leukoplakia - semmelweis egyetemsemmelweis.hu/parodontologia/files/2012/10/leukoplakia.pdf ·...
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![Page 1: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/1.jpg)
Leukoplakia
![Page 2: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/2.jpg)
Leukoplakia is a white
patch on the oral
mucous membrane,
which is undeliable and
can not diagnose
neither clinically nor
pathologically as an
other disease.
(Pindborg. 1978)
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Precancerous lesion
Precancerosis:
is a morphologically
changed area on the
oral mucosal surface,
on which malignant
transformation develop
more frequently, than
on same localised
appearantly health
areas.
![Page 4: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/4.jpg)
Leukoplakia is the most
frequent precancerous
lesion on the oral
mucosal surface.
In Hungary according to
the data of
Sugar and Banóczy (1972)
the leukoplakia transform
to malignant tumor in
5,6%.
This result increased to
6,6%, in 1978.
![Page 5: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/5.jpg)
The rate of malignisation in the head
and neck region
(out of all malignancies)
Hungary: 2,15%
USA: 1,8%
India: 3,4%
China: 10.8%
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Pathogenesis
Leukoplakia is a defense
mechanism of the oral
mucosa against any
irritativ factors.
This factor in Hungary in
83,3%
are
Smoking
(e.x. in India chewing
betel nuts)
dysplasia
![Page 7: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/7.jpg)
Classification and malignant
transformation of leukoplakia
(according to Bánóczy. 1978)
Homogen
Non-homogen
Nodulat
Specled
Verrucous
Erythro-
leukoplakia
new old
![Page 8: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/8.jpg)
The remaining 16,7% are
bad dental appliances
(filings, bridges,
dentures).
Beside of the mechanical
irritations the
galvanism
between different metals
is important
(saliva is an electrolite)
![Page 9: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/9.jpg)
Cofactors
Anemia: macro and
microcyter
Chronic Candida
infectios
Ventricular ulcer
Möller-Hunter glossitis
![Page 10: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/10.jpg)
The main sustaining
factor in the smoking
is not the nikotine, but
the
TAR
and the
HEAT
(the chimney cleaner
scrotal cancer)
![Page 11: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/11.jpg)
Clinical forms
Homogenous Leukoplakia
![Page 12: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/12.jpg)
Homogenous Leukoplakia
![Page 13: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/13.jpg)
Non-Homogenous
Leukoplakia
(nodular form)
![Page 14: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/14.jpg)
Non-homogenous
leukoplakia
(verrucous form)
![Page 15: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/15.jpg)
Proliferativ-Verrucous
Leukoplakia
(non-homogenous)
![Page 16: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/16.jpg)
Erythroleukoplakia
![Page 17: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/17.jpg)
Erythroleukoplakia
![Page 18: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/18.jpg)
Squampous cell
carcinoma
![Page 19: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/19.jpg)
Diagnosis
In generally the clinical
diagnosis seems to be
enough.
Histlogy could
differentiate between
malignant and non
malignant disease.
![Page 20: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/20.jpg)
Histological signs
Hyperortho, or
hyperparakeratosis
Acanthosis (wider
spongy layer)
Intracellular hydropic
degeneration
(apoptosis)
Rete pegs
Round cell infiltration
in the connective
tissue (wider than the
hyperkeratosis)
Epithelial Pearl
![Page 21: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/21.jpg)
Further diagnostic tools
Exfoliativ cytology
according to the
method of Papanicolau
Vital Paint (Toluidin
Blue)
Fluorescent diagnostic
methods
Monoclonal antibodies
![Page 22: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/22.jpg)
Exfoliative cytology
Picture of healthy
mucosa
(the apithelial cells are
light)
![Page 23: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/23.jpg)
Cytology of Lichen Oris
(the epithelial cells are
light)
![Page 24: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/24.jpg)
Cytology of
hyperkeratosis
(homogenous
leukoplakia, the
epithelial cells are
darker)
![Page 25: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/25.jpg)
Cytology of a squamous
cell cancer
(the epithelial cells are
dark and you can see a
cell multiplications).
![Page 26: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/26.jpg)
Vital Paint
(OraTest)
Negative OraTest
examination
![Page 27: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/27.jpg)
Erythroleukoplakia
(before painting)
![Page 28: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/28.jpg)
After painting
(positive study)
![Page 29: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/29.jpg)
Positive OraTest study
![Page 30: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/30.jpg)
Human Basic
Encephalitogenic
Protein Monoclonal
antibody in oral
squamous cell cancer
![Page 31: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/31.jpg)
Differential Diagnosis
Stomatitis Nikotina
Palati
Lichen Oris
Pseudomembranous
Candidasis
Morsication
White Sponge Nevus
Median Rhombic
Glossitis
Hand-Foot-Mouth
disease
Fox-Fordyce patches
![Page 32: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/32.jpg)
Plaque-like form of
Lichen Oris
![Page 33: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/33.jpg)
Pseudomembranous
Candidasis
![Page 34: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/34.jpg)
Morsicatio Buccarum
![Page 35: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/35.jpg)
White sponge nevus
![Page 36: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/36.jpg)
Median Rhombic Glossitis
(this form only)
![Page 37: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/37.jpg)
Oral symptom of Hand-
Foot and Mouth
disease
![Page 38: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/38.jpg)
Fox-Fordyce patches
(filled sebaceous glands)
![Page 39: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/39.jpg)
Management
All diseases in which are
known etiologic factor
the elimination of its is
the basic point of the
therapy.
The leukoplakia patients
are in most of the
cases indolent, not
cooperate with the
doctor
(not an easy thing to ask
them to give up they
bad habit).
![Page 40: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/40.jpg)
Therapy II.
The homogenous form is
reversible (give up the
bad habit: spontanous
healing).
If the patients give up the
smoking need
conservative therapy
with „A” vitamin acid
(Neotigason caps. Or
HTR-4)
The best is the surgery.
![Page 41: Leukoplakia - Semmelweis Egyetemsemmelweis.hu/parodontologia/files/2012/10/LEUKOPLAKIA.pdf · Leukoplakia is a white patch on the oral mucous membrane, which is undeliable and can](https://reader031.vdocument.in/reader031/viewer/2022022008/5ae1fbba7f8b9a595d8c9e1a/html5/thumbnails/41.jpg)
Prognosis
The number of head and
neck cancer develop
from leukoplakia in our
country increase
continously.
The patients need
continous follow up.
( the recurrence is very
frequent)
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In our days there are new
immunehistological
diagnostic tools by
which the severe
clinical forms can be
recognize as early as
possilble by this way
there is possible the
early treatment.
Study of p53 gene
product