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PA5 White lesions白色病變 (Introduction (color of the oral epithelium is…

- - - - thickening of the keratin
      - epithelial hyperplasia上皮增生
      - reduced vascularity of sub adjacent connective tissue減少鄰近結締組織的血管分佈
      - Suface necrosis
- - - - White spongy naves
      - Luekoedema
    - - Treatment
      - Histopathologic features
      - Classification according to the surface texture
      - Clinical features
      - Etiology
      - Introduction
    - - Frictional keratosis 摩擦性角化病
      - Themal
      - chemical
    - - Liquen erythematous
      - Liquen planes
    - - Hairy leukoplakia
      - Candidiasis
- - - - Concepts
        
        chronic mucocutaneous disease of unknown cause原因不明的慢性粘膜皮膚病
      - Etiology
        
        immunologically mediated process免疫介導的過程
      - histopathology
        
        Hyperkeratosis角化過度
        
        Liquefaction of the basal cell layer基底細胞層液化
        
        Civatte bodies
        
        apoptotic keratinocytes at the basal zone
        基底區凋亡角質形成細胞
        
        discrete eosinophilic ovoid bodies離散嗜酸性卵圓形體
        
        position
        
        intense band-like
        
        predominantly T- lymphocytes主要是T淋巴細胞
        
        subepithelial lymphocit band上皮下淋巴結帶
        
        lying beneath the epithelium-connective tissue junction
        
        thickness of the spinous layer
      - Clinical types
        
        females (more in menopausal更年期 women)
        
        located mainly in tongue, gingival, palate and lips.
        
        Liquen planus affects middle age
      - Forms
        
        Atrophic type
        
        diffuse red patches –resembling erithroplakia- with fine white striae細白色條紋
        
        Cause
        
        burning
        
        sensivity
        
        generalized discomfort.
        
        Erosive :erithematous areas with central ulceration
        
        Bullous types
        
        Plaque type
        
        Reticular forms
        
        numerous interlacing white keratotic lines or striate that produce an annular or lacy pattern.許多交織的白色角化線或條紋，其產生環形或花邊圖案。
        
        most common
- - - - characteristic
        
        whitish lesion in oral mucosa
        
        does not detach when scraped
        
        Increased risk of cancer (precancerous癌症前期)
        
        Gum > jugal mucosa
        
        most common oral pre-cancer
        
        all leukoplakias should be treated as premalignant lesions
      - Epidemiology
        
        There is a strong male predilection (70%). Leukoplakia is usually found in adults between 40 and 70 years of age, with a 2:1 male predominance.
      - clinical recommendation
        
        2 weeks no healing ---- biopsy活檢
        
        Clinical diagnosis
      - Etiology病因
        
        Associated tobacco
        
        More than 80% of patients with leukoplakia are smokers.
        
        Ultraviolet radiation
        
        Microorganisms
        
        Candida albicans.
        
        The hairy leukoplakia can go on to develop lymphoma when associated with HIV.
        
        Human papillomavirus (HPV)
        
        Serum levels of patients with leukoplakia were found to be low in Vit A,B-12,C & folic acid
        
        Bloodroot
        
        known as sanguinaria
      - Classification of Texure
        
        Homogeneous同質
        
        smooth平坦
        
        shallow cracks淺裂縫,wrinkle surface
        
        homogeneous均勻
        
        Whitish
        
        uninflammed normal appearing tissue
        
        Non Homogeneous
        
        Inhomogeneous whitish lesion
        
        erythematous
        areas紅斑
        
        Irregular,nodular or exophytic surface不規則，結節或外生表面
        
        Exophytic erythroleucoplasias外生性紅斑狼瘡
        
        Proliferative verrucous leukoplakia增殖性疣狀白斑
        
        concept
        
        appears as exophytic外生性
        
        persisting white lesions
        
        這種類型開始一種簡單的角化病，最終變成疣狀。它具有持久性，多焦點，並且有可能複發
        
        etiology:unknowm
        
        tobacco
        
        HPV
        
        Funghi
        
        Oncogens致癌物
        
        Clinical presentation
        
        Women 4:1 Men
        
        Age: 60y.
        
        Long standing Leukoplakia, progressive enlargement
        
        Pain less----pain ful
        
        • Yugal Mucosa>hard palate>soft palate>alveolar>mucosa >tongue> mouth floor>gum>lips
        
        Nodular erythroleucoplasias結節性紅斑狼瘡
        
        Speckled 斑點
        
        more than lesions with a homogeneous surface.
        
        combination組合 between leukoplakia and erytroplakia
        
        White flecks o fine nodules on an atrophic base
      - Diagnosis
        
        progress
        
        Definitive--> Histological
        
        dysplasia or not發育不良與否
        
        Subtypes
        
        Evolution
        
        Malignization --- Carcinoma of squamous cells
        
        First Clinically
        
        Risk factors
        
        Location: mouth floor
        
        Clinical type: non-homogeneous leukoplakia.
        
        Biomolecular markers生物分子標記
        
        P53
        
        Loss heterozygosity缺失雜合性
        
        DNA content
        
        AgNOR
        
        Dysplasia發育異常
      - Conclusion
        
        Despite the fact that leukoplakia is a premalignant lesion癌前病變 it should be noted that most of the lesions are non dysplastic非發育不良的.
        
        In fact, dysplastic epithelium or invasive carcinoma浸潤性癌 is found in only 5 to 25 % of the biopsy samples of leukoplakia.
      - Histopathologic features
        
        Histopathologic changes varies
        
        Hyperkeratosis
        
        Dysplasia
        
        abnormal epithelium and disordered growth.
        
        level
        
        Moderate
        
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        Sevrere
        
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        Mild
        
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        invasive carcinoma
        
        a focus of epithelial cell invades the lamina propria 1 to 2 mm. beyond the basal lamina超出基底層
        
        carcinoma in situ
        
        most severe dysplasia where abnormalities extend throughout the thickness of the epithelium.
        
        spreads in a lateral direction.
        
        Histopathologic alteration of dysplastic epithelial cells
        
        Hyperchromatic雙色 (dark-staining) nuclei.
        
        Pleomorphic多形 (abnormally shaped) nuclei and cells.
        
        Increased nuclear-cytoplasmic ratio.
        核 - 細胞質比率增加。
        
        Dyskeratosis角化不全 (premature keratinization過早角化)
        增加有絲分裂活動和異常的有絲分裂數字
        
        Enlarged nuclei and cells.
        
        Large and prominent突出 nucleoli.
        
        Increased mitotic activity and abnormal mitotic figures
        
        Histopathologic alteration of dysplastic epithelial
        
        Loss of polarity (lack of progressive maturation toward the surface).
        
        Keratin or epithelial pearls.
        
        Bulbous or teardrop-shaped rete ridges.
        
        Loss of typical epithelial cell cohesiveness.
- - - - opportunistic related to Epstein-Barr virus
      - easily removed
      - Found in immunocompromized patients
        
        organ transplantion器官移植
        
        corticosteroids皮質類固醇
        
        HIV+
        
        chemotherapy
      - 舌側有白色斑點，有波紋狀或毛狀外觀
    - - attack oral mucosa
      - mild superficial mucosal 輕度淺表粘膜 --> fatal disseminated disease致命性播散性疾病
      - easily to remove
      - a fungus causal agent of opportunistic oral and genital生殖器 infections in humans
      - immunocompromised patients免疫功能低下的患者
- - - - Aspirin burn
      - habit of chewing tobacco
    - - pizza burn(cheese , on palate )
      - Smoking
        
        Nicotinic stomatitis菸鹼性口炎
        
        pipe 煙斗煙草
        
        cigar
      - Hot food
      - healed when it regress completely 完全消除或癒合
      - regular smokers of cigarettes, cigars and pipes, often develop white lesions on their oral mucosa –anterior parts of buccal mucosa, tongue and palate
    - - example
        
        Broken tooth
        
        Rough edges of a carious tooth齲齒的粗糙邊緣
        
        Badly-aligned teeth 牙齒不對齊
        
        Habitual cheek bitting
        
        Orthodontic appliance矯治器
      - treatment: remove the irritant
      - white lesion caused by prolonged mild irritation of the mucous membrane.
- - - - concepts
        
        autosomal dominant hereditary disorder染色體顯性遺傳性疾病 that may affect different mucosal sites.
      - clinical features
        
        appearance
        
        Almost always bilateral and symmetric對稱
        
        starts small -->increases in size -->maximum at adolescence
        
        No treatmenent , asyntomatic
        
        Lesions have a spongy consistency海綿狀一致性
        
        White, thickened, corrugated or velvety波紋狀或天鵝絨般的, diffuse plaques瀰漫性
        
        typically before puberty青春期之前
    - - Concept
        
        Generalized opacification廣泛混濁 of the bucal mucosa頰粘膜 that is regarded a variation of normal
        
        apparent in non-whites, specially african- americans
      - clinical feature
        
        surface appears folded
        
        wrinkles
        
        white streaks
        
        bilaterally 雙側 on the bucal mucosa
        
        Asymptomatic無症狀
        
        Grayish-white filmy灰白色薄膜, milky opalescent appearance乳白色外觀
      - Diagnosis
        
        white appearance greatly disappears or diminishes when the cheek is stretched拉伸.