Constellation of Oral Inflammatory Hyperplastic Lesions: Case Series with Review of Literature

Oral cavity, when subjected to various forms of chronic insults or microtrauma, often results in a hyperplastic lesion, commonly referred to as inflammatory reactive hyperplasia. This category includes various lesions such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma, and peripheral giant cell granuloma. They are primarily seen to develop in close proximity to the source of chronic irritant and have a close resemblance in terms of biological behavior and clinical presentation. Histopathologically, they display a common feature of hyperplastic fibrous tissue, but also have some variations like the presence of giant cells or aggregate of calcified mass depending on the histogenesis of the lesion. They were the most common tumor-like lesions to be seen in the oral cavity, familiarity with these lesions are of utmost importance. The present article portrays a series of 5 cases of different clinical forms of reactive hyperplasia with a brief literature review. The current manuscript is presented with an aim to enhance the knowledge about hyperplastic lesions.

Análisis clínico e histomorfológico de la mucosa oral normal, hiperplasia fibroepitelial inflamatoria oral y displasia oral / Clinical and histomorphological analysis of normal oral mucosa, oral inflammatory hyperplasia and oral epithelial displasia

El desarrollo del cáncer oral puede darse a partir de una mucosa aparentemente normal o a partir de una lesión precursora inicial, las cuales pueden representar pasos diferentes del proceso de carcinogénesis epitelial oral. El objetivo de este estudio fue analizar morfológicamente, a través de la técnica de la hematoxilina / eosina, la mucosa oral normal, con hiperplasia fibroepitelial oral y displasia epitelial oral, con el propósito de obtener mayor información sobre las alteraciones epiteliales que pueden preceder al establecimiento y evolución de una neoplasia propiamente tal. Fue observado que muchas de las alteraciones morfológicas observadas en las hiperplasias fibroepiteliales orales probablemente eran asociadas al proceso inflamatorio, donde es conocida la acción de mediadores químicos con capacidad de promover modificaciones morfológicas celulares y en la estructura tisular y no necesariamente representan alteraciones comunes de lesiones potencialmente malignas. Correlacionando el aspecto clínico de las lesiones con el diagnóstico histopatológico de displasia epitelial oral, no fue observada diferencia expresiva; sin embargo, la mayoría de los especímenes tuvo diagnostico clínico de leucoplasia. Se concluyó que la simple observación de las características morfológicas de las alteraciones de la mucosa oral puede ayudar el establecimiento del diagnóstico de las lesiones sufridas por la mucosa; sin embargo, no ofrecen muchas información sobre cuáles serían los eventos que llevarían al establecimiento de una determinada lesión.

The oral cancer development can be from apparently normal mucosa, or from precursory lesions, that can represent different step of oral epithelial carcinogenesis process. This study aimed to analyze morphologically trough the hematoxilina/eosine technique normal oral mucosa, oral fibroepithelial inflammatory hyperplasia and oral epithelial dysplasia (OED) to get more informations about the epithelial alterations that can to precede the installation and evolution of oral cancer. Its was observed that some of the morphologic alterations in the oral fibroepitelial hyperplasia were provably associated to the inflammatory process, where exist the action of chemical mediators with capacity to promote cellular morphologic modifications and alterations of the tissue architecture but not to common alterations of lesions potentially malignant. Correlating the clinical aspect of the lesions with the histopatologic diagnosis of oral epithelial dysplasia its was not observed expressive difference, however the majority of the OED specimens had clinical diagnosis of leucoplasia. Its was concluded that the simple observation of the morphologic characteristics of epithelial alterations in the oral mucosa can to improve the diagnostic of the lesions suffered by this mucosa, however, its not offers much informations about which would be the events that would lead to the establishment of a determined lesion.

Expressão imuno-histoquimico das integranas a2B1, a3B1, e a5B1, em mucosa oral norma hiperplasia fibroepitalial inflamatória oral e displasia epitelial oral

Este estudo se propôs analisar através da técnica da estreptoavidina-biotina a expressão imuno-histoquímica das integrinas α2ß1, α3ß1 e α5ß1 em 11 espécimes de mucosa oral normal (MON), 16 de hiperplasia fibroepitelial inflamatória oral (HFIO) e 25 de displasia epitelial oral (DEO) (16 leves, 2 moderadas e 7 graves), procurando determinar se existe alteração qualitativa na expressão destas integrinas e se a mesma guarda relação com as modificações sofridas pelo epitélio oral. Para a integrina α2ß1 a maioria dos espécimes exibiu uma marcação predominantemente intensa e difusa nos contatos intercelulares e no citoplasma celular das camadas basal e suprabasal, sem diferença desse perfil entre os diferentes tipos de espécimes, porém com uma tendência a fraca ou perda da expressão em 21.1% das DEOs, sendo todos os espécimes que não expressaram marcação para este heterodímero DEOs graves. Para a integrina α3ß1 a maioria da amostra exibiu uma marcação fraca ou ausente predominantemente em camada basal. A integrina α5ß1 exibiu uma forte marcação difusa nos contatos intercelulares e citoplasmática na camada suprabasal, com diferença apenas na intensidade de marcação entre os tipos de espécimes, residindo essa diferença nas DEOs, onde 12 (48%) espécimes exibiram uma fraca marcação. Concluiu-se que as integrinas avaliadas podem estar envolvidas nas interações célula-célula e célula-MEC que garantem a diferenciação celular e manutenção do arranjo estrutural tecidual. A variável expressão da integrina α5ß1 nas DEOs, poderia sugerir, respectivamente, um papel dessa molécula na sobrevida celular, com o intuito de perpetuar o fenótipo alterado nessas lesões, ou uma ação supressora desse fenótipo devido à falta de interação desta molécula com a fibronectina da MEC (AU).

The objective of this study was perform by the streptoavidin-biotin technique an immunohistochemical analysis of α2ß1, α3ß1 e α5ß1 integrins in 11 normal oral mucosa (NOM), 16 oral inflammatory fibroepithelial hyperplasia (OIFH) and 25 oral epithelial dysplasia (OED) (16 mild, 2 moderates and 7 severe), to determine if exists qualitative alteration in the expression of these integrins and if this guard relation with the oral epithelial modifications. It was observed that for the α2ß1 integrin the majority of the sample showed a predominantly intense labeling diffusely distributed in the intercellular contacts and the cytoplasm of cells of the basal and suprabasal layers, without difference of this profile between the different types of specimens, however with a trend to weak or loss of expression in 21.1% of the OEDs, being all the specimens that had not expressed this heterodimer, severe OEDs. For the α3ß1 integrin the majority of the sample showed a weak or absent labeling in basal layer. The α5ß1 integrin showed a predominant strong diffuse labeling in the intercellular contacts and cytoplasm in the suprabasal layer, with difference only in the labeling intensity between the types of specimens, inhabiting this difference in the OEDs, where 12 (48%) specimens had shown a weak labeling. It was concluded that the evaluated integrins can be involved in the cell-cell, cell-ECM interactions modulating the cellular differentiation and maintenance of the epithelial structural arrangement. The variable expression of the α5ß1 integrin in the OEDs, could suggest, respectively, a role of this molecule in the cellular survival, with intention to perpetuate the modified phenotype in these lesions, or a suppressor role on the modified phenotype due to lack of interaction of this molecule with the fibronectina of the MEC (AU).