Oral hairy leukoplakia: ultrastructural observations

On the basis of the clinical appearance and the light microscopic findings, we determined 16 biopsy specimens to be possible examples of oral hairy leukoplakia. All 16 specimens were studied by means of electron microscopy. Ten of these specimens contained typical herpes-type viral particles in the epithelial cells of the upper stratum spinosum. None of the specimens contained ultrastructural evidence of human papillomaviruses.     

Oral hairy leukoplakia: ultrastructural features

Ten instances of a white plaque of the lateral tongue unique to homosexual males and referred to as oral hairy leukoplakia were analysed ultrastructurally. The surface epithelial layer exhibited extracellular, intracellular and intranuclear penetration by hyphae of Candida albicans, sometimes accompanied by coccobacilli in the extracellular space. The subcorneal epithelial layer included koilocytoid ballooned cells which had a paucity of cytoplasmic organelles and displayed condensation and emargination of the chromatin. Cells that exhibited these nuclear changes were found to be infected by a herpes-type virus which was visualized by electron microscopy in all ten cases. Clusters of nucleocapsids (86-110 nm in diameter) occurred in the nuclei and enveloped virions (111-175 nm in diameter) occurred in the cytoplasm and extracellular spaces. Virions showed budding from the nuclear envelope. Bundles of tubular structures (20 nm diameter) arranged in parallel occurred in the cytoplasm of some koilocytoid cells. There was no evidence by electron microscopy of the presence of papilloma virus within koilocytotic nuclei.     

Oral hairy leukoplakia: ultrastructural features

Ten instances of a white plaque of the lateral tongue unique to homosexual males and referred to as oral hairy leukoplakia were analysed ultrastructurally. The surface epithelial layer exhibited extracellular, intracellular and intranuclear penetration by hyphae of Candida albicans , sometimes accompanied by coccobacilli in the extracellular space. The subcorneal epithelial layer included koilocytoid ballooned cells which had a paucity of cytoplasmic organelles and displayed condensation and emargination of the chromatin. Cells that exhibited these nuclear changes were found to be infected by a herpes-type virus which was visualized by electron microscopy in all ten cases. Clusters of nucleocapsids (86-110 nm in diameter) occurred in the nuclei and enveloped virions (111-175 nm in diameter) occurred in the cytoplasm and extracellular spaces. Virions showed budding from the nuclear envelope. Bundles of tubular structures (20 nm diameter) arranged in parallel occurred in the cytoplasm of some koilocyloid cells. There was no evidence by electron microscopy of the presence of papilloma virus within koilocytotic nuclei.     

Oral exfoliative cytology.

Oral exfoliative cytology can be a powerful tool for early detection of malignant and premalignant lesions as well as for some viral and fungal infections, if the limitations of the method are thoroughly understood and appreciated by the dental clinician. The rationale for oral cytology is developed and documented, and interpretations of the results are explained. Advantages and disadvantages of this technique are given and indications and contraindications for this diagnostic adjunct are discussed. A simple method involving the use of inexpensive equipment in the office is suggested.     

Oral hairy leukoplakia: a light microscopic and immunohistochemical study

We compared the light microscopic features and immunoperoxidase staining for human papillomavirus antigen of oral hairy leukoplakia (OHL) and flat condylomatous lesions of the cervix. Our findings support the conclusion that OHL and flat condylomatous lesions of the cervix are not similar morphologically or etiologically. Therefore the term koilocyte seems inappropriate to describe the swollen epithelial cells in OHL. The various diagnostic criteria for a diagnosis of OHL were reviewed. On the basis of the review of our cases of OHL and our review of the literature, we conclude that a definitive diagnosis of OHL requires either the biochemical evidence of Epstein-Barr virus or the ultrastructural demonstration of herpesviruses in suspected lesions.     

Oral hairy leukoplakia: diagnosis and management

Oral hairy leukoplakia (HL) is a remarkable lesion associated with Epstein-Barr virus (EBV) found in persons infected with the human immunodeficiency virus. The clinical and histologic features of HL are characteristic and distinctive. However, none of these features are entirely specific for HL, and we consider that the presence of EBV is required for diagnosis in questionable cases. EBV can be demonstrated by means of electron microscopy, immunocytochemistry, or molecular biologic techniques. Therapy directed toward the HL lesion is sometimes indicated; acyclovir is the current drug of preference in such cases.     

Oral lesions mimicking hairy leukoplakia: a diagnostic dilemma

Oral hairy leukoplakia is seen in immunosuppressed persons infected with the human immunodeficiency virus and is a predictor of the development of acquired immunodeficiency syndrome in that population. Over the past 3 years we have seen 16 examples of a lesion that histologically resembles hairy leukoplakia but is found in patients who are not in risk groups for acquired immunodeficiency syndrome. All these specimens tested negative for Epstein-Barr virus DNA and for human papillomavirus antigen. Sera from five of the 16 patients were tested for antibodies to human immunodeficiency virus, and all results were negative. These findings suggest that the diagnosis of hairy leukoplakia cannot be based on histologic criteria alone but should be verified by DNA in situ hybridization for Epstein-Barr virus.     

Oral exfoliative cytology: review of methods of assessment

The use of oral exfoliative cytology in clinical practice declined due to the subjective nature of its interpretation and because there may be only a small number of abnormal cells identifiable in a smear. The more recent application of quantitative techniques, together with advances in immunocytochemistry. have refined the potential role of cytology, stimulating a reappraisal of its value in the diagnosis of oral cancer. This review considers the influence of the quantitative analysis of cytomorphology. DNA, analysis and other tumour markers applied to oral exfoliative cytological samples. These studies indicate that oral cytology may provide an important adjunct in the assessment of the patient with a potentially cancerous oral lesion.     

Diagnosis of oral hairy leukoplakia by ultrastructural examination of exfoliative cytologic specimens

Lingual exfoliative cytologic specimens (scrapings) were obtained from 18 patients positive for human immunodeficiency virus with clinical oral hairy leukoplakia. Buccal mucosal scrapings were obtained from 12 of these patients. The specimens were processed for examination by transmission electron microscopy (TEM). Sixteen (89%) of the lingual specimens revealed infection of keratinocytes by herpes-type virus. There was no evidence of virus infection in the 12 buccal mucosal scrapings. Fungal hyphae were seen by TEM in 14 (78%) of the lingual scrapings and two (17%) of the buccal scrapings. One exfoliative specimen and two biopsy specimens were stained for Epstein-Barr virus DNA with a DNA probe. The demonstration of herpes-type virions by TEM in keratinocytes from a lesion clinically suspected to be hairy leukoplakia provides direct, objective diagnosis. Furthermore, use of exfoliative cytologic specimens provides a clinically simple, noninvasive technique.     

Oral hairy leukoplakia. Early sign of AIDS

Oral hairy leukoplakia (OHL) is a new lesion that appears specifically on the lateral borders of the tongue. It has basically been detected in immunosuppressed male homosexuals and it is associated with the later development of the acquired immunodeficiency syndrome (AIDS) or HIV infection. Epstein-Barr virus has been suggested to be the possible etiological agent. A review of the existing literature pointing out definition, clinical, histopathologic and ultrastructural features, prognostic and treatment is made. Moreover the characteristics of the individuals suffering from it are equally studied. The role of the dentist at detecting the lesion, as well as the importance of its definitive diagnostic are emphasized, in virtue of the effects that may have a bearing on patients.     

Oral hairy leukoplakia among HIV-positive intravenous drug abusers: a clinicopathologic and ultrastructural study

During a prospective investigation of oral lesions of 120 consecutive patients positive for human immunodeficiency virus, belonging to the intravenous drug abuser risk group and other risk categories, we observed hairy leukoplakia (HL) in 23 cases (19%). The median age of the patients was 27 years (range, 20 to 50 years). Twenty patients were men and three were women. All but two of the twenty three patients used intravenous drugs for a median period of 6 years (range, 5 to 18 years) and were involved in several episodes of needle sharing. Eight men were also bisexual, one man was homosexual, and one man was hemophiliac and bisexual. Eleven patients had asymptomatic infection, five had lymphadenopathy syndrome, six had AIDS-related complex, and one had acquired immunodeficiency syndrome. In all patients, HL lesions were localized on the lateral borders of the tongue. In twelve patients, the lesion was unilateral, and in eleven patients, it was bilateral. Microscopically, hyperparakeratosis and the presence of koilocytes were observed in all cases. Surface candidiasis could be detected with staining with periodic acid-Schiff in two thirds of the cases. In four cases, electron microscopy showed the presence of intracellular and extracellular hyphae of Candida albicans in the parakeratin layer associated with coccobacilli in the spaces between surface epithelial cells. The spinous layer included koilocytes, which had a clear cytoplasmic matrix, sparse organelles and tonofilaments, and dispersed chromatin. These cells were found to be infected by a herpes-type virus in all cases examined. There was no ultrastructural evidence of human papillomavirus in the nuclei of the epithelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)     

Oral hairy leukoplakia in HIV infection: a diagnostic pitfall.

Twenty-nine human immunodeficiency virus (HIV)-infected patients with white, nonremovable lesions on the lateral border of the tongue, clinically suggestive of oral hairy leukoplakia (HL), were studied. In particular, the value of local antifungal therapy in establishing the diagnosis of HL was investigated. In 15 patients (52%) the lesions could be ultimately attributed to a candidal infection of the tongue. In 10 of the remaining 14 patients, a biopsy was obtained from lesions persisting after local antifungal treatment. In all biopsy specimens, the diagnosis of HL was confirmed by histopathologic examination and the demonstration of Epstein-Barr virus DNA by polymerase chain reaction, Southern blot hybridization, and DNA in situ hybridization. The present data confirm that the diagnosis of HL in HIV-infected patients cannot be reliably made on clinical criteria alone, but requires histopathologic confirmation including the demonstration of Epstein-Barr virus DNA, preferably by DNA in situ hybridization. However, with regard to the differential diagnosis of white, nonremovable lesions on the lateral border of the tongue in HIV-infected patients, the present study suggests that persistence of lesions after local antifungal therapy is highly suggestive of HL.     

Oral hairy leukoplakia in an HIV-seronegative heart transplant patient

While oral hairy leukoplakia has been observed predominantly in patients with HIV-infection at various stages, recent reports have shown that HL may also occur in patients immunosuppressed for other reasons. This report describes oral hairy leukoplakia in a heart transplant recipient with negative HIV serology. The histopathologic diagnosis of HL was confirmed by immunohistochemical detection of EBV-VCA in the surface epithelium of the lesion and by negative staining electron microscopy.