 21 patients seen during a 16-month period. RESULTS: Statistical analysis demonstrated 17 cases of agreement (81%) and 4 cases of discordance (19%) between the clinical diagnosis and pathology diagnosis. DISCUSSION: Such discordance can be operator-dependent or related to sample procurement or handling.     

Precancer stages of the oral mucosa: a review

According to the WHO collaborating centre precancerous lesions and precancerous conditions have to be distinguished. Precancer: BACKGROUND: Erythroplakia is the most dangerous precancerous lesion. It is rare, but may often remain undetected. It will transform into cancer within five years and therefore, has to be excised in every case. Leukoplakias show malignant transformation in 3-45% of the cases. In spite of modern molecular biological and immunohistochemical techniques the clinical appearance and the histological grading of the dysplasia are still most important prognostic factors. Until 1992 every lesion showing signs of moderate and severe dysplasia was excised in our department. Despite this treatment strategy 6.2% of the leukoplakias (n = 161) transformed into cancer. Therefore, we recommend to remove every lesion which does not disappear after eliminating the etiological factors. METHODS: Since 1992 168 leukoplakias were completely removed using the CO2 Laser and underwent histological examination. RESULTS: In 3% of these cases a carcinoma was detected in the leukoplakia; 5% of the lesions recurred. Precancerous condition: The most important precancerous condition, the oral lichen planus is treated in cases of erosive lesions only or if the patient is suffering from the symptoms. Malignant transformation is seen in 1.5% of the patients within 10 to 15 years. Histologically the oral lichen planus does not differ from the oral lichenoid reactions, lesions in contact with amalgam restorations mostly. In these cases a causative treatment with replacement of the amalgam is recommended.