Diagnosis of Oral Hairy Leukoplakia: The Importance of EBV In Situ Hybridization.

Luana L Martins,Juliana Bertoldi Franco,Karem L Ortega,Paulo Henrique Braz-Silva,José Henrique F Rosseto,Natália Silva Andrade

doi:10.1155/2017/3457479

Luana L Martins, Juliana Bertoldi Franco + Show 4 more

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https://doi.org/10.1155/2017/3457479

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Abstract

Oral hairy leukoplakia (OHL) is caused by the Epstein-Barr virus (EBV), which has been related to HIV infection. In situ hybridization (ISH) is the gold-standard diagnosis of OHL, but some authors believe in the possibility of performing the diagnosis based on clinical basis. The aim of this study is diagnose incipient lesions of OHL by EBV ISH of HIV-infected patients and the possible correlations with clinical characteristics of the patients. Ninety-four patients were examined and those presenting with clinical lesions compatible to OHL were submitted to biopsy prior to EBV ISH. Twenty-eight patients had lesions clinically compatible to the diagnosis of OHL, but only 20 lesions were confirmed by EBV ISH. The patients with OHL had a mean age of 41.9 years and were HIV-infected for 11.2 years, on average, including CD4 count of 504.7 cells/mm3 and log10 viral load = 1.1. Among the quantitative variables, there was a statistically significant correlation with age only (P = 0.030). In conclusion, the presence of OHL in patients with HIV/AIDS results in changes in the epidemiological characteristics of the disease, and this fact allied with subtle clinical-morphological features makes clinical diagnosis very difficult. Therefore, EBV ISH is important for a definitive diagnosis of OHL.

Highlights

60 percent of the HIV-infected individuals and 80 percent of those with acquired immunodeficiency syndrome (AIDS) present oral manifestations such as oral candidiasis, oral hairy leukoplakia (OHL), Kaposi’s sarcoma, non-Hodgkin’s lymphoma, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis [1, 2].The presence of oral candidiasis and OHL within the oral cavity suggests HIV infection, but is possibly one of the first signs of development into AIDS in the HIV-infected individual [3, 4].OHL represents an opportunistic infection related to the Epstein-Barr virus (EBV), being present in patients infected by HIV [3, 5, 6]
According to Greenspan et al “Puzzled by these findings, we tentatively applied to this lesion the name oral hairy leukoplakia (HL) because of the white color and corrugated or shaggy appearance of the lateral tongue seen many cases” [2]
The mean duration of HIV infection was 12.4 years, with 63.8% developing AIDS (36.2% were in category B2 and 63.8% were in category C3 of the 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults)

Summary

Introduction

60 percent of the HIV-infected individuals and 80 percent of those with acquired immunodeficiency syndrome (AIDS) present oral manifestations such as oral candidiasis (erythematous and pseudomembranous), oral hairy leukoplakia (OHL), Kaposi’s sarcoma, non-Hodgkin’s lymphoma, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis [1, 2].The presence of oral candidiasis and OHL within the oral cavity suggests HIV infection, but is possibly one of the first signs of development into AIDS in the HIV-infected individual [3, 4].OHL represents an opportunistic infection related to the Epstein-Barr virus (EBV), being present in patients infected by HIV [3, 5, 6]. According to Greenspan et al “Puzzled by these findings, we tentatively applied to this lesion the name oral hairy leukoplakia (HL) because of the white color and corrugated or shaggy appearance of the lateral tongue seen many cases” [2]. This lesion is commonly found in the lateral border of the tongue. The histopathological characteristics are not exclusive to this lesion, which may include hyperkeratosis, epithelial hyperplasia, ballooning degeneration, and discrete or even absent inflammatory mononuclear cells infiltrate For this reason, the criteria used for the final diagnosis of OHL have been always discussed [2, 7]. Previous study published by our group showed that among 36 cases of OHL diagnosed in clinical and histopathological basis, only 80.55% were EBV positive, confirming the previous diagnosis [8]

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