Oral Lesions In Patients Research Articles

Oral tylosis: a re-appraisal

The oral lesions in patients with tylosis (palmoplantar keratoderma) associated with oesophageal cancer, are evaluated, based on their clinical presentation, histological features and long term follow-up. The terminology of these lesions is discussed, together with a proposed reclassification of some forms of palmoplantar keratoderma.

Oral lesions in patients with chronic GVHD

Oral lesions in patients with chronic GVHD

Characteristics of the oral lesions in patients with cutaneous recurrent erythema multiforme

Erythema multiforme may be recurrent and the oral cavity is often affected. A series of 82 patients with unequivocal recurrent cutaneous erythema multiforme were examined to determine the incidence and nature of oral lesions. Seventy per cent of patients had oral lesions, comprising multiple, large, shallow, extremely painful and debilitating ulcers, which affected the entire oral mucosa in over 20%. The buccal mucosa and tongue were the most frequently affected sites in the remainder and the lips were affected in 13% of patients. Lesions generally lasted for 1-3 weeks. In over 60% of cases these attacks followed an episode of herpes simplex virus infection during the preceding fortnight. Recurrent attacks showed a different site distribution from the initial attacks, with a greater proportion having genital as well as skin and oral mucosal involvement. Detailed case histories of five patients are presented to illustrate the role of azathioprine in treating oral lesions and to document a familial case of recurrent erythema multiforme, with severe mucosal involvement.

Oral lesions in systemic lupus erythematosus: Do ulcerative lesions represent a necrotizing vasculitis?

It has been suggested that oral lesions in patients with systemic lupus erythematosus (SLE) may be grouped clinically as erythema, discoid lesions, or oral ulcerations. Oral ulcerations have been said to foretell a severe systemic disease flare and the proposal that oral ulcers represent a mucosal vasculitis has been suggested to explain this hypothesis. Our objective was to test the hypothesis that oral ulcers in patients with SLE result from vasculitis. We studied 10 patients with American College of Rheumatology (ACR) criteria for a diagnosis of SLE who had oral lesions of lupus (six prospectively and four retrospectively) clinically and by routine and immunofluorescence microscopy. Biopsy specimens were reviewed in a single-blinded fashion. In our patients, no oral lesion, regardless of morphology, demonstrated vasculitis histologically. All lesions demonstrated an interface mucositis. Our data strongly contradict the hypothesis that leukocytoclastic vasculitis explains a possible unproven correlation between oral ulceration and disease flares in patients with SLE.

Oral condyloma lesions in patients with extensive genital human papillomavirus infection

The incidence, location, and morphologic appearances of human papillomavirus oral lesions in patients with genital condylomatosis were investigated with clinical, colposcopic, and histologic examination as diagnostic procedures. The human papillomavirus types were also evaluated with filter in situ hybridization. One hundred one patients, 66 female and 35 male, with genital condyloma underwent an oral cavity examination. Ninety-nine (99%) practiced orogenital sex, and all were asymptomatic for oral lesions. Ninety-one underwent biopsy; histologic studies gave a diagnosis of condyloma in 48% of 101 specimens collected. In 8 of 91 (9%) oral lesions were suspected by naked-eye examination; they were confirmed histologically in all eight. Of 83 patients suspected of having oral condyloma on colposcopic examination, 38 (46%) were confirmed histologically. Thus 38 of 46 patients (83%) had oral condyloma not visible to the naked eye. Colposcopically, oral lesions appeared filiform (50%), moruloid (26%), and mixed (24%). Twenty cytologic oral samples were also collected for deoxyribonucleic filter in situ hybridization analysis. Human papillomavirus deoxyribonucleic genital types were observed in 45% (9/20) of all oral scrapings collected, and all were histologically confirmed. Our data indicate that genital human papillomavirus types are capable of establishing a local infection in the oral cavity and demonstrate a high incidence of human papillomavirus oral lesions in patients with genital condyloma.

Unusual oral presentation of non-Hodgkin's lymphoma in association with HIV infection

In 4.4% of human immunodeficiency virus-associated non-Hodgkin's lymphoma the presenting lesion is seen in the mouth. Often the lesion may clinically resemble a less sinister process, and a definitive diagnosis of lymphoma may be delayed. We describe three unusual cases of non-Hodgkin's lymphoma, appearing intraorally in association with other oral lesions, in HIV-positive homosexual men. The three patients reported here were all diagnosed as having diffuse, large-cell malignant non-Hodgkin's lymphoma. We performed Epstein-Barr virus DNA in-situ hybridization on our cases and Epstein-Barr virus DNA sequences were not seen. We review the pertinent literature and stress the importance of including non-Hodgkin's lymphoma in the differential diagnosis of oral lesions in patients at risk of HIV infection.

The incidence and distribution of oral lesions in patients with Darier's disease

Darier's disease is an uncommon autosomal dominant genodermatosis that may be accompanied by oral lesions. The incidence and distribution of oral manifestations was studied in 24 patients with cutaneous Darier's disease. Oral lesions comprising whitish papules of varying severity were present in 12 patients, with the palate being the most common site affected, followed by gingiva, buccal mucosa and tongue. Generally, the severity of the oral lesions paralleled that of the skin condition. Seven patients (30%), six of whom also had oral mucosal involvement, reported intermittent parotid swelling. Parotid sialograms of two patients revealed strictures in the main ducts, suggesting an obstructive aetiology.

Squamous cell carcinoma of the upper aerodigestive tract in nonusers of tobacco.

Nine hundred forty-five patients with squamous cell carcinoma of the upper aerodigestive tract (SCC-UADT) were treated at three University of Louisville-affiliated hospitals from 1970 through 1979. Retrospective analysis disclosed that 33 patients (3.4%) never used tobacco. This group offers interesting contrasts to the more prevalent tobacco-related epidermoid cancers. Cancers in nonusers of tobacco (mean age, 68 years) occurred approximately 10 years later than most epidermoid UADT cancers. Women predominated with a ratio of 2.7 to 1. Fifteen of 16 patients (94%) older than 70 years were women. Twenty-four of 33 primary lesions (72%) were in the oral cavity and two thirds of these were staged 0, I, and II (American Joint Commission [AJC]). Of the patients younger than 70 years of age, 42% were men, 42% had non-oral primaries, and most (74%) had advanced disease in AJC Stages III and IV. Second squamous cell primaries of the UADT developed in 6 of the 33 patients (18%) with an average of 48 disease-free months. Five of six were oral lesions in patients with original oral primaries. Of the 16 patients older than 70 years with small, localized oral cancers, conservative surgery failed in 9 (56%). Although 4 were salvaged by re-excision or radiation, 5 of these 16 patients in AJC Stage 0, I, and II died of this cancer (32%). The tendency for conservative initial surgical treatment in older patients is believed to be responsible for the higher than expected rate of treatment failure. An aggressive approach is recommended and further supported by the complete absence of surgical mortality in this group of patients.

An unusual presentation of Wegener's granulomatosis mimicking inflammatory bowel disease

An unusual presentation of Wegener's granulomatosis is described in a 16.67-yr-old black woman with diarrhea, fever, weight loss, abdominal pain, arthralgias, and mouth ulcers, suggesting the diagnosis of inflammatory bowel disease. However, biopsy specimens of rectal mucosa, oro- and nasopharynx, and skin conclusively demonstrated the vasculitic lesion of Wegener's granulomatosis. Furthermore, cyclophosphamide therapy induced remission of clinical and histologic abnormalities. This case emphasizes the diagnostic value of taking biopsy specimens of oral lesions in patients with suspected inflammatory bowel disease and demonstrates that the presentation of Wegener's granulomatosis may mimic that of inflammatory bowel disease.

Sebaceous glands in the buccal mucosa in patients with rheumatic disorders.

When seeking oral lesions in patients with rheumatic disorders (RD), the most frequent discernible finding in the buccal mucosa seems to be sebaceous glands (SG). The purpose of the present study was to examine whether or not SG are associated with RD, especially Reiter's syndrome (RS). Observation of SG in the buccal mucosa took place by thorough inspection of 50 males and 80 females suffering from RD. Controls were 237 males and 231 females from an oto-rhino-laryngologic clientèle. Further rheumatological examination was made of 12 males and 7 females from the control group who showed positive SG findings. Biopsies from SG were performed for 9 patients suffering from RS. SG were observed in 24 males (48%) and 35 females (43.8%) among patients with RD and in 19 males (8%) and 8 females (3.7%) in the control group (p less than 0.001). Rheumatological examination of the above-mentioned 12 males and 7 females revealed either a history and/or objective signs of RD, most often RS, in 7 males (58.3%) and 6 females (85.7%). The histological pattern of SG was different from that of the mucocutaneous lesions of RS. The results speak in favour of a close association of oral SG and RD, with a certain emphasis in the direction of RS. SG seem to be an important additional non-specific clinical sign in the protean picture of rheumatic disorders.

Oral manifestations of Crohn's disease.

In a systematic study of 100 patients with Crohn's disease, 100 with ulcerative colitis, and of 100 normal subjects matched for age, sex, and denture status, nine patients with Crohn's disease, two with ulcerative colitis, and one normal control were found to have oral lesions. In Crohn's disease, the macroscopic and histological appearances resembled those encountered elsewhere in the gastrointestinal tract and their incidence was related to the activity of the disorder. The lesions in the other two groups were different macroscopically and histologically. Production of salivary IgA was found to be reduced in Crohn's patients with active bowel disease. It is suggested that the occurrence of oral lesions in patients with Crohn's disease might represent a local immunological reaction to oral antigens.

ORAL LESIONS IN PITYRIASIS ROSEA

There are no clinical reports on the presence of oral lesions in patients with pityriasis rosea. However, such lesions have been observed and reported at meetings of some American dermatologic societies. Both Wile 1 and Hazen 2 have described oral involvement in pityriasis rosea. However, Guequierre 3 appears to have been the first to present before a dermatologic society patients showing concomitant oral lesions. Rosen 4 has observed lesions on the tongue. It is not generally known that the cutaneous lesions of pityriasis rosea may be accompanied by oral lesions. Such lesions are symptomless and usually insignificant but apparently may occasionally, as in the present instance, be extensive. The oral lesions of pityriasis rosea are not present during the entire course of the disease, but it appears that they are more apt to be seen during the height of the disease. As a rule only solitary lesions are observed, and