Search

The association between tylosis (palmoplantar keratoderma) and esophageal carcinoma in a group of related patients has been previously established and has been shown to depend on dominant genetic transmission. Sixteen out of seventeen such affected patients have been found to exhibit lesions of the oral mucosa classified as pre-leukoplakia in the younger subjects and as leukoplakia in the older patients. The histology of the pre-leukoplakias examined resembles in some features that of several developmental oral epithelial disorders. The histological appearance of the leukoplakias examined was of benign keratosis with no special features. No similar lesions were found in small control groups of unaffected siblings of the subjects involved or in unrelated tylotic patients. It is suggested that the oral leukoplakia associated with tylosis should be considered as a possible indication of a tendency to develop esophageal carcinoma.

– Histologic material of typical lichen planus lesions from 43 patients was studied. Two sections of each specimen were stained with hematoxylin-eosin and 10 sections by the PAS method. Only 1 of 43 biopsies was invaded by Candida, and hyphae were present in all of the 10 PAS-stained sections of this case. The results show that oral lichen planus has a considerably lesser susceptibility than oral leukoplakia to invasion by Candida albicans.

One hundred and seventeen white adults with oral leukoplakia were examined and followed up from 1 to 11 years to correlate the clinical and histologic characteristics with the natural history of this disease.

The prevalence of leukoedema, preleukoplakia and leukoplakia has been studied among 1226 Papuans and New Guineans in two coastal areas and in one highland area. Leukoedema is found in 2.4-16.9%, preleukoplakia in 10.6- 13.4% and leukoplakia in 3.1-6.2%. Chewing and smoking habits seem to be associated with varying rates of the conditions recorded. In view of a previously supposed obvious association with the betel chewing habit, it is deeply interesting that the results of this study indicate that smoking may be more closely associated with the risk for these conditions. Epithelial atypia, carcinoma in situ or carcinoma were not noted among 26 biopsies taken from the lesions studied.

In a sample of 450 patients with oral leukoplakias, 32 used snuff, which was a Danish wet variety, Goteborg snus ® (Gothenburg Snuff). The group of snuff users consisted of males only, with a mean age of 58.4 years. The mean life exposure time lo snuff was 197,000 hours, the equivalent of 22 years of constant use. Patients with leukoplakia due lo the use of snuff experienced fewer symptoms than did patients with leukoplakia due to other unknown causes. The snuff users also tended to be older at first examination, and to have a higher alcohol intake. Histological changes characteristic of snuff-users' leukoplakias were: (1) vacuolated cells in the upper part of the spinous cell layers of the epithelium with intervening streaks of parakeratinized cells, (2) epithelial hyperplasia, and (3) hyalinized, eosinophilic deposits around salivary glands. However, statistically significant differences were not found between snuff-induced leukoplakias and other leukoplakias either as lo dysplasia observed histologically or as to malignant development.

(1964). Studies in Oral Leukoplakias. VIII. Epithelial Changes in Tobacco-Induced Leukoplakias in India. Acta Odontologica Scandinavica: Vol. 22, No. 4, pp. 499-512.

Quantitative determinations were made in a group of 22 leukoplakias of the cheek obtained in Bombay, India, from 16 male patients chewing tobacco in pan and in six control specimens. There were no marked differences between group averages, but leukoplakias and controls differed strikingly in the small variability of the controls and the great variability of the leukoplakias. In every quantitative trait, at least one third of the leukoplakias and usually the great majority had values below and above the probable range containing 99 % of controls.Leukoplakias with atrophic and with thick epithelium averaged similar spacing and relative height of connective tissue papillae. In the thin group the length of the basal layer relative to that of the surface was one half that in the thick group. The number of mitoses per 100 μ basal layer was the same in both groups, but the number per 100 μ surface was twice as high in the thick group. Mitotic activity according to both measures averaged higher values in both gro...

Cytologic examination of 195 patients with clinically diagnosed leukoplakia revealed signs of malignancy in 4% after a single examination and in 8.8% after repeated smears in a five-year observational period. Positive cytologic results occurred mostly in patients with erosive leukoplakia.

This is a report of a second follow-up study of 3,674 Bombay policemen after 10 years. One among 117 patients with leukoplakia was reported to have developed oral cancer in the 10-year period. The 10-year incidence rate for leukoplakia was 2.8 per cent. Among chewers, the leukoplakia regressed, whereas among smokers, the leukoplakia was found to be more persistent. Although tobacco chewing remained the most prevalent form of tobacco habit, cigarette smoking was found to be on the increase.

In a retrospective survey of 235 cases in which the diagnosis on biopsy was lichen planus, keratosis or leukoplakia, the histological features were re-assessed as objectively as possible and without reference to the original diagnosis. The tissue changes were recorded under 39 headings, and many were assessed on a roughly quantitative basis. In addition, two clinical features were included; whether the biopsy was from the buccal mucosa (as opposed to some other intraoral site) and whether the lesions involved multiple intraoral sites. For each possible pair of diagnostic categories (keratosis and leukoplakia, lichen planus and keratosis, lichen planus and leukoplakia) the recorded findings were subjected to discriminant analysis in order to provide a quantitative assessment of the value of each individual feature for discriminating between the two diagnostic groups. The computer programme also provided for the application of these calculated values to yield a “score” for each case, and for an assessment of the significance of the separation of the diagnostic groups thus achieved. In general, the values calculated by the computer for the discriminatory value of each tissue change accorded with our subjective impressions, but a number of features that were given a relatively high value had not previously been recognized as important in differential diagnosis A discriminant analysis was also performed on those cases of leukoplakia known to have later developed a carcinoma, in comparison with the leukoplakia cases that did not develop carcinoma. High values were accorded mainly to the well-known features of epithelial atypia, but a similar high value was indicated for the presence of Russell bodies. we had not previously realized that the presence of Russell bodies was of prognostic significance in this context. When the total scores for the groups of cases were analysed, it was found that the separation of each pair of diagnostic groups was significant at the 1% level. The separation of leukoplakia cases that subsequently developed carcinoma, from those that did not develop carcinoma, was significant at the 5% level. In this latter analysis, a better separation might be achieved with larger numbers of cases, but there will always be the complicating factor that an unknown number of leukoplakia cases would develop carcinoma if the patient had received no treatment.

— Oral leukoplakias and clinically normal mucosa of 226 patients were examined by smear or biopsy or both. From the biopsies eleven consecutive sections were evaluated, the first section being stained with hematoxylin-eosin and the following ten with PAS. Clinically normal mucosa did not show Candida, whereas Candida was present in 31 % of the biopsied leukoplakias. Eight of the 30 Candida-invaded biopsies did not contain the hyphae in all ten PAS-stained sections. Had only one section been evaluated per biopsy, the risk of arriving at a false negative diagnosis was estimated to be 13 %. 40% of leukoplakia biopsies invaded by Candida showed atypia and 67 % of all atypias were associated with Candida. No relationship between intensity of Candida invasion and presence of atypia could be demonstrated.

(1965). Mycotic Infection in Oral Leukoplakia. Acta Odontologica Scandinavica: Vol. 23, No. 3, pp. 239-256.

Tissue extracts from 11 oral leukoplakias and from normal oral mucosa of the same patients were tested in the LMT against autologous leukocytes. Five patients showed inhibition of the migration with leukoplakial tissue and one showed inhibition with normal mucosa. The migration of leukocytes from matched controls was not influenced by the tissue extracts, which accordingly had no non-specific toxicity. It is concluded that oral leukoplakia is associated with a state of tissue-specific, cellular hypersensitivity against antigenic components of the leukoplakial tissue.

1. 1. The criteria used for clinical and histopathologic changes in leukoplakia are given in detail. 2. 2. This is a 5-year follow-up study of 3,785 men out of an initial group of 4,734 who were examined in 1959. 3. 3. A detailed clinicopathologic correlation is presented. 4. 4. A correlation of the clinical appearance of the lesions with the habits indulged in is presented. 5. 5. No malignant transformation of leukoplakia lesion was reported after a 5-year follow-up study, and no lesions diagnosed as clinical leukoplakia were found to be carcinoma in situ. 6. 6. Of 161 leukoplakia cases, twenty cases were histologically diagnosed as atypias. 7. 7. The homogeneous type of leukoplakia accounted for only 3.7 per cent of the atypias, while the speckled accounted for 8.6 per cent. 8. 8. Bidi smoking, pan chewing, and mixed habits are significantly responsible for leukoplakias, in the descending order of importance.

SUMMARY.— The authors have observed the presence of intranuclear micro-bodies, 0·4—2·5 μ in size, containing osmiophilic particles 200 A. in size, in 1 of 2 cases of oral leukoplakia and in 1 of 7 cases of bullous erythema multiforme. The different types of intranuclear microbodies so far reported in various dermotoses are classified and their significance is discussed.

The smoking habits of 345 Danish and 184 Hungarian leukoplakia patients were analysed against the histopathology of the leukoplakias, i.e. type of keratinization, epithelial thickness, epithelial dysplasia and inflammation. In spite of the reasonable size of the numbers forming the basis for the analysis, no statistically significant differences were found between smokers and non-smokers. However, it was found that the frequency of epithelial dysplasia is not higher among smokers than among non-smokers.

We have used cryosurgical technics in the management of 106 malignant lesions of the head and neck region over the past six years. Morbidity has been minimal and short-term follow-up study indicates satisfactory tumor control. We currently use cryosurgery for the treatment of oral leukoplakia, for multiple small primary carcinomas, for widely spreading but superficially invading tumors, and for malignant lesions adjacent to but not deeply invading bone. For palliation and in patients too ill for resectional therapy, we have also found this modality to be advantageous. We are pleased with the minimal cosmetic defect engendered by the cryosurgical destruction of facial skin cancer.

Among 248 patients with oral leukoplakia lesions, 214 were reexamined with a median observation period of 3.7 years. found under the conditions of the present study.

(1963). Studies in Oral Leukoplakias III. Effects of Vitamin a Comparing Clinical, Histopathologic, Cytologic, and Hematologic Responses. Acta Odontologica Scandinavica: Vol. 21, No. 3, pp. 271-292.

– Among 50,915 individuals from 4 different states of India, 723 oral leukoplakias were biopsied and examined for the presence of Candida. Histologic sections were stained by hernatoxylin-eosin and PAS; 6.8% of the biopsies showed Candida estimated on the basis of a single PAS stained section. All Candida-positive cases were seen in males. The most striking observation was that out of 325 palatal biopsies in reverse smokers only one Candida-positive case was seen on the palate and none was seen on the labial mucosa out of 33 biopsies. It was surprising that although the number of leukoplakias among tobacco chewers was high, all of the Candida-positive cases, except one, were observed among smokers. Seven (14%) of the 49 Candida-positive biopsies showed epithelial atypia. No significant association between Candida-positive cases and atypia was found.

Clinically, oral leukoplakia is defined as a premalignant condition of the oral mucosa. Because of its indefinite histological orientation, however, there are many interpretations as to its malignant transformation. A case of tongue carcinoma developed from leukoplakia is presented, and the course of treatment by irradiation is described in detail. The clinical and histopathologic features of the leukoplakia lesions are reviewed and discussed.

Summary The present situation in the treatment of oral leukoplakia is outlined. Six cases treated by a new method with Yttrium 90 applicators are presented. The suitability of radium, and of several isotopes, is reviewed from the literature and the prospects for this new avenue of treatment are discussed.

(1967). Oral Leukoplakia as a Precancerous Condition. Acta Oto-Laryngologica: Vol. 63, No. sup224, pp. 15-15.