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[Course in oral diagnosis. Cancer of the mouth and maxillo-mandibular complex. 10th lecture].
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[Course in oral diagnosis. Bone lesions. Lecture 12].
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The biological approach in oral diagnosis.
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Dark oral lesions: differential diagnosis with oral melanoma.
Oral melanoma is a neoplasm with a poor prognosis; its premature diagnosis is of foremost importance. We review here pathologic situations to be considered in the clinical differential diagnosis: tattoos, melanotic macules, Laugier's disease, melanocytic nevus, drug intake, some vascular lesions, and oral pigmented lesions associated with endocrine disorders or with different syndromes.
Histopathology, immunology, and serology of oral yeast infections. Diagnosis of oral candidosis.
For diagnostic purposes it is normally not important to obtain a biopsy specimen, since an oral smear from the lesion will yield blastospores and pseudohyphae in abundance. However, in lesions that respond poorly to antimycotic treatment a biopsy should be carried out to detect possible malignant changes in the epithelium. Assessment of cell-mediated immunity against Candida albicans and other antigens may be important in patients with severe chronic candidosis to assess the degree of immunocompetence and prognosis. Usually, patients with oral candidosis show only moderately elevated antibody titers in serum and saliva against C. albicans, and serologic tests are normally not a diagnostic tool for oral candidosis. However, such tests may be a prognostic instrument in patients with severe oral candidosis who respond poorly to antimycotic therapy.
Cysticercosis of the oral mucosa: aspiration cytologic diagnosis.
Oral mucosa is a rare site for cysticercosis. This paper describes eight cases of cysticercosis involving the oral cavity: four in the buccal mucosa, two in the lips, one in the tongue and one in the gums. All of the patients presented with a solitary superficial mucosal nodule, with duration varying from one month to three years. Larval fragments of cysticercus cellulosae on an inflammatory background were seen in cytologic smears in all cases. Diagnosis of cysticercosis was clinically unsuspected in all these cases prior to aspiration cytologic diagnosis.
Differential diagnosis of oral lesions. 4. Differential diagnosis of soft tissue tumours of the oral cavity.
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[Usefulness of oral exfoliative cytology for the diagnosis of oral squamous dysplasia and carcinoma].
AIM: It is well known that diagnostic oral exfoliative cytology, even if a useful, economical and practical tool in the diagnosis of oral dysplasia and carcinoma, is not yet used so extensively as is cervico-vaginal cytology. METHODS: Exfoliative cytology was used for the diagnosis of oral dysplasia and carcinoma, and the results compared to the histological examination. Cytological smears were taken from 89 patients with oral lesions suspicious for neoplasia (in particular erythro- and leukoplakia and lichen). All patients were also subjected to oral biopsy and histological examination. RESULTS: Out of 89 cases studied, histology showed the presence of an invasive squamous carcinoma in 32, dysplasia in 17, phlogosis in 15 and other types of lesions (2 of which malignant non-epithelial tumours) in 25. The cytological smear was inadequate for diagnosis in 11/89 cases (12.4%). In cytologically adequate and histologically positive cases, cytology confirmed the histological diagnosis of dysplasia and/or carcinoma in 38/45 cases (sensitivity 86.5%, accuracy 89.6%). Moreover, 1 case which was histologically negative at the onset, proved positive at cytology. There were 2 false-positive cytology results (specificity 94.3%, predictive positive value 95.7%). CONCLUSIONS: Despite the small number of cases in the cohort, oral cytology can improve the accuracy of histology, and may be a useful screening tool for the diagnosis of oral neoplasia/dysplasia.
Malignant melanoma of the oral cavity--an increasing clinical diagnosis?
Oral malignant melanoma is fortunately a rare lesion. However the actual incidence in the population at present is unknown but may be increasing. The overall prognosis remains poor despite more radical surgery with adjuvant radiotherapy, chemotherapy and immunotherapy. The clinical presentation of oral malignant melanoma can vary widely from a typically pigmented macular or proliferative lesion to a non-pigmented soft vascular tumour; single or multiple, primary or metastatic. Our experience of five patients with malignant melanoma of the oral cavity is presented and the management of such lesions discussed.
[Molecular diagnosis of oral cavity trichomonas infections in HIV patients].
The occurrence of trichomonas in oral cavity of HIV patients is not well known. HIV patients often suffer from oral lesions (candidiosis, advanced caries) and it remains unclear if any oral parasites can affect that, therefore the aim of the study was verification of species that can occur in HIV patients' oral cavity. Diagnosis of oral trichomonas can be performed by conventional methods (microscopic observation of wet and stained preparations and cultivation) but these are time consuming and insufficient for proper species differentiation, therefore in order to detect and identify species of parasites precisely, molecular methods such as PCR (Polymerase Chain Reaction) and sequencing of its product, were applied. 54 HIV patients (18 females and 36 males at the age of 20-54) were examined. All of them were addicted to intravenous drugs for at least 6 years. Saliva, smears and spittle samples were collected and used for cultivation, preparations and molecular diagnosis. For PCR amplification a pair of primers (T1 and T2) specific for ITS 1 - 5.8 SrRNA - ITS 2 region was designed. The oral trichomonas were detected in saliva samples of 3 HIV patients; these were males at the age of 25, 27 and 44. The identification of species by PCR and sequencing of the PCR products showed the trichomonads belonging to Trichomonas tenax. Infection of HIV patients' oral cavity caused by T. tenax is rather related with inflammatory processes than with the immunosuppression of these patients but should be considered as a potential factor in pathogenesis of oral disorders in immunosuppressed patients.
Dentists' knowledge, case-finding behavior, and confirmed diagnosis of oral cancer.
A questionnaire was developed for dental general practitioners that was used to measure three types of clinician knowledge believed to be central to the early detection and management of oral cancer. Oral cancer management issues (case-finding behavior and clinician knowledge of patient outcomes) were also studied. The hypothesis that clinician knowledge is associated with oral cancer case-finding behavior could not be validated, but the hypothesis that clinician case-finding behavior is associated with knowledge of confirmed oral cancer or precancerous diagnoses was substantiated.
Oral smears in the diagnosis of oral cancer.
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Oral ulcers in HIV-infected patients: an update on epidemiology and diagnosis.
Oral ulcers observed during the course of HIV infection may be very severe. Such manifestations may interfere with oral functions and alter the patients' quality of life. It is important to stress that when HIV-infected individuals present with ulcerative lesions of the oral cavity, neoplastic processes and rare infections must be included in the differential diagnosis. Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers, since either infection or a neoplastic process may be present. In the absence of infection or neoplasm, such lesions are then designated ulcers not otherwise specified.
Oral lesions and HIV. An approach to the diagnosis of oral mucosal lesions for the dentist in private practice.
The diagnosis and treatment of oral mucosal lesions in HIV infected individuals is of importance. Oral lesions are reliable indicators of HIV infection and immunosuppression. They are important for staging HIV disease, they have been used as clinical markers in trials to test drug efficacy, and to determine the correct time for institution of treatment for HIV or prophylaxis against opportunistic infections. For the patients, they can cause pain, loss of taste and severe discomfort, leading to decreased quality of life. In more severe cases, they can disseminate and become life-threatening. Several types of lesions may affect the oral mucosa of HIV infected individuals. Although caused by different etiological agents, these lesions may have similar clinical appearance. They may also look like other oral mucosal lesions not commonly associated with HIV infection. Their correct diagnosis is important so adequate treatment can be prescribed. This article provides information to the dentist in private practice on how to elaborate a differential diagnosis and arrive to a final diagnosis of oral mucosal lesions in HIV infected individuals.
The use of Calcofluor white in the histopathologic diagnosis of oral candidiasis.
Calcofluor white (CW) is a water-soluble, colorless dye that selectively binds to beta 1-4 polysaccharides (cellulose) in fungal cell walls. The planar, trans-form of the molecule fluoresces light blue when exposed to UV light (345 to 365 nm). Recuts of all biopsy specimens, accessioned over a 6-month period, that had been stained with Grocott's methenamine silver (GMS) were stained with CW and examined. Of the 34 cases from which specimens were reviewed, 17 had specimens that were positive for the presence of fungal organisms as indicated by both GMS and CW staining. Specimens from all of the 17 remaining cases were negative for the presence of fungal organisms, as staining with both GMS and CW indicated. Similar results were obtained with direct fungal smears. The CW technique has significant advantages over traditional methods, including rapidity, cost, sensitivity, simplicity, and absence of interference with permanent fungal stains.
Assessment of the value of immunofluorescence microscopy in the diagnosis of oral mucosal lichen planus.
Accurate diagnosis of oral mucosal lichen planus (OMLP) is essential if appropriate management is to be instituted. Direct immunofluorescence microscopy (DIF) has facilitated the diagnosis of some dermatologic diseases with oral manifestations, but its use in the diagnosis of OMLP is less well documented. In the present study, 165 biopsies from consecutive cases for which a provisional diagnosis of OMLP was suggested clinically or on the basis of routine histopathologic, or DIF assessment were studied. In 27 cases the results of DIF were non-contributory. In 13 cases the diagnosis could only be established by DIF examination. Nine cases clinically diagnosed as OMLP were assigned to a different condition on the basis of routine histology and DIF. It was concluded that DIF was an integral step in the diagnosis of OMLP.
Diagnosis of oral precancer and cancer.
The early diagnosis of oral cancer and precancer is important because oral cancer is usually well advanced at the time of diagnosis, having spread to regional lymph nodes in a substantial percentage of cases. The earlier the diagnosis is made, the better the prognosis. Several diagnostic methods that are used, such as stomatoscopy, toluidine blue staining, oral exfoliative cytology, histopathological examination and other more advanced diagnostic procedures, are discussed.