Search

A patient with intra-oral squamous cell carcinoma arising in an area of cyclosporin-induced gingival hyperplasia associated with a renal transplant is presented. This appears to be the first reported case of its kind. Subsequently, the patient developed a carcinoma of the lateral margin of the tongue, with metastasis to the deep cervical lymph nodes. The incidence and types of malignancy following conventional immunosuppressive and cyclosporin therapy are briefly reviewed. Long-term frequent follow-up of cyclosporin-treated patients is recommended to facilitate early diagnosis of such lesions.

Mixed connective tissue disease (MCTD) is a multisystem disorder with overlapping features of systemic lupus erythematosus, scleroderma and polymyositis and is differentiated from them by a high titre of antibody to ribonucleoprotein. Orofacial manifestations of MCTD include trigeminal neuralgia-like pain, neuropathy, features suggestive of Sjögren's syndrome and lymphadenopathy. The recent experience of two patients presenting with trigeminal neuropathy as an early manifestation of this disease is described. One of these patients presented with 'lichenoid' oral mucosal lesions as a further early manifestation of MCTD. This appears to be the first case with this presenting feature to be described in the literature.

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.

Ultrastructural studies have been carried out on epithelium taken from seven cases of non-erosive oral lichen planus. Structural abnormalities observed have been consistent with light microscopic findings but no cellular changes specific to lichen planus have been noted. In particular the intranuclear structures seen have been similar to those described in a number of other epithelial disorders. Discontinuities of the basement membrane have been observed, without thickening or duplication of the lamina densa. No evidence of a viral etiology for the condition has been detected.

Plaque-like lesions of the oral mucosa have been observed in seven immunosuppressed renal transplant patients. Whilst bearing a superficial resemblance to acute pseudomembranous candidiasis (thrush), these lesions have been shown to be associated with bacterial overgrowth and not with fungi. Treatment has depended on the use of appropriate antibiotics and antiseptics together with the adoption of measures to cause disintegration of the mucoid matrix of the lesions.

Ultrastructural studies have been carried out on epithelium taken from the oral lesions of tylosis-related leukoplakia and preleukoplakia in a group of patients known to be at high risk for esophageal carcinoma. Several structural abnormalities are described; in particular, the presence of intranuclear electron dense particles 90 nm in diameter. Similar particles have been found in the nuclei of epithelial cells from an esophageal carcinoma developing in one of the patients under study.