Manifestaciones clínicas e histopatológicas de la eritroplasia bucal en pacientes fumadores de tabaco

Fundamento la eritroplasia es la lesión precancerosa más agresiva de la cavidad oral, con un gran potencial de transformación maligna. Al momento de practicar la biopsia y analizar la muestra, puede aparecer una displasia severa o un carcinoma invasivo. Objetivo describir las manifestaciones clínicas e histopatológicas de la eritroplasia bucal en pacientes fumadores activos de tabaco. Métodos se realizó un estudio descriptivo y transversal, con 12 fumadores diagnosticados clínica e histopatológicamente con eritroplasia bucal, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Saturnino Lora Torres, de Santiago de Cuba. Para la recolección del dato primario se confeccionó una encuesta con las variables: edad, sexo, diagnóstico clínico, tiempo en el hábito de fumar, diferentes formas de consumir tabaco, localización anatómica y estudio histopatológico de la enfermedad. Resultados prevaleció el sexo masculino, el grupo etario de 60 y más años, y los fumadores convencionales de 21 y más años. El infiltrado inflamatorio crónico intenso y la displasia epitelial severa resultaron los cambios hísticos más comunes. Los signos displásicos tisulares mayormente implicados fueron la alteración de los clavos interpapilares, pérdida de la polaridad de las células basales e hiperplasia de las células del estrato basal; mientras que los displásicos citológicos más relevantes resultaron la hipercromasia de núcleos y nucleolos, el pleomorfismo nuclear y el aumento de la relación núcleo-citoplasma, siendo el paladar blando el sitio más frecuente. Conclusiones todos los pacientes fumadores mostraron lesiones eritroplásicas al examen clínico bucal, lo cual fue confirmado por estudio histopatológico.

Foundation erythroplasia is the most aggressive precancerous lesion in the oral cavity, with great potential for malignant transformation. At the time of performing the biopsy and analyzing the sample, severe dysplasia or invasive carcinoma may appear. Objective to describe the clinical and histopathological manifestations of oral erythroplasia in patients who are active tobacco smokers. Methods a descriptive and cross-sectional study was carried out, with 12 smokers clinically and histopathologically diagnosed with oral erythroplasia, attended in the Specialties Polyclinic stomatological consultation of the Saturnino Lora Torres Hospital, in Santiago de Cuba. For the collection of the primary data, a survey was made with the variables: age, sex, clinical diagnosis, time in the smoking habit, different ways of consuming tobacco, anatomical location and histopathological study of the disease. Results the male sex, the age group of 60 years old and over, and conventional smokers of 21 and over prevailed. Intense chronic inflammatory infiltrate and severe epithelial dysplasia were the most common tissue changes. The tissue dysplastic signs most involved were alteration of the interpapillary nails, loss of polarity of the basal cells, and hyperplasia of the basal layer cells; while the most relevant cytological dysplastics were hyperchromasia of nuclei and nucleoli, nuclear pleomorphism and increased nucleus-cytoplasm ratio, with the soft palate being the most frequent site. Conclusions all the smoking patients showed erythroplastic lesions on oral clinical examination, which was confirmed by histopathological study.

Abordaje quirúrgico primario en un paciente con eritroplasia de Queyrat / Primary surgical approach to a patient with erythroplasia of Queyrat

Presentación del caso. Paciente masculino de 52 años que se presentó a la consulta de urología con historia de dos años de notar una lesión en el glande y el prepucio, de color rojo brillante, pruriginosa y dolorosa con aumento progresivo del tamaño que no mejoró con tratamientos antibióticos y anti fúngicos. Intervención terapéutica. Se realizó una glandectomía parcial con injerto de piel de muslo. Evolución clínica. Luego de un mes, el injerto presentó un 95 % de acoplamiento. No se observó recurrencia local de cáncer. El estudio histopatológico reportó un carcinoma escamoso invasor en la lesión del prepucio y en la piel del glande, con todos los márgenes quirúrgicos, limites laterales y profundos, negativos a malignidad. Luego de ocho meses posquirúrgicos, se observó el recubrimiento del glande con un adecuado resultado estético, con apariencia similar a la cubierta natural

Case presentation. A A 52-year-old male patient presented to the urology office with a two-year history of noticing a bright red, pruritic, and painful lesion on the glans and foreskin with a progressive increase in size that did not improve with antibiotic and antifungal treatments. Treatment. Partial glandectomy with thigh skin graft was performed. Outcome. After After one month, the graft presented a 95 % of coupling. No local recurrence of cancer was observed. The histopathological study reported invasive squamous cell carcinoma in the lesion of the foreskin and glans skin, with all surgical margins, lateral and deep limits, negative for malignancy. After eight months post-surgery, the covering of the glans was observed with an appropriate esthetic result, with a similar appearance to the natural covering

Leucoplasia Verrucosa Proliferativa: Revisão da Literatura com Ênfase no Diagnóstico, Manejo e Tratamento / Proliferative Verrucous Leukoplakia: Literature Review With Emphasis on Diagnosis, Manegement and Treatment

As Desordens Potencialmente Malignas Orais (DPMO) descrevem um grupo de doenças com risco aumentado de desenvolver o Carcinoma Espinocelular (CEC), e a mais comum é a Leucoplasia Oral (LO), que apresenta uma variante agressiva denominada Leucoplasia Verrucosa Proliferativa (LVP). Descrita pela primeira vez em 1985 por Hansen et al., a LVP é considerada uma forma multifocal incomum da doença, com curso clínico agressivo e implacável para malignidade, sem associação com os fatores de risco tradicionais da LO. O diagnóstico e manejo dessa variante é um desafio, pois, além da ausência de biomarcadores comprovados que possam predizer seu curso evolutivo, a subjetividade existente na sua avaliação clínica e histopatológica, faz com que a presença ou grau de Displasia Epitelial Oral (DEO) não consiga determinar se haverá ou não transformação maligna da lesão. O objetivo desse trabalho foi realizar uma Revisão da Literatura Tradicional, focando especificamente nos aspectos sobre diagnóstico, transformação maligna, manejo e tratamento da LVP, variante agressiva da LO. Concluímos que, ainda hoje, não existem biomarcadores que possam predizer o avanço das LO, tornando-se obrigatório o acompanhamento e/ou tratamento de toda e qualquer LO, inclusive os casos de Queratose de significado incerto.

Oral Potentially Malignant Disorders (OPMDs) describe a group of diseases at increased risk of leading to Squamous Cell Carcinoma (SCC). The most common is Oral Leukoplakia (OL), which presents itself through an aggressive variant known as Proliferative Verrucous Leukoplakia (PVL). First described in 1985 by Hansen et al., PVL is considered an uncommon multifocal form of the disease, with an aggressive and relentless clinical course towards malignancy, and lacks association with traditional OL risk factors. The diagnosis and management of this disease form posits a significant challenge since, in addition to the absence of proven biomarkers that can predict its evolutionary course, the subjectivity existing in its clinical and histopathological evaluation means that the presence or degree of Oral Epithelial Dysplasia (OED) is not enough to determine whether or not the lesion will undergo a malignant transformation. The objective of this work was to carry out a Traditional Literature Review focused specifically on aspects of diagnosis, malignant transformation, management and treatment of PVL, an aggressive variant of OL. Our conclusion is that, to this day, there are no biomarkers able to predict the progress of OL, making it necessary to monitor and/or treat all OL cases, including cases of Keratosis of unknown significance.

Evaluación clínico-epidemiológica de trastornos bucales potencialmente malignos en adultos de Montalvo en Ambato, Ecuador / Clinical-epidemiological evaluation of potentially malignant oral disorders in adults of Montalvo in Ambato, Ecuador

RESUMEN Introducción: Las neoplasias de cabeza y cuello representan el 17,6 por ciento a nivel mundial. El cáncer de la cavidad bucal es uno de los más comunes que aparece en dicha región; el 95 por ciento corresponde a carcinoma epidermoide con un pobre pronóstico de supervivencia, debido a que algunos se desarrollan a partir de trastornos potencialmente malignos peligrosamente asintomáticos, por lo que su detección precoz es imprescindible. Objetivo: Caracterizar los trastornos bucales potencialmente malignos mediante aspectos epidemiológicos, clínicos y topográficos en adultos atendidos en el subcentro de salud de Montalvo. Métodos: Se realizó un estudio descriptivo y transversal en 99 pacientes atendidos en el subcentro de salud de Montalvo en Ambato, Ecuador, desde noviembre de 2012 a enero de 2013. Los datos fueron recogidos en la historia clínica estomatológica, que incluyó: datos generales, interrogatorio y examen físico de la cavidad bucal. Los trastornos bucales potencialmente malignos que se consideraron fueron la leucoplasia, eritroleucoplasia, eritroplasia y paladar del fumador invertido. Se aplicó la estadística descriptiva y el estadígrafo chi cuadrado de Sperman. Se trabajó con confidencialidad en el manejo de los datos obtenidos y con la autorización correspondiente al consentimiento. Resultados: Los pacientes con más de 60 años representaron el grupo de edad más afectado para el 60,6 por ciento, con un predominio del sexo femenino (54,5 por ciento). El color de la piel no tuvo una diferencia significativa. El trastorno más frecuente fue la leucoplasia (30 por ciento), seguida de la eritroleucoplasia (15 por ciento) y la eritroplasia (11 por ciento). El 75,8 por ciento de los pacientes no presentó síntomas, sin embargo, el 73 por ciento de los casos con lesiones presentó trauma físico. La localización más frecuente de la leucoplasia fue la mucosa del carrillo y la base de la lengua. Conclusiones: La leucoplasia, la eritroleucoplasia y la eritroplasia fueron los trastornos bucales potencialmente malignos más frecuentes, localizados con mayor frecuencia en la base de la lengua y la mucosa del carrillo, con un predominio en los pacientes mayores de 60 años y en las mujeres(AU)

ABSTRACT Introduction: Head and neck neoplasms represent 17.6 percent worldwide. Cancer of the oral cavity is one of the most common that appear in this region, being 95 percent epidermoid carcinoma with a poor prognosis of survival because they develop from premalignant lesions dangerously asymptomatic, the reason why the precocious detection is imperative. Objective: Characterize potentially malignant oral disorders through epidemiological, clinical and topographical aspects in adults served at the Montalvo health subcenter. Methods: A descriptive and cross-sectional study was conducted on 99 patients treated at the Montalvo health subcentre in Ambato, Ecuador, from November 2012 to January 2013. The data were collected in the stomatological medical history, which included: general data, interrogation and physical examination of the oral cavity. The potentially malignant oral disorders considered were leukoplakia, erythroleukoplakia, erythroplasia and the palate of the inverted smoker. The descriptive statistic and the Sperman chi square statisticwast were applied. It was worked with confidentiality in the handling of the data obtained and with the authorization corresponding to the consent. Results: Patients over 60 years of age accounted for the most affected age group for 60.6 percent, with a female predominance (54.5 percent). The skin color did not make a significant difference. The most common disorder was leukoplakia (30 percent), followed by erythroleukoplakia (15 percent) erythroplasia (11 percent). 75.8 percent of patients had no symptoms, however 73 percent of injured cases had physical trauma. The most common location of leukoplakia was the mucosa of the cheek and the base of the tongue. Conclusion: Leukoplakia, erythroleukoplakia and erythroplasia were the most common potentially malignant oral disorders, most commonly located at the base of the tongue and mucosa of the carrillo, with predominance in patients over 60 years of age and in patients over 60 years of age and in Women(AU)

Recent advances of basal cell carcinoma, squamous cell carcinoma, and carcinoma in situ

Incidence of basal and squamous cell carcinoma is increasing among Korean. With increasing this incidence we need to attend the management and prevention of these cutaneous malignancies. Basal cell carcinoma (BCC) is the most common skin malignancy. Sun exposure is the most important environmental cause of BCC. Daily sun protection especially avoiding sun exposure between 10 a.m. and 4 p.m. provides most effective prevention against chronic ultraviolet-induced skin damage. Hedgehog pathway inhibitors are used locally advanced and metastatic BCC lesions in Korea. Until recently, there are no reports whether it developed resistance of Hedgehog pathway inhibitors with advanced BCC in Korean patients. Among malignant skin tumors, 19.1% were squamous cell carcinoma (SCC). The incidence of SCC was rapidly increased over the past years. However, the incidence rate of SCC in Japan has not been changed from the period 1976–1980 to 1986–1990. Sentinel lymph node biopsy for SCC did not provide diagnostic value. Bowen's disease and Erythroplasia of Queyrat are considered as carcinoma in situ of the skin. Erythroplasia of Queyrat have worse prognosis with a higher rate of malignant degeneration. Dermoscopy may helpful tool in assisting the noninvasive diagnosis of carcinoma in situ of the skin.

Potentially malignant oral lesions: clinicopathological correlations / Lesões orais potencialmente malignas: correlações clínico-patológicas

ABSTRACT Objective To determine the incidence of potentially malignant oral lesions, and evaluate and correlate their clinical and pathological aspects. Methods The sample consisted of cases clinically diagnosed as oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, and oral lichen planus treated at a diagnostic center, between May 2012 and July 2013. Statistical tests were conducted adopting a significance level of 5% (p≤0.05). Results Out of 340 patients, 106 (31.2%) had potentially malignant oral lesions; and 61 of these (17.9%) were submitted to biopsy. Actinic cheilitis was the most frequent lesion (37.5%) and the lower lip was the most affected site (49.6%). Among 106 patients in the sample, 48 (45.3%) reported nicotine consumption, 35 (33%) reported alcohol intake and 34 (32.1%) sun exposure while working. When clinical and histopathological diagnoses were compared, oral erythroplakia and atypical ulcer were the lesions that exhibited greater compatibility (100% each). Conclusion In most cases, clinical and histopathological diagnoses were compatible. An association between the occurrence of erythroplakia, leukoplakia and erythroleukoplakia with smoking was observed. Similarly, an association between actinic cheilitis and sun exposure was noted. Erythroleukoplakia presented the highest malignancy grade in this study. Finally, dental surgeons should draw special attention to diagnosis of potentially malignant oral lesions, choose the best management, and control the lesions to avoid their malignant transformation.

RESUMO Objetivo Verificar a incidência das lesões orais potencialmente malignas, e avaliar e correlacionar seus aspectos clínico-patológicos. Métodos A amostra foi composta pelos casos diagnosticados clinicamente como leucoplasia oral, eritroplasia oral, eritroleucoplasia, queilite actínica e líquen plano oral em um serviço de diagnóstico no período entre maio de 2012 e julho de 2013. Foram realizados testes estatísticos adotando-se nível de significância de 5% (p≤0,05). Resultados Dos 340 pacientes examinados, 106 (31,2%) se apresentaram com lesões orais potencialmente malignas; destes, 61 (17,9%) biópsias foram realizadas. A lesão mais frequente foi a queilite actínica (37,5%), e o sítio anatômico mais acometido foi o lábio inferior (49,6%). Entre os 106 pacientes da amostra, 48 (45,3%) relataram consumo de nicotina, 35 (33%) ingeriam bebidas alcoólicas e 34 (32,1%) trabalhavam expostos ao sol. Comparando o diagnóstico clínico com o histopatológico, as lesões que apresentaram maior compatibilidade foram a eritroplasia oral e a lesão ulcerada atípica (100% ambas). Conclusão Na maioria dos casos, houve compatibilidade do diagnóstico clínico com o histopatológico. Notou-se correlação entre a ocorrência de eritroplasia, leucoplasia e eritroleucoplasia com o hábito de fumar, e entre a queilite actínica com a exposição solar. A eritroleucoplasia foi a lesão que demonstrou maior grau de malignização neste estudo. Diante do exposto, recomenda-se maior atenção por parte dos cirurgiões-dentistas ao diagnóstico das lesões orais potencialmente malignas, para aplicação da melhor conduta e controle da lesão, impedindo sua transformação maligna.

Carcinoma in situ in a patient with erythroleukoplakia: challenges in the diagnosis and in the therapeutic choice / Carcinoma in situ in erythroleukoplakia

A 41-year-old Caucasian male smoker presented a red and white plaque on the left jugal mucosa suggestive of oral erythroleukoplakia (OEL). Biopsy followed by microscopic examination revealed carcinoma in situ. Since OEL is considered a precancerous lesion with a high malignant transformation potential, the present case set out to discuss the challenges in diagnosing the condition and choosing the most appropriate treatment. The discussion deals with issues such as whether there is a limit for choosing either a radical or a more conservative approach to treatment and the importance of using a procedure that allows a microscopic examination of the entire lesion. Carcinoma in situ associated with OEL made the treatment planning even more complex in the present case. In order to avoid a mutilating approach, multiple excisions with safety margins were performed, and the patient was instructed not to smoke. A strict 12-month follow-up shows no signs of recurrence of the OEL... (AU)

Eritroplasia e leucoeritroplasia oral: análise retrospectiva de 13 casos / Oral erythroplakia and speckled leukoplakia: retrospective analysis of 13 cases

Eritroplasia e leucoeritroplasia são lesões orais cancerizáveis com elevado potencial de transformação maligna. OBJETIVOS: Neste estudo retrospectivo foram analisadas as características clínico-patológicas de 13 casos de eritroplasias e leucoeritroplasias orais de pacientes atendidos em um Serviço especializado em Estomatologia e diagnóstico histopatológico. MATERIAL E MÉTODO: Foram revisados os registros de biópsia de pacientes atendidos entre os anos de 1978 e 2006. Foram registradas e características clínicas e histopatológicas das lesões, bem como sexo, idade dos pacientes e associação com fatores de risco. RESULTADOS: As lesões exibiram predileção por pacientes do sexo masculino na proporção de 1:3.3. A média etária dos indivíduos foi de 57 anos e o palato mole foi o sítio envolvido em 77 por cento dos casos. Sintomatologia dolorosa foi relatada por 61,5 por cento dos pacientes e associação com tabagismo e etilismo foi observada em 100 por cento e em 46 por cento dos casos, respectivamente. As lesões analisadas exibiam displasia epitelial e mais de 50 por cento foram diagnosticadas como carcinoma in situ ou carcinoma invasivo. CONCLUSÕES: Apesar de apresentarem baixa prevalência, as eritroplasias homogêneas e as leucoplasias salpicadas exibem alterações epiteliais que vão de displasia epitelial a carcinoma invasivo, o que justifica sua inclusão entre as lesões bucais com maior potencial de malignização.

Erythroplakia and speckled leukoplakia are oral precancerous lesions that have a high potential for malignant transformation. AIM: A retrospective analysis was conducted to investigate the clinicopathologic features of 13 cases of oral erythroplakia and speckled leukoplakia in patients who were seen at a center specialized in stomatology and Histopathological diagnosis of oral diseases. MATERIALS AND METHODS: All cases diagnosed with erythroplakia and speckled leukoplakia between 1978 and 2006 were retrieved from the service archives. RESULTS: The lesions exhibited a predilection for males with a female-to-male ratio of 1:3.3. Mean age was 57 years old and soft palate was the site affected in 77 percent of the cases. Pain symptoms were reported by 61.5 percent of the patients and association with risk factors such as smoking and excessive alcohol intake was seen in 100 percent and in 46 percent of the cases, respectively. The lesions showed epithelial dysplasia, where more than 50 percent were diagnosed as in situ or invasive carcinoma. CONCLUSIONS: Despite low prevalence, oral homogeneous erythroplakia and speckled leukoplakia show Histopathological alterations vary from epithelial dysplasia to invasive carcinoma. These lesions must be included among those oral lesions with the highest potential for malignant tranformation.

A Case of Erythroplasia of Queyrat Treated with Imiquimod 5% Cream and Excision

Imiquimod is a new immunomodulating agent with antitumor and antiviral properties that has been shown to be clinically effective in various kinds of skin diseases, including precancerous dermatoses. Erythroplasia of Queyrat is a carcinoma in situ that mainly occurs on the glans penis. There are several non-invasive treatment options for erythroplasia of Queyrat such as photodynamic therapy, cryosurgery and applying various kinds of topical agents. We now report a case of typical erythroplasia of Queyrat on glans penis associated with human papillomavirus type 16 infection that was treated by imiquimod 5% cream and the subsequent excision of an imiquimod-resistant penile lesion.

Cyclin E, p27 in the Pathogenesis of External Genital Epidermal Tumors / 中华皮肤科杂志

Objective To investigate the significance of cyclin E and p27 in genital epidermal benign and malignant tumors. Methods HPV DNA was examined and typed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) in 99 biopsy specimens taken from skin lesions of condyloma acuminatum, external genital carcinoma in situ and invasive squamous cell carcinoma. The expression of cyclin E and p27 in the lesions was examined by immunohistochemistry technique. Results (1) The cyclin E expression in epidermis was notably higher in the lesions than that in normal skin. In HPV-positive samples, the cyclin E expression was higher than that in HPV-negative ones. The cyclin E expression was strongest in invasive squamous cell carcinoma lesions and lowest in condyloma acuminatum lesions. (2) The p27 expression in condyloma acuminatum was slightly higher than that in normal epidermis. But it was notably lower in the lesions of carcinoma in situ and invasive squamous cell carcinoma than that in the normal skin. The expression was also lower in HPV-positive lesions than that in HPV-negative ones. Comparing the three kinds of HPV positive lesions, the intensity of expression was highest in condyloma acuminatum and lowest in invasive squamous cell carcinoma. (3) The study also showed that cyclin E expression was correlated with p27 expression in the lesions. Conclusions The expression of cyclin E and p27 is associated with HPV infection in the lesions. HPV infection might induce epidermal proliferation and malignant transformation by influencing the expression and interaction of cyclin E and p27.

A Case of Erythroplasia of Queyrat Treated with Topical 5% 5-Fluorouracil Cream / 대한피부과학회지

Erythroplasia of Queyrat is an uncommon intraepithelial carcinoma in situ affecting the mucosal surface of the penis with a significant risk of invasion. Treatment is often difficult and is associated with significant recurrence rates. Topical 5-fluorouracil treatment is very effective and regarded as the treatment of choice for histologically confirmed erythroplasia of Queyrat because of its superior results compared with those of surgery or radiation therapy. We report a typical case of erythroplasia of Queyrat involving the mucosa of the glans penis in a 64-year-old male patient who was treated by topical 5% 5-Fluorouracil cream and has achieved a long-term complete response and no recurrence after 12months.

Topical 5-aminolaevulinic acid-photodynamic therapy in the treatment of precancerous changes and carcinoma of the skin in situ / 中华皮肤科杂志

Objective To investigate the effects of 5-aminolaevulinic acid-photodynamic therapy (ALA-PDT) on precancerous changes and carcinoma of the skin in situ. Methods Fifteen patients with actinic keratosis, 3 patients with erythroplasia of Queyrat and 8 patients with Bowen′s disease were given topical ALA followed by PDT. Results The clearance was achieved in 17 lesions of 15 patients with actinic keratosis, 2 patients with erythroplasia of Queyrat and 7 patients with Bowen′s disease by topical ALA-PDT. The recurrence rates were 13.33%, 0 and 14.28% for actinic keratosis, erythroplasia of Queyrat and Bowen′s disease, respectively. Conclusions Topical ALA-PDT is a simple, effective and new treatment with lower recurrent rates, no scar formation and excellent cosmetic results for precancerous changes and carcinoma in situ of the skin, especially for the large and multifocal lesions located on the face and external genitalia.

Erythroplasia of Queyrat Involving the Distal Glans Penis Surrounding the Urethral Meatus / 대한피부과학회지

Erythroplasia of Queyrat is an uncommon form of carcinoma in situ involving the glans penis and adjacent mucosal structures. Treatment modalities of Erythroplasia of Queyrat vary widely and topical 5-fluorouracil treatment is very effective and regarded as the choice of t eatment. This article reports a case of erythroplasia of Queyrat involving the perimeatal region of the glans penis and identifies the difficulty of effectively treating erythroplasia of Queyrat which is adjaer to the urethral meatus with 5-fluorouracil and usefulness of electron beam irradiation therapy.

Treatment of Erythroplasia of Queyrat with Topical 5 % 5 - Fluorouracil Cream under Occlusion / 대한피부과학회지

We herein reported a typical case of erythroplasia of Queyrat in a 35-year-old male patient who had a 6 month-duration of a erythroplastic lesion on the glans penis and coronal sulcus. He was treated 5% 5-fluorouracil cream under occlusion twice a day for 10 days. Three months after treatment, no erythroplastic lesion was found and rebiopsy showed marked improvement histopathologically.