Humans ; Leukoplakia, Oral/therapy*

Humans ; Leukoplakia, Oral ; diagnosis ; Mouth Diseases ; diagnosis

Dyskeratosis congenita is a rare multisystemic genodermatosis of ectodermal dysplasia, and is characterized by the diagnostic triad consisting of reticulated hyperpigmentation, dystrophic nails, and leukoplakia. Complications such a malignancy and bone marrow involvement will be predisposition. A 44-year-old male was presented with reticulated hyperpigmentation, nail dystrophy, oral leukoplakia, mild hyperkeratosis of the palms and soles, and short stature. His brothers were presented with reticulated hyperpigmentation and nail dystrophy, and underwent a surgical operation due to oral cavity cancer. The histopathological findings taken from the reticulated lesion showed epidermal thinning and a mild inflammatory cell infiltration with melanophages in the dermis. We report a typical case of dyskeratosis congenita in a male with family history.
Adult ; Bone Marrow ; Dermis ; Dyskeratosis Congenita* ; Ectodermal Dysplasia ; Humans ; Hyperpigmentation ; Leukoplakia ; Leukoplakia, Oral ; Male ; Mouth ; Siblings

BACKGROUND AND OBJECTIVES: Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity. SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites. RESULTS: There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant. CONCLUSION: For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.
Biopsy ; Early Diagnosis ; Head ; Humans ; Leukoplakia ; Leukoplakia, Oral ; Methods ; Mouth ; Neck ; Parakeratosis ; Retrospective Studies ; Tongue

Oral immunosuppression caused by smoking creates a microenvironment to promote the occurrence and development of oral mucosa precancerous lesions. This study aimed to investigate the role of metabolism and macrophage polarization in cigarette-promoting oral leukoplakia. The effects of cigarette smoke extract (CSE) on macrophage polarization and metabolism were studied in vivo and in vitro. The polarity of macrophages was detected by flow cytometric analysis and qPCR. Liquid chromatography-mass spectrometry (LC-MS) was used to perform a metabolomic analysis of Raw cells stimulated with CSE. Immunofluorescence and flow cytometry were used to detect the polarity of macrophages in the condition of glutamine abundance and deficiency. Cell Counting Kit-8 (CCK-8), wound-healing assay, and Annexin V-FITC (fluorescein isothiocyanate)/PI (propidium iodide) double-staining flow cytometry were applied to detect the growth and transferability and apoptosis of Leuk-1 cells in the supernatant of Raw cells which were stimulated with CSE, glutamine abundance and deficiency. Hyperkeratosis and dysplasia of the epithelium were evident in smoking mice. M2 macrophages increased under CSE stimulation in vivo and in vitro. In total, 162 types of metabolites were detected in the CSE group. The metabolites of nicotine, glutamate, arachidic acid, and arginine changed significantly. The significant enrichment pathways were also selected, including nicotine addiction, glutamine and glutamate metabolism, and arginine biosynthesis. The results also showed that the supernatant of Raw cells stimulated by CSE could induce excessive proliferation of Leuk-1 and inhibit apoptosis. Glutamine abundance can facilitate this process. Cigarette smoke promotes oral leukoplakia via regulating glutamine metabolism and macrophage M2 polarization.
Animals ; Glutamine ; Leukoplakia, Oral ; Macrophages ; Mice ; Smoking ; Tumor Microenvironment

OBJECTIVES: To study the hypoxia response gene and microRNA (miRNA) expression profiles in the pathogenesis and progression of oral leukoplakia (OLK). METHODS: Affymetrix GeneChip human transcriptome array 2.0 was used to detect the transcriptome of normal mucosa, low-risk OLK, high-risk OLK, and early squamous cell carcinoma (SCC). Gene ontology function analysis was used to screen genes and key miRNAs whose biological role is hypoxia response. Quantitative reverse transcription polymerase ch-ain reaction (qRT-PCR) was used to verify the expression of hypoxia response genes and miRNAs. RESULTS: A total of 7 different genes of hypoxia response between normal mucosa and low-risk OLK, 10 genes between low-risk and high-risk OLK, and 21 genes between high-risk OLK and SCC were identified. The results of qRT-PCR showed that the expression of hypoxia-inducible factor 1α, chemokine cc-motif ligand 2, and matrix metalloproteinase 3 mRNA and miR-21 in normal mucosa, OLK, and SCC increased in a stepwise manner. The expression difference between OLK and SCC was statistically significant and consistent with the results of transcriptome array. CONCLUSIONS The hypoxia response gene and related miRNA play roles in the development and progression of OLK.
Carcinogenesis ; Humans ; Hypoxia ; Leukoplakia, Oral ; MicroRNAs ; Mouth Neoplasms ; Transcriptome

Objective: To evaluate the inter-observer agreement of the severity of oral epithelial dysplasia in oral leukoplakia, providing a theoretical basis for the development of a more objective grading system. Methods: This study included 60 digital pathological slides of oral leukoplakia from Oral Medicine Department of West China Hospital of Stomatology, Sichuan University, and 239 tissue microarray images of oral leukoplakia from State Key Laboratory of Oral Diseases, Sichuan University, to evaluate the agreement of grading. Besides, 1 000 patches were generated from the 60 digital pathological slides and were divided into 500 small-sized patches (224 pixel×224 pixel) and 500 large-sized patches (1 024 pixel×1 024 pixel), to evaluate the agreement of feature detection. Gradings and feature detections were completed by three pathological experts from the oral pathology departments of two Grade 3, Class A stomatological hospitals in China. Kappa coefficient was used to quantify the inter-observer agreement among pathologists. Results: Minimal agreement was found in the grading of oral epithelial dysplasia among pathologists (Kappa=0.30 in the pathological slide group, Kappa=0.30 in the tissue microarray group). None agreement was found in feature detection within the small-sized patches group (median Kappa=0.14 for architectural features, median Kappa=0.18 for cytological features), and minimal agreement was found in feature detection within the large-sized patches group (median Kappa=0.25 for architectural features, median Kappa=0.25 for cytological features). Conclusions: Generally, the agreement of grading and feature detection of oral epithelial dysplasia in oral leukoplakia is poor. Development of a more objective grading system of oral epithelial dysplasia based on artificial intelligence may be helpful to improve the agreement.
Artificial Intelligence ; China ; Humans ; Leukoplakia, Oral ; Observer Variation ; Precancerous Conditions

OBJECTIVETo collect evidence in diagnosis and treatment of oral mucosal diseases.

METHODSThe Cochrane library (Issue 3, 2009) was searched to get the full texts of published related Cochrane systematic reviews. The results were summarized for recommendation to dentists. The current status of evidence based medicine in this field was analyzed.

RESULTSReliable evidence for management of oral submucous fibrosis is still limited; amifostine, hydrolytic enzymes, ice chips and Chinese medicine may be effective in preventing oral mucositis for patients with cancer receiving radiotherapy or chemotherapy; the evidence in treating oral mucositis with allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin or human placentral extract for patients with cancer receiving treatment is weak and unreliable yet; there is evidence that acyclovir is efficacious in prevention and treatment of herpes simplex virus infections in patients being treated for cancer; there is strong evidence that drugs absorbed or partially absorbed from the gastrointestinal tract prevent oral candidiasis in patients receiving treatment for cancer; relapses and adverse effects are common in using beta carotene, lycopene, vitamin A or retinoids to treat oral leukoplakia; only some weak evidence is provided in using cyclosporines, retinoids, steroids or phototherapy for treating oral lichen planus; the evidence about acyclovir for treating primary herpetic gingivostomatitis is insufficient; there is little research evidence for treatment of burning mouth syndrome.

CONCLUSIONIt is essential to raise the quality of design and conduction of clinical trials in the field of oral mucosal disease to provide solid bases for systematic review, so that to improve evidence based treatment of these diseases.

Humans ; Leukoplakia, Oral ; genetics ; Lichen Planus, Oral ; genetics ; Polymorphism, Single Nucleotide

Oral leukoplakia is the most common premalignant lesion and malignant transformation has been reported from verrucal lekoplakia. Homogenous, benign leukoplakia develops into a line of squamous cell carcinoma such as verrrucous carcinoma, papillary squamous cell carcinoma and invasive squamous cell carcinoma. Early diagnosis and intervention of premalignant leukoplakia is up-most important to prevent transformation into a oral squamous cell carcinoma. Any change in surface, size and color warrants repeated biopsy. If verrucous carcinoma is evidently derived from the previous leukoplakia, wide surgical excision and periodic follow up is needed. Surgically removed lesion of leukoplakia has the tendency to recur. Follow-up is very important to patient and clinician. Although many therapies have been reported to oral leukoplakia and verrucal carcinoma, accepted treatment principle is not exist so far. But surgical removal is recommended as the treatment of choice.]]>
Biopsy ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Early Diagnosis ; Follow-Up Studies ; Humans ; Leukoplakia ; Leukoplakia, Oral