Types Of Mucosal Lesions Research Articles

Clinical Profile and Prevalence of Oral Mucosal Lesions in Tobacco Users-A Prospective Study from Jammu, India.

To evaluate the incidence of tobacco-related oral mucosal lesions in the adult population visiting ENT-OPD at Shri Maharaja Gulab Singh Hospital, GMC Jammu, India. From December 2021 to November 2022 we attempted to compile the prevalence of tobacco-induced oral mucosal lesions in the adult population visiting ENT-OPD at Shri Maharaja Gulab Singh Hospital Jammu, India. The study included a total of 400 patients of various age groups. The patients were divided as current users with a habit of tobacco consumption for atleast 6months and ex-users who had used any form of tobacco in their lifetime for a minimum of 6months but had abstained the use since last 1year. Age group, gender, employment, type of tobacco use, site of placement of tobacco in the oral cavity, frequency and duration of use, and the types of mucosal lesions were all documented on a standardized interviewer-based questionnaire.The oral mucosal lesions were diagnosed in accordance with international recommendations. Males (55%) had somewhat more oral mucosal lesions than females (45%). Oral submucous fibrosis was found in 110 individuals, followed by leukoplakia in 102, erythroplakia in 14, tobacco pouch keratosis in 81, tobacco induced melanosis in 82 patients and malignancy in 11 patients. 107 conventional smokers (26.75%), 254 patients using smokeless tobacco (63.5%) and 39 patients using combined form of tobacco (9.75%) showed oral mucosal lesions. The most prevalent site of lesions was the labial comissure, which showed 117 lesions (29.25%), followed by 114 lesions on the buccal mucosa (28.5%), and 99 lesions (24.75%) on buccal sulcus. Gingiva showed 41 lesions (10.25%), tongue had 15 entities (3.75%) and palate had 14 (3.5%). The most frequent oral mucosal lesion was shown to be oral submucous fibrosis, followed by leukoplakia. Smokeless tobacco was the most commonly used tobacco product. This study emphasizes the need of routine evaluation of the oral mucosa and the need for patients to be urged to stop this hazardous behavior.

Pathologies of oral and sinonasal mucosa following facial vascularized composite allotransplantation

Cutaneous changes of facial vascularized composite allotransplants (fVCAs) are extensively described in the literature. Parts of the nose, nasal, and oral cavities are included in most fVCAs. Distinctively, the nose and mouth are lined by mucosa. Little is known about the histopathology and complications of the mucosa involved in fVCA patients. The study constitutes a retrospective cohort study of nine fVCA patients. Medical records were reviewed for information about changes of oral and nasal mucous membranes. Types of mucosal lesions were recorded and analyzed. Uni- and multivariate generalized estimating equation (GEE) models were used to assess the odds of developing mucosal inflammation in the presence of clinico-pathologic variables. A total of 186 clinical encounters with examination of oral and nasal mucous membranes were included. Membranes were devoid of clinical pathology in 101 instances (53% of all clinical assessments). Ulcerations/erosions (27%), edema (18%), and erythema (14%) were the most common lesions. Oral lesions affected the lips (58%), buccal mucosa (38%), and palate (5%). Sinonasal processes predominantly affected nasal vestibules and septae. In univariate analysis, sirolimus, skin rejection, and skin Banff grade were associated with the presence of an acute inflammatory mucosal lesion (p<0.05). In multivariate analysis, skin Banff grade and sirolimus were independent predictors of mucosal inflammation. Pathologies of fVCA mucous membranes are more common than previously reported. Mucosal assessment plays an important role in the pleomorphic allograft rejection process evaluation rather than diagnosis and treatment based on cutaneous pathology. A closer look at the pathophysiology of fVCA mucosal rejection and inflammation is warranted.

Morphological, immunohistochemical and molecular features of inflammatory bowel disease associated colorectal carcinoma and associated mucosal lesions – Single institution experience

BackgroundPatients with inflammatory bowel disease (IBD) – ulcerative colitis (UC) and Crohn’s disease (CD) have an elevated risk of developing colorectal carcinoma (CRC). Major risk factor in IBD patients is the continuous chronic inflammation leading to development of dysplasia and carcinoma. Nevertheless, other types of non-conventional but suspicious mucosal changes serrated change/dysplasia, NOS and villous hypermucinous change, have also been reported in IBD patients. Preneoplastic potential of these lesions is still not well elucidated. AimsThe aim of this study was identification of IBD-associated CRCs focusing on finding related precursor lesions in the surgical specimen or in archival biopsy samples followed by a detailed morphological, immunohistochemical and molecular evaluation. For the purpose of the study the mucosal lesions were divided into conventional IBD-associated dysplasia and non-conventional lesions that were merged under a provisory term of putative preneoplastic lesions (PPL). MethodsA total of 309 consecutive IBD colectomy specimens diagnosed during a 10-year period were reviewed. Detailed morphological evaluation, immunohistochemical analysis of mismatch repair (MMR) proteins, p53 and O6-methylguanine DNA methyltransferase (MGMT) expression and molecular analysis for KRAS, NRAS and BRAF gene mutation were performed in the retrieved CRC cases as well as in the detected dysplasia and PPLs of these patients. ResultsWe identified 11 cases of morphologically heterogenous IBD-associated CRCs, occurring in 5 males and 6 females, aged 26–79 years (mean 44 years). A total of 22 mucosal lesions were revealed in 8 CRC patients comprising conventional IBD-associated dysplasia (4 lesions), PPLs as serrated change/dysplasia NOS (11 lesions), villous hypermucinous change (5 lesions), and two true serrated lesions (one sessile serrated adenoma and one traditional serrated adenoma). More than one type of lesion was found in 6 patients. Seven CRC cases harbored mutation of KRAS/NRAS and one case of BRAF. Two patients with KRAS-mutated CRC showed the same mutation in PPL in the same specimen (one serrated change NOS and one TSA with high-grade dysplasia). Similarly, one BRAF-mutated carcinoma case presented the same mutation in serrated change/dysplasia, NOS in the same specimen. Of the CRCs, two showed deficient MMR system profile, six presented with loss of MGMT expression, and six showed aberrant p53 expression. PPLs showed deficient MGMT expression (14 cases) and aberrant p53 (10 cases) as well. ConclusionIBD-associated CRCs are very heterogeneous entities. Besides conventional IBD-related dysplasia, other types of mucosal lesions may be associated with long lasting IBD and CRC e.g. villous hypermucinous change and serrated change/dysplasia, NOS. Since these lesions share certain genetic or immunohistochemical changes with the related CRC, a suspicion is raised that these lesions may also have preneoplastic potential. Awareness of these changes is necessary to prevent their missing and under-reporting, and further studies of these lesions should be carried out.

Competing Influences in the Management of Gastrointestinal Bleeding

OBJECTIVES:Management of gastrointestinal (GI) bleeding centers on the issues of location, type of mucosal lesion, effects of anticoagulation, diagnosis, and therapy. Each one of these five individual factors is affected by multiple interactions with the other coexisting factors. The aim of the present study is to analyze which set of factors ultimately exerts the largest and most lasting influence on the disease process.METHODS:The interactions among the five contributing factors are analyzed using a transposed Markov chain model.RESULTS:The analysis reveals that, in declining order, location, anticoagulation, and type of lesion exert the largest influence on the disease process. Under steady state conditions, their magnitudes of influence are 50, 33, and 17%, respectively. The other two factors, diagnosis and therapy, result as a consequence of the aforementioned three primary factors, but do not exert any major influence themselves. The outcome of the analysis remains robust to multiple wide-ranging variations in the assumptions underlying the model.CONCLUSIONS:The model of a transposed Markov chain translates an initially bewildering array of interacting influences into a coherent and transparent model of gastrointestinal bleeding.

Laryngeal examination is superior to endoscopy in the diagnosis of the laryngopharyngeal form of gastroesophageal reflux disease

Objective. The laryngopharyngeal form of gastroesophageal reflux disease (LF GERD) is a frequent manifestation of supraesophageal GERD. Diagnosis of LF GERD is difficult: most of the common diagnostic methods of GERD have insufficient accuracy in establishing LF GERD. The purpose of this study was to evaluate the role of endoscopic and laryngologic examination in the diagnosis of LF GERD and to create a laryngoscopic reflux index (LRI). Material and methods. A total of 108 LF GERD patients and 90 controls were investigated. The criteria for LF GERD were: complaints, reflux-laryngitis, and esophagitis (endoscopically or histologically proven). Lesions in four laryngeal regions were evaluated: arytenoids (A), intraarytenoid notch (IAN), vestibular folds (VF), and vocal cords (VC). Three types of mucosal lesions were evaluated on a points basis: alterations of the epithelium, erythema, and edema. Total LRI was calculated by summing-up the indices in the separate laryngeal areas. Results. The LRI mean value (11.48±3.78 points) of LF GERD patients was statistically significantly greater than that (1.64±1.93 points) of the controls. The most significant laryngoscopic changes of LF GERD were: mucosal lesions of IAN, mucosal lesions of VC, and edema of VC. A combination of these three findings reliably distinguishes the LF GERD patients from controls in 95.9% of cases. The mucosal lesions of IAN have the greatest importance in diagnosing LF GERD: the odds ratio to LF GERD – 21.32, p<0.001. Endoscopic esophagitis was established in 36 (33.3%) cases. The severity of esophagitis did not correlate with the severity of the laryngeal findings. Conclusions. Laryngoscopy is superior to endoscopy in diagnosing LF GERD. Endoscopy has limited value in the diagnosis of LF GERD. Establishing the LRI could be helpful in the differential diagnosis of the disease in the everyday clinical practice.

Presence of Candida albicans in potentially malignant oral mucosal lesions

Recently, an interest in the study of oral candidiasis has markedly increased mainly because of its association with viral infections due to human immunodeficiency, but also because of its relation with potentially malignant lesions of oral mucosa. These lesions belong to the wide group of leukoplakia. Leukoplakia is a clinical term used to describe a range of nonspecific white lesions, whose appearance does not generally correlate well with histopathologic changes; therefore, biopsy should be performed in all cases to determine which are precancerous or potentially malignant ones. In order to study the association of Candida albicans and the types of mucosal lesions, we took 30 consecutive biopsies of oral mucosa and the smears for microbiologic examination from the changed surface of mucosa and from the rest of oral cavity. The study group consisted of 30 patients, 21 women and 9 men, with the average age of 50.23 years (range, 25-77 years). In 6 cases Candida was diagnosed in mucosal biopsy. In the smear from the lesion, it was present in 3 cases, and 2 cases were found in the smear from an unchanged oral mucosa. In 9/30 cases (30%) Candida was positive regardless of the smear area or mode of diagnosis. The most common lesion is leukoplakia, diagnosed in 12/30 cases (40%), in 6 female and 6 male patients. The average age of those patients was 52.42 years. The lesions were located as follows: cheek mucosa - 5 cases; gingival mucosa - 2; lower lip - 2; floor of the mouth - 2; soft palate - 1; Candida was present in 3/12 cases. The lesion with the second highest incidence is lichen planus (9 cases), with positive Candida infection in 4/9 (44.44%). Epithelial dysplasia, although diagnosed in a very small number of cases (1/30 or 3.3%) with leukoplakia, was associated with a Candida infection. Generally, Candida is present in potentially malignant oral mucosal lesions (in 3/12 or 25% of leukoplakia cases, in 4/9 or 44.44% of lichen planus cases, and 1/1 squamous papilloma), with an increasing incidence in lesions with serious dysplastic epithelial changes.

Upper GI bleeding in healthy full-term infants: a case-control study.

The aim of this case-control study was to evaluate the frequency and the type of mucosal lesions in newborn babies with upper GI bleeding (UGIB), the diagnostic role and safety of upper GI endoscopy, and the recognition of risk factors associated with the hemorrhagic event. A population of 5180 infants born from June, 1988 to May, 1997 was examined. A case was defined as any patient who had UGIB within 4 days of delivery. The diagnosis was made by endoscopic examination in an endoscopy room. The following parameters were determined: amniotic fluid features, funicular blood pH, Apgar index at 5 min, neonatal weight, body length, gestational age, and the presence of other pathologies. Biochemical profiles were also evaluated. Clinical and demographic data of the mothers of the newborn babies were analyzed. Sera of cases and the respective parents were tested for gastrin and pepsinogen. As a control group, 53 full-term healthy infants matched for sex and age were randomly selected from the population of infants born in our pediatric department. Sixty-four of 5180 newborn babies (1.23%) suffered from UGIB within 26.5 +/- 20 h of life. In 53 of 64 cases (mean age = 24.2 +/- 25.5 h) it was possible to carry out an endoscopic examination. In one case, endoscopy was limited to the esophagus because of the presence of multiple mucosal ulcers and substenosis of the viscus. Esophageal damage was observed in 24/53 patients. The esophageal lesions were isolated in nine cases, and occurred jointly with gastric or duodenal damage in 14 cases and one, respectively. Gastric and duodenal lesions were seen in 43/52 and 1/52 patients, respectively. There were 17 cases of gastric ulcers and one case of duodenal ulcer. Blood clots were observed in 14 gastric ulcer patients; in one case there was evidence of active bleeding at the margins of a gastric ulcer. There was no significant difference with regard to the demographic and clinical characteristics of the cases and controls. Median values of serum gastrin of the cases and controls were similar. Median serum pepsinogen was significantly higher in the case group. UGIB in the newborn babies is often associated with clinically relevant mucosal lesions of the upper GI tract. The evolution, after treatment with antisecretory drugs, is generally rapid and favorable, with clinical recovery usually obtained within 24-48 h. The higher serum pepsinogen levels may only represent a significant risk factor of mucosal lesions and complications.

Upper GI bleeding in healthy full-term infants: a case-control study

OBJECTIVE: The aim of this case-control study was to evaluate the frequency and the type of mucosal lesions in newborn babies with upper GI bleeding (UGIB), the diagnostic role and safety of upper GI endoscopy, and the recognition of risk factors associated with the hemorrhagic event. METHODS: A population of 5180 infants born from June, 1988 to May, 1997 was examined. A case was defined as any patient who had UGIB within 4 days of delivery. The diagnosis was made by endoscopic examination in an endoscopy room. The following parameters were determined: amniotic fluid features, funicular blood pH, Apgar index at 5 min, neonatal weight, body length, gestational age, and the presence of other pathologies. Biochemical profiles were also evaluated. Clinical and demographic data of the mothers of the newborn babies were analyzed. Sera of cases and the respective parents were tested for gastrin and pepsinogen. As a control group, 53 full-term healthy infants matched for sex and age were randomly selected from the population of infants born in our pediatric department. RESULTS: Sixty-four of 5180 newborn babies (1.23%) suffered from UGIB within 26.5 ± 20 h of life. In 53 of 64 cases (mean age = 24.2 ± 25.5 h) it was possible to carry out an endoscopic examination. In one case, endoscopy was limited to the esophagus because of the presence of multiple mucosal ulcers and substenosis of the viscus. Esophageal damage was observed in 24/53 patients. The esophageal lesions were isolated in nine cases, and occurred jointly with gastric or duodenal damage in 14 cases and one, respectively. Gastric and duodenal lesions were seen in 43/52 and 1/52 patients, respectively. There were 17 cases of gastric ulcers and one case of duodenal ulcer. Blood clots were observed in 14 gastric ulcer patients; in one case there was evidence of active bleeding at the margins of a gastric ulcer. There was no significant difference with regard to the demographic and clinical characteristics of the cases and controls. Median values of serum gastrin of the cases and controls were similar. Median serum pepsinogen was significantly higher in the case group. CONCLUSIONS: UGIB in the newborn babies is often associated with clinically relevant mucosal lesions of the upper GI tract. The evolution, after treatment with antisecretory drugs, is generally rapid and favorable, with clinical recovery usually obtained within 24–48 h. The higher serum pepsinogen levels may only represent a significant risk factor of mucosal lesions and complications.

Characterization of ureteral lesions associated with impacted stones.

Few studies have addressed the various types of ureteral lesions apparent in patients treated for ureteral stones, especially in those with impacted stones. Macroscopic and microscopic analyses of ureteral lesions associated with impacted stones were therefore undertaken. From May 1994 to October 1996, 36 patients with ureteral stones, 21 of whom showed stone impaction, were treated with transurethral ureterolithotripsy. After ureteroscopic examination, biopsied specimens were obtained from six patients with impacted stones and were examined microscopically by conventional hematoxylin and eosin staining. Ureteroscopy revealed two types of mucosal lesions in the patients with impacted stones: Type 1 lesions were defined as edematous or cystic hemispheric lesions and occurred in 18 patients, whereas type 2 lesions had a villous appearance and were present in three patients. Microscopically, type 1 lesions appeared as submucosal edema without specific findings, whereas type 2 lesions appeared as columnar mesenchymal tissue coated with several layers of transitional epithelium. With regard to factors that might contribute to lesion formation, duration of stone presence was significantly greater for patients with impacted stones than for those with-non-impacted stones. However, no differences in such parameters were apparent between patients with type 1 lesions and those with type 2 lesions. Two types of ureteral lesions associated with impacted stones were confirmed microscopically. The duration of stone presence is a potential contributing factor in the development of ureteral lesions, but factors that determine the type of ureteral lesion remain unclear.

Inverse relationship between colonic (Na+ + K+)-ATPase activity and degree of mucosal inflammation in inflammatory bowel disease.

In inflammatory bowel disease (IBD), mucosal damage and loss of colonic function are regarded as major consequences of inflammation. Decreased colonic (Na+ + K+)-ATPase activities with diminished reabsorption of sodium and water have been found in active stages of ulcerative colitis. In this study, we report an inverse relationship between colonic (Na+ + K+)-ATPase activity and the degree of mucosal inflammation in 19 patients with IBD of mild to moderate disease activity. Various macroscopic and histologic types of mucosal lesions were differently associated with the (Na+ + K+)-ATPase activities. 5'-nucleotidase activity was not associated with the degree of mucosal inflammation or the kind of macroscopic or histologic lesions. Our findings support the view that, in contrast to 5H-nucleotidase, (Na+ + K+)-ATPase activity may better reflect the severity of mucosal damage and the degree of inflammation in IBD.

Gastrointestinal disturbances in stroke.

The study includes analysis of 498 post-mortems of stroke patients treated in the Department of Vascular Diseases of the CNS Warsaw, in the years 1974-1985. In that group, gastrointestinal complications were found in 120 cases (24.09%) which included 82 cases of ischaemic focus in the brain and 38 cases of haemorrhagic focus due to cerebral haemorrhage. Of the 120 patients with gastrointestinal complications 75 (63.5%) had massive haemorrhage into the lumen of the alimentary tract; in half, gastrointestinal haemorrhage had occurred within 7 days of the stroke. No statistically significant correlation was observed between the type of mucosal lesion and the site of ischaemic or haemorrhagic lesion in the brain.