Oral Lichenoid Dysplasia Research Articles

Stabilized oral lichen planus does not compromise dental implants survival: A systematic review and meta-analysis.

This study aimed to evaluate the incidence of implant failure in patients with oral lichen planus (OLP) and investigate the potential association between OLP and peri-implant diseases. Embase, Web of Science, PubMed, and Scopus databases were searched for studies with no time restrictions. Meta-analysis was performed calculating pooled proportion of peri-implantitis (PI), peri-implant mucositis (PIM), and bleeding on probing (BOP) prevalence using fixed-effects model. Odds ratio and corresponding 95% CI were calculated to assess the potential risk of PI, PIM, and BOP in dental implant patients with OLP compared to healthy controls. Implant failure rate was 4.38% at the patient level and 4.37% at the implant level. Six patients (3.92%) from five studies were diagnosed with oral cancer after receiving implant. The prevalence of PI, PIM, and BOP at the implant level were 14.00%, 20.00%, and 40.00%, respectively. There was no significant difference in the occurrence of PI and PIM between OLP patients and healthy controls. Stabilized OLP is not considered a significant risk factor for peri-implant diseases. It is advised against placing implants or prostheses during the acute phase of the disease. Histopathological investigation to differentiate OLP from oral lichenoid dysplasia is crucial.

CD44 Expression in Oral Lichen Planus and Related Lesions-An Immunohistochemical Study.

Cluster of differentiation 44 (CD44) is a cell surface adhesion protein involved in the progression and metastasis of oral squamous cell carcinoma. The current study aims to evaluate the expression of CD44 in oral lichen planus and related lesions and thereby assess the relative risk of malignant transformation of these lesions. Formalin-fixed paraffin-embedded tissue blocks of 10 oral lichen planus (Group 1), 10 oral lichenoid lesions (Group 2), 8 with oral lichen planus with dysplasia (Group 3), and 5 with lichenoid dysplasia (Group 4) were included in the study. Immunostaining was done for the tissue sections using CD44 mouse monoclonal antibody. Staining density, staining intensity, and immunoreactive scores of CD44 were evaluated in all four groups. Statistical analysis was done by Statistical Package for the Social Sciences® software and the Kruskal-Wallis test was used. CD44 staining pattern of lichenoid dysplasia and lichen planus with dysplasia changed from membranous to cytoplasmic. The membranous CD44 immunoreactivity was mild with a score of 2.25 for Group 3 and 1.6 for Group 4 whereas moderate for other groups with a P-value of 0.009. The cytoplasmic immunoreactivity was significantly high in Group 3 (5.3 ± 2.6) followed by Group 4 (3.2 ± 1.2), Group 2 (1 ± 1.8), and Group 1 (0.7 ± 1.3) with a P-value of 0.001. The CD44 membranous immunoreactivity scores were low while the cytoplasmic immunoreactivity was high in oral lichen planus with dysplasia and oral lichenoid dysplasia when compared to oral lichen planus and oral lichenoid lesions. CD44 immunostaining pattern can help in assessing the malignant transformation of oral lichen planus or lichenoid lesions.

Lichenoid dysplasia is not a distinct pathological entity

ObjectivesOral Lichenoid Dysplasia (OLD) is a controversial histological term applied to lesions that display features of oral lichen planus (OLP) and oral epithelial dysplasia (OED). In this study we investigated the molecular profiles of OLD, OLP and OED to determine whether OLD exists as a distinct pathological entity. Materials and MethodsSamples from patients presenting with lesions diagnosed histologically as OLP, OLD or OED underwent RNA sequencing followed by differential gene expression, functional enrichment and network analysis, sparse partial least squares discriminant analysis, and immune cell phenotypic estimation. ResultsUnsupervised clustering demonstrated a group of genes with high expression in OLP and OLD, and low expression in OED, predominantly involved in inflammatory processes. Many genes were significantly differentially expressed between either OLD or OLP and OED, but few between OLD and OLP. Functional enrichment showed significant pathways and ontologies related to inflammatory signalling and immune response between OLD or OLP and OED. Broad commonality was found between OLP and OLD in upregulation of specific immune system pathways. Classifying models discriminated histologically diagnosed OLD from OED based upon molecular data alone. Bioinformatic profiling showed that immune cell populations in OLP and OLD were consistent, and distinct from OED. ConclusionMolecular data shows that OLD is not a distinct pathological entity. Its transcriptomic and immunophenotypic profile is similar to OLP and distinct from OED. We recommend that oral lichenoid dysplasia not be used as a distinct pathological entity. Our data further supports exclusion of dysplasia in diagnosis of OLP.

The natural history of oral mucosal lesions with both lichenoid and epithelial dysplastic features: a systematic review.

BackgroundAssessing the natural history of oral mucosal lesions with both lichenoid and epithelial dysplastic features through a systematic review of published literature.MethodsScopus, PubMed, and Web of Science were searched for oral mucosal lesions showing both lichenoid and epithelial dysplastic features from original studies using the keywords “oral lichenoid dysplasia; oral epithelial dysplasia (OED) with lichenoid features; oral lichen planus (OLP) with dysplastic features; oral lichenoid lesions (OLL) with dysplastic features”.ResultsThe search yielded 152 articles (PubMed-84, Scopus-32, Web of Science-36). Among these only 5 studies complied with the selection criteria including the provision of sufficient clinical and histopathological data. Out of these 5 studies, 181 cases were described to exhibit both lichenoid and epithelial dysplastic features. The most common diagnostic criterion employed was of van der Meij et al. Although some studies accepted the presence of epithelial dysplasia in OLL, most rejected the notion of epithelial dysplasia in OLP and designated such lesions as an OLL or oral lichenoid dysplasia. The few studies which accepted the presence of epithelial dysplasia in OLP rendered a diagnosis of OLP with dysplasia.ConclusionsThe review shows that several diagnoses were used for lesions with similar clinicopathological features and distinct clinicopathological entities were designated similar diagnosis. These diagnostic variations are the primary cause for the discrepancies in the prevalence and malignant transformation rates of these enigmatic entities which in turn often leads to erroneous treatment.

Oral lichenoid dysplasia and not oral lichen planus undergoes malignant transformation at high rates.

Oral potentially malignant disorders (OPMD) include a variety of mucosal lesions such as oral lichen planus (OLP), oral lichenoid lesions (OLL) and oral lichenoid dysplasia (OLD). Their rate of malignant transformation ranges from 0% to 34% and is dependent on OPMD type, lesion site and a range of risk factors. This study seeks to determine the proportion of oral lichenoid conditions that transform into oral squamous cell carcinoma (OSCC) in an Australian population. The study is a retrospective audit of patients from a private oral medicine clinic, diagnosed with OLP, OLL or OLD using clinical and histopathological data between 2006 and 2014. Patients were cross-matched with Cancer Registry data for OSCC, and the rate and time to malignant transformation determined. OLP and OLL patients displayed a low risk of malignant transformation; 0.49% (1/206) for OLP and 0% (0/31) for OLL. In contrast, OLD patients, all of whom presented clinically as OLP, were at much higher risk with 6.81% (3/44) developing OSCC over an average time of 4.6years (±2.4 SD). Rates of smoking and alcohol consumption were no higher in OLD patients compared to others. Compared with other oral lichenoid conditions, OLD lesions are at a particularly high risk of malignant transformation and should be managed based on the presence of dysplasia and not the lichenoid inflammatory infiltrate. OLP demonstrates a relativelylow rate of malignant transformation. Diagnostic histopathology is important for discriminating OLP from OLD.

Toluidine blue application to detect dysplasia and malignant changes in patients with oral lichenoid lesions

Background Oral lichen planus (OLP) is a chronic disease with immune-mediated pathogenesis which can be premalignant. Oral lichenoid dysplasia (OLD) is a precancerous process with lichenoid features which is frequently confused with OLP.Objective In this study, we aimed to investigate the efficacy of toluidine blue (TB) administration before biopsy to detect the dysplastic changes in patients who were clinically diagnosed with OLP.Methods Thirty consecutive patients with oral lichenoid lesions whose clinical findings were consistent with OLP were included in the study. Demographic and clinical characteristics of the patients studied were recorded and clinical photos were taken before and after the administration of TB. Areas to be biopsied were determined according to the results of the TB staining. Histopathologically, all the specimens were evaluated in terms of the diagnostic features of OLP and the presence of dysplastic findings. Results The mean age of the 30 patients (21 females, 9 males) included in the study was 51.03 (26-70 years) and the median value of disease duration was 12.00 ± 67.23 months (2-360 months). Six patients (20.0%) had positive staining after application of TB. Histopathological examination revealed OLP findings in 17 patients (56.7%), OLP and dysplasia findings in nine patients (30.0%) and lichenoid dysplasia in four patients (13.3%). Dysplasia was detected in all of the lesions (six patients) which were stained blue with TB. The relationship between staining and dysplasia was significant (p<0.05). OLP and dysplasia were observed in four of these six patients (66.7%), and lichenoid dysplasia was observed in the other two (33.3%). The relationship between presence of dysplasia and presence of mitosis was found statistically significant in patients with histopathological dysplasia (p<0.05). When the presence of mitosis was evaluated in biopsies taken from the stained lesions, a statistically significant relation was found (p<0.05).ConclusionsIn our study, it was observed that dysplasia was detected in all stained areas after the application of TB to clinically classical OLP patients, but there was no staining in some patients despite the presence of dysplasia. Therefore, the sensitivity of the application was 46%, specificity was 100%, positive predictive value was 100% and negative predictive value was 70.8%. TB application is a specific test to detect the dysplasia; however because of the low sensitivity in oral lichenoid lesions, another method is needed to increase the sensitivity.

Molecular classification of autofluorescence excision margins in oral potentially malignant disorders.

To define molecular differences between autofluorescence and white light defined excision margins in oral potentially malignant disorders (OPMD) using transcriptome expression profiles. Excisional biopsy specimens were taken from 11 patients at three different sites for each lesion: centre, white light margin and autofluorescence margin. The lesions were diagnosed histopathologically as oral epithelial dysplasia, oral lichenoid dysplasia, oral lichen planus or other. Transcriptome analysis was performed by RNA sequencing, hierarchical clustering, differential expression and biological pathway analysis. For hierarchical clustering, the samples broadly clustered according to histology rather than the margins with lichenoid samples clustering together. Differential expression analysis showed that independent of histology, there was greater molecular dysregulation between the lesion centre and autofluorescence margin compared to the lesion centre and white light margin. Furthermore, the autofluorescence and white light margins were molecularly distinct, indicating the white light margins harboured abnormality. Our results indicate that the molecular profile of OPMD changes with divergence away from the centre of the lesion, and that autofluorescence determined margins are superior to the white light margin in achieving a clear molecular margin when excising an OPMD.

Expression of survivin and p53 in oral lichen planus, lichenoid reaction and lichenoid dysplasia: An immunohistochemical study.

Context:The malignant transformation potential of oral lichen planus (OLP) and related lesions is a subject of great controversy.Aim:The aim of this study was to compare the expression of proteins related to apoptosis and tumour suppressor gene processes in OLP, oral lichenoid reaction (OLR) and oral lichenoid dysplasia (OLD).Materials and MethodsThe immunohistochemical study was carried out to investigate the expressions of survivin and p53 in a total of 30 lesional biopsy specimens - 10 cases each of OLP, OLR and OLD. The expression rates were further compared with 10 control specimens of normal oral mucosa (NORM).Results:Immunoreactivity for p53 was seen in 7 cases (70%) of OLD, 4 cases (40%) of OLP and 2 cases (20%) of OLR and none of NORM. We obtained a significant difference (P = 0.01) in mean p53 expression between the different entities. The positive staining rate of survivin was found to be significantly different between OLD (50%), OLP (10%), OLR (0%), and normal mucosa (0%) (P = 0.004). There was a positive correlation between p53 and survivin expression in OLP and OLD using Pearson's correlation coefficient.Conclusion:Lichenoid dysplasia has shown p53 and survivin expression in the range of not OLP, but leukoplakia. On the other hand, OLR seems to be an innocuous lesion. The study results with OLP are inconclusive but points toward a small but important malignant potential in OLP. This kind of comparative study highlights the importance of biopsying OLP and related lesions for proper diagnosis and appropriate management.

Estimation of silver nucleolar organizer regions in oral lichen planus, oral lichenoid reactions and oral lichenoid dysplasia.

Aims and Objective:(1) To study the clinical and histological features of oral lichen planus, oral lichenoid reaction (OLR) and oral lichenoid dysplasia (OLD). (2) To estimate and compare the silver nucleolar organizer regions in OLR and OLD.Materials and Methods:A total of 40 biopsies were studied; sections were divided as study group, which consists of OLP, OLR and OLD each of 10 cases and 10 biopsies of normal oral mucosa as control group. Sections were stained by silver staining technique and total number of silver stained nucleolar organizer regions (AgNORs) were counted in nucleoli of 100 cells in each section under x100 objective (oil immersion).Results:Our study revealed that the difference between the (AgNOR) count of OLP (2.272 ± 0.09) and OLR (2.27 ± 0.073) is not statistically significant (P = 0.81). The mean AgNOR count of OLD (2.388 ± 0.043) compared to that of OLP (2.272 ± 0.09) and OLR (2.27 ± 0.073) showed an increase and it is statistically highly significant (P = 0.002 and P = 0.003, respectively).Conclusion:AgNOR count is an objective test, which has stronger biological basis for diagnosing epithelial dysplasia. It is easy to perform, inexpensive and is performed on biopsied specimen. However, this technique cannot differentiate OLP and OLR, as there is no much difference in the proliferative activity of cells in these two lesions. It is reasonable to suggest that all biopsy tissues from lichenoid lesions where dysplastic features are observed in routine histopathological sections should be additionally stained by silver technique to ascertain dysplastic status of the lesion.Clinical Significance:This is an improved diagnostic parameter, which will help pathologists to formulate more definitive final histopathological diagnosis and will in turn facilitate the formulation of patient treatment and follow-up care by clinicians.

Oral lichen planus and epithelial dysplasia with lichenoid features: a review and discussion with special reference to diagnosis.

Despite guidelines for the diagnosis of oral lichen planus (OLP), there has been much difficulty and ambiguity in rendering a straightforward diagnosis. The root of the problem might arise in not following universal guidelines and being too rigid and unilateral in making a diagnosis. Because of its autoimmune pathogenesis, the dynamic nature of OLP has further fueled confusions. This has had repercussions in the form of controversies in its diagnosis, treatment protocols, research, and most importantly, its potentially malignant nature. Oral lichenoid dysplasia (OLD), an enigmatic entity, proposed by Krutchkoff and Eisenberg, has not found universal acceptance by the pathology community. The objective of the present review was to outline these debates and discuss ongoing controversies regarding OLD and uncertainties in the diagnostic criteria of OLP.

Abstract 4458: Discovery of novel epigenetic biomarkers in premalignant/malignant oral cavity lesions by methylation arrays

Abstract Purpose: The incidence of the oral squamous cell carcinoma (OSCC) is around 50% of all head and neck cancer (HNC), the sixth most common type of cancer in the world. Aberrant hyper/hypo-methylation in the promoter region of some known or putative tumor suppressor/protoonco-genes occurs frequently during the development of various cancers including OSCC. Both of genetic and environmental factors play roles in the carcinogenesis of malignant lesions. Etiological factors predisposing to OSCC are smoking, alcohol and tobacco consumption, snuffuse, viral factors, chronic irritation, iron and various vitamin deficiencies, poor oral hygiene and diseases such as syphilis. Despite the advances in cancer diagnosis and treatment, the 5-year survival rate of OSCC patients is poor and because of advanced stage of disease, it has high mortality and morbidity. Another the most important ethiological factor of OSCC is oral premalignant lesions (OPML), since OPML is related with malignant transformation. In our study, we included three different OPML associated with different risks of leading to malignancy: Oral leukoplakia has a high risk of conversion into malignancy, whereas oral lichen planus and oral lichenoid dysplasia are associated with lower risk. We aimed to investigate the epigenetic characterization of OSCC and OPML relative to the epigenetic changes in these groups. Experimental Design: Tumor and corresponding healthy tissues from 12 and 10 Turkish patients with OPML and OSCC, respectively were collected. The samples were analyzed histopatologically and after DNA extraction and bisulfite modification, methylation patterns of the samples were investigated by using the Illumina Infinium HumanMethylation450 (450K) BeadChip array. Results: According to our preliminary results obtained from the methylation array experiments, CpG regions in the UOX, ABCC12, FCRLB, ABL2, LGR6 and SLC22A18 genes were found unmethylated while CpGs located in YPEL-3 were highly methylated (p<0.005). Conclusion: We concluded the UOX, ABCC12, FCRLB, ABL2, LGR6, SLC22A18 and YPEL-3 may be potential biomarker candidate genes playing role in the transformation mechanism of OPML/OSCC. In the further studies, we will compare the methylation patterns between OPML subgroups to discriminate the potential candidates. *This study was supported by the Scientific and Technological Research Council of Turkey (TUBITAK-SBAG-114S497). Citation Format: Semra Demokan, Sevde Comert, Cansu Ozkoklesen, Murat Ulusan, Gulsum Ak, Canan Alatli, Nejat Dalay. Discovery of novel epigenetic biomarkers in premalignant/malignant oral cavity lesions by methylation arrays. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4458.

Oral lichen planus: A benign lesion

Is oral lichen planus (OLP) by nature a premalignant condition? Few questions in clinical practice have generated more controversy or passionate debate than this one has in recent years. Based on previously published case reports of OLP's progression to squamous cell carcinoma, some clinicians and pathologists are convinced that it is inherently precancerous. 1 Pindborg JJ Reichart PA Smith CJ et al. WHO International Histological Classification of Tumors: Histological Typing of Cancer and Precancer of the Oral Mucosa. Springer, Berlin, Germany1997 Crossref Google Scholar , 2 Silverman S Gorsky M Lozada-Nur F A prospective follow-up study of 570 patients with oral lichen planus: Persistence, remission and malignant association. Oral Surg Oral Med Oral Pathol. 1985; 60: 30 Abstract Full Text PDF PubMed Scopus (280) Google Scholar , 3 Holmstrup P Thorn JJ Rindum J et al. Malignant development of lichen planus-affected oral mucosa. J Oral Pathol. 1988; 17: 219 Crossref PubMed Scopus (181) Google Scholar , 4 Holsmtrup P The controversy of a premalignant potential of oral lichen planus is over. Oral Surg Oral Med Oral Pathol. 1992; 73: 704 Abstract Full Text PDF PubMed Scopus (69) Google Scholar However, others are not persuaded that this is so. 5 Krutchkoff DJ Eisenberg E Lichenoid dysplasia: A distinct histopathologic entity. Oral Surg Oral Med Oral Pathol. 1985; 30: 308 Abstract Full Text PDF Scopus (151) Google Scholar , 6 Lovas JGL Harsanyi BB El Geneidy AK Oral lichenoid dysplasia: A clinicopathological analysis. Oral Surg Oral Med Oral Pathol. 1989; 68: 57 Abstract Full Text PDF PubMed Scopus (28) Google Scholar , 7 Eisenberg E Krutchkoff DJ Controversies in oral pathology: Lichenoid lesions of oral mucosa. Diagnostic criteria and their importance in the alleged relationship to oral cancer. Oral Surg Oral Med Oral Pathol. 1992; 73: 699 Abstract Full Text PDF PubMed Scopus (110) Google Scholar , 8 Allen CM Is oral lichen planus really premalignant? (Editorial). Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 347 Abstract Full Text PDF PubMed Scopus (12) Google Scholar

Oral lichenoid dysplasia: A clinicopathologic analysis

Three women had a diagnosis of oral lichen planus (OLP), which was made on the basis of clinical and histologic features. All three had persistent burning pain associated with large mucosal lesions. Changes in the color (red, red and white, white), configuration, and severity of the lesions were unpredictable and did not correlate well with topical corticosteroid therapy. Only one patient used tobacco (cigarettes)—this patient had recurrent oral candidiasis and was receiving multiple medications. One of the two nonsmokers was a denture wearer with a single episode of candidiasis. After 63, 32, and 56 (mean 50) months, carcinoma developed in all three. In retrospect, the initial biopsy specimens of two patients exhibited lichenoid dysplasia, whereas that of the third showed only lichenoid mucositis. Although speckled erythroplakia was the earliest clinical sign of a classic, nonregressing premalignant lesion, it already signaled the presence of invasive carcinoma. Some early epithelial dysplasias appear to have a robust inflammatory/immunologic response to the antigenically (but as yet not histologically) altered dysplastic epithelium and a high probability of at least temporary resolution. Mucosal erythema of obscure origin displaying spontaneous, usually temporary, partial to complete regression may be common to both purely inflammatory conditions like lichen planus and early epithelial dysplasia. We contend that some, if not most, cases of apparent malignant transformation of OLP likely represent red and white lesions that were dysplastic from their inception but that mimic OLP both clinically and histologically.