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White lesions ii

White lesions ii



Oral Pathology I

Oral Pathology I
Third Year



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    White lesions ii White lesions ii Presentation Transcript

    • By Dr. Wael Mohammed Swelam ١٤٣٥A ‫٩١ ربيع اللول‬
    • References January 20, 2014 Dr Wael M. Swelam
    • (Erythema migrans, Benign Migratory Glossitis) tiology: Exact cause still unknown a) hypersensitivity to environmental factors b) hormonal factors c) emotional stress d) recently linked to psoriasis genetic predisposition (HLA-Cw6) athogenesis atrophy of filiform papillae result in erythematous spots ncidence: common benign condition affect the tongue, lip and palate 1~3% of population ♀2>♂1 January 20, 2014 Dr Wael M. Swelam
    • Clinical features – Usually asymptomatic but occasionally painful – Usually discovered accidentally – Affect anterior 2/3 of dorsal tongue mucosa – White annular lesions with atrophic red centers – There is no loss of the sense of taste – There is, a measurable decrease in the tongue's sense of touch. – Course of disease • Appear quickly in one area • Heal within days, • Then appear in a very different area January 20, 2014 Dr Wael M. Swelam
    • Histopathology – – – – Thinning of the epithelium, Elongation of the rete ridges, Focal submucosal accumulation of inflammatory cells, Leukocytes are often noted within microabscess, {Munro abscess} near surface – Surface parakeratosis January 20, 2014 Dr Wael M. Swelam
    • common non- neoplastic dermatologic condition manifesting as flat, lacy, white, intersecting lines on the oral mucosa; lichen planus has a distinctive microscopic appearance Etiopathogenesis: Exact cause still unknown BUT immunologic mechanisms triggered by poorly defined antigenic stimulations plays a pivotal role in the disease pathogenesis a) Chronic stress, as the disease is oftenly affects the educated, the well-to-do, and high achievers. b) Cell-mediated immune response because i) Presence of activated antigen presenting cells (Langerhans' cells, dendritic macrophages) in the lesion could be demonstrated in the early stage of the disease. ii) CD4+ cells initiates immune response in which activated keratinocytes also take part. iii)CD8+ T lymphocytes mediate the damage to the epidermis and leads to the characteristic reaction. c) HLA-associated genetic susceptibility in the causation of the disease d) Hepatitis C virus infection are implicated in the triggering of LP January 20, 2014 Dr Wael M. Swelam
    • Antigenic stimulation Langerhans cells & F XIIIa dendrocytes Endothelium upregulate Adhesion molecules Lymphocytes recruited to & retained in submucosa Basal keratinocytes express ICAM & lymphocytes attach Attract lymphocytes ->attach Basal cell apoptosis
    • Clinical features – Middle aged adults – ♀3>♂2 – Skin lesions incidence among population is 1% – Affect flexor surfaces of extremities – Skin lesion appear as purple, pruritic, polygonal papules – Oral lesions prevalence is 0.1~2.2% January 20, 2014 Dr Wael M. Swelam
    • Characteristic lesion looks like lichen Lesions are usually Bilateral January 20, 2014 Dr Wael M. Swelam
    • Lesions are named after their shape Plaque Reticular/annular Wickham’s straia are diagnostic January 20, 2014 Dr Wael M. Swelam Bullous/Erosive
    • Histopathological features – – – – – – Characteristic but not specific Varying degree of ortho/para keratosis, Varied thickness of prickle cell layer, Rete ridges either absent or hyperplastic=Saw toothed, Destructed (hydrobic degeneration) basal cells Intense band of T lymphocytes subjacent to epithelium Degenerating keratinocytes may be seen around basement membrane as Civatte, Colloid, Cytoid bodies January 20, 2014 Dr Wael M. Swelam
    • Immunologically mediated condition, so-called (collagen vascular) or (connective tissue) disease Systemic form Discoid form January 20, 2014 Dr Wael M. Swelam
    • Genetic factors B cell reactivity alter the function of T cells, antigen-presenting cells & cytokines production B cells to enhance the function of other cells autoantibody production Organ damage January 20, 2014 Dr Wael M. Swelam
    • It is inflammatory disease that target skin and to lesser extent mucosa Clinical features – No sex predilection (systemic ♀8~10>♂1 ) – Middle age – Skin lesions affect mainly face & scalp – Skin lesions appear as disk-shaped erythematous plaques with hyperpigmented margins – Involvement of hair follicles results in permanent hair loss (Alopecia) – Mucous membrane lesions affect 25% of patients mainly (buccal mucosa, gingiva, vermilion border) January 20, 2014 Dr Wael M. Swelam
    •  Commonly affect buccal mucosa, gingiva, and vermillion border  Lesions are either erythematous or ulcerative with delicate white, keratotic striae radiate from the periphery January 20, 2014  Commonly affect buccal mucosa, gingiva, and vermillion border  Lesions are generally similar to DLE; erythematous or ulcerative with delicate white, keratotic striae radiate from the periphery  Systemic symptoms include fever, weight loss, malaise  Involve many organ systems (Joints, kidneys, heart, and lungs)  Kidney lesion = glomerulonephritis  Glomerulonephritis are mostly responsible for death Dr Wael M. Swelam
    • “Anti Nuclear Antibody” ANA test “Regarded as reliable & specific test” • Anti-single stranded DNA • Anti-double stranded DNA • Antinuclear ribonuclear protein “LE” cell test “less sensitive & less specific” Anti Small nuclear “Sm” antibodies {very specific} Ro (SS-A), (SS-B) Antibodies to cytoplasmic antigens January 20, 2014 Dr Wael M. Swelam
    • – Basal cell destruction – Thickened basement membrane – Hyperkeratosis – Epithelial atrophy – “perivascular” Lymphocytic infiltration • DLE more intense & less diffuse • SLE less intense & more diffuse – Vascular dilatation with submucosal edema Direct Immunoflurescent show: * Granular-linear deposits of: IgG, IgM, IgA, C3, & fibrinogen January 20, 2014 Dr Wael M. Swelam
    • January 20, 2014 Dr Wael M. Swelam
    • Thrush, Angular cheilitis, median rhomboid glossitis, denture sore mouth, moniliasis Causative microorganism: Candidal species specially albicans Acute Chronic Mucocutaneous Erythematous Pseudo membranous “Thrush” Erythematous Hyperplastic Familial Localized Syndrome associated January 20, 2014 Dr Wael M. Swelam
    • Erythematous Pseudomembranous “thrush” White, soft plaques grow centrifugally & merge, symptomatic only in sever cases Composed of : – Fungal organisms – Keratotic debris – Inflammatory cells – Desquamated epithelial cells – Bacteria – Fibrin Can be wiped away with gauze Site: – Buccal mucosa, mucobuccal fold, – Lateral aspect of tongue – Oropharynx January 20, 2014 “Antibiotic stomatitis” • Develop on the top of persistent acute pseudomembranous C. • Site: Dorsum of the tongue • Etiology: follow prolonged usage of narrow spectrum antibiotic • Symptomatic Dr Wael M. Swelam
    • Erythematous/ Atrophic “Denture sore mouth” Hyperplastic “Candidal leukoplakia” Similar to speckled leukoplakia Age: adults Site: Dorsum of tongue, Usually asymptomatic Can't be wiped away with gauze Histopathologically: • Develop under Dentures specially ill-fitting ones + poor oral hygiene. • Site: Palatal mucosa • shape: bright red, velvety surfaces “Angular cheilitis” – Evident epithelial hyperplasia – Bulbous rete process – Candidal hyphae seen in upper epithelium Considered as premalignant lesion “Papillary hyperplasia” Site: Under palatal dentures Shape: ovoid or spherical nodules on erythematous background January 20, 2014 • Site: oral commeasures • Affect individuals with deep folds at oral commeasures secondary to over closure • Subsequently colonized with yeasts & staphylococcus aureus • Moderately painful Dr Wael M. Swelam
    • “Candidal leukoplakia” “Denture sore mouth” “Papillary hyperplasia” “Angular cheilitis” January 20, 2014 Dr Wael M. Swelam
    • Long standing, persistent candidiasis  Site: Oral mucosa, nails, skin & vaginal mucosa  Age: Often resistant to treatment  Usually start as pseudomembranous and soon is followed by nail and cutaneous candidiasis Familial Hereditary Auto-immune associated • Autosomal recessive Triad consisting of : a. Myositis b.Mucocutaneous C c. Thymoma = deficiency of T cell mediated immunologic function •Associated with autoimmune disease • Etiopathogenesis: depleted cellmediated arm of immune system • 50% associated with endocrinopathy • 50% associated with defects in iron metabolism January 20, 2014 Dr Wael M. Swelam
    • Acute forms – Fungal hyphae penetrate the upper layers of epithelium at acute angles – Neutrophilic infiltration = superficial micro-abscess Chronic forms – Epithelial Hyperplasia is characteristic No clear evidence that chronic candidiasis is precancerous January 20, 2014 Dr Wael M. Swelam
    • Iatrogenic Drug abuse Connective tissue intense inflammation Epithelial cells coagulative necrosis Fibrinous exudate January 20, 2014 Dr Wael M. Swelam
    • January 20, 2014 Dr Wael M. Swelam
    • Etiopathogenesis – Habitual chewing of areca nut – Nutritional & vitamin deficiency specially • prolonged deficiency of Vit B complex • Folic acid – Hypersensitivity to various dietary constituents Increase cellular sensitivity to many potential irritants Areca nut (alkaloids) Impaired degradation of collagen by fibroblasts rather than excessive deposition January 20, 2014 Dr Wael M. Swelam
    • Clinical features – Age: 20~40 – Site: • soft palate, • buccal mucosa – Shape: Whitish yellow, chronic, – Geographic incidence: • Southeast Asia, • India & neighboring countries – Insidious course might be preceded with vesicle formation – Symptoms: affected mucosa loose its resilience and elasticity January 20, 2014 Dr Wael M. Swelam
    •  Atrophic epithelium  Subjacent fibrosis  mild, moderate, and sever  Poorly vascularized lamina propria & hyalinized  Diffuse mild to moderate inflammatory cell infiltrate January 20, 2014 Dr Wael M. Swelam
    • Ectopic sebaceous glands (developmental condition) Multiple, in aggregates Site: Buccal mucosa & vermilion border of upper lip January 20, 2014 Dr Wael M. Swelam
    • Lingual tonsil: – – – – At posterolateral surface of tongue Consist of aggregates of lymphoid tissue Appear white-yellow, dome-shaped elevations Crypts of these structures when obstructed  lymphoepithelial cyst January 20, 2014 Dr Wael M. Swelam
    • Etiopathogenesis: • In infants (Bohn’s nodules, Epstein’s pearls): Epithelial entrapment within midline of palatal fusion • In adults: – Proliferation of rests of Serres (remnants of dental lamina) – Traumatic implantation of surface epithelium into gingival CT. – Age: 10~12 weeks of age – Site: along palatine shelves – Painless growth in attached gingiva often within interdental papilla January 20, 2014 Dr Wael M. Swelam
    • Gum boil – Gingival abscess appear either • The base of gingival pocket • Apex of non vital tooth – Yellowish-white gingival swelling – Painful January 20, 2014 Dr Wael M. Swelam
    • – Yellowish-white – Un inflamed submucosal mass January 20, 2014 Dr Wael M. Swelam
    • January 20, 2014 Dr Wael M. Swelam