[Precancers of the oral mucosa: clinic, diagnostics]. / Predraki slizistoi obolochki rta: klinika i diagnostika.

OBJECTIVE: The aim of the study. Improving the efficiency of diagnosis and detailing the features of the clinic of «potentially malignant¼ diseases of the oral mucosa. MATERIALS AND METHODS: Clinical and laboratory examination of 124 patients of the department of oral mucosa diseases aged 35 to 80 years, among whom there were 75 women and 49 men, with diseases such as erythroplakia - 12 patients, verrucous leukoplakia - 52 patients, erosive form of leukoplakia - 35 patients, cheilitis Manganotti - 25 patients. Histological and immunohistochemical methods of investigation were used as diagnostics. To assess the proliferative activity of epithelial cells, the determination of the Ki-67 index was used. The synthesis of keratin 15 (K15) in epithelial layers was determined as a diagnostic criterion for the severity of neoplasia. The expression of human papillomavirus type 16 (HPV 16) antigens and p16INK4a protein in epithelial cells was studied, as well as the expression of p53 protein. RESULTS: A high prevalence of p53 mutations was observed in patients with erythroplakia. In leukoplakia, the expression of the Ki-67 protein was detected in the cell nuclei in both the basal and parabasal layers of the multilayer squamous epithelium, in 77% of cases, the expression of the p16INK4a protein in the epithelial nuclei with varying degrees of dysplastic changes was noted, and a positive reaction to HPV16 was also observed in the cell nuclei and cytoplasm of epithelial cells in the basal, parabasal and spiny epithelial layers. The appearance of K15 in the cytoplasm of cells above the basal layer with abrasive precancerous cheilitis was found in 48% of cases. CONCLUSION: To diagnose early manifestations of neoplastic processes in «potentially malignant¼ diseases of the oral mucosa, it is necessary to use both classical histological and immunohistochemical methods of investigation with various markers.

[Study of the kinetics of accumulation and distribution of the photosensitizer photoditazin in the oral mucosa in patients with lichen planus]. / Izuchenie kinetiki nakopleniya i raspredeleniya fotosensibilizatora fotoditazin v slizistoi obolochke rta u patsientov s krasnym ploskim lishaem.

THE AIM OF THE STUDY: Was to explore the accumulation and distribution of the photosensitizer Photoditazine in the oral mucosa when applied to pathological lesions in patients with severe forms of lichen planus. MATERIAL AND METHODS: A clinical and laboratory examination was carried out in 50 patients with severe forms of lichen planus (bullous and erosive-ulcerative) aged 18 to 70 years, including 6 men and 44 women. For autofluorescent imaging a LED device with a wavelength in the violet region of the spectrum (400±10 nm) was used. Quantitative registration of the kinetics of accumulation and distribution of the photosensitizer was carried out using the method of local fluorescence spectroscopy by measuring the fluorescence spectra. RESULTS: The measurements were made before applying the photosensitizer, 10, 20 and 30 minutes after application. The study showed that in most patients with erosive-ulcerative and bullous forms of lichen planus, the accumulation of the photosensitizer in the lesions on the oral mucosa increased as the exposure time increased from 20 to 30 minutes. The fastest accumulation of the photosensitizer occurred in the areas of mucosal lesions with the most pronounced vascularization, namely, in the area of the tongue and the bottom of the oral cavity. CONCLUSION: Using the method of local fluorescence spectroscopy, the kinetics of accumulation and destruction of photosensitizer in pathological areas of the oral mucosa was determined, and therefore the optimal time of laser exposure to the lesion was determined.

[Features of molecular genetic diagnosis of verrucous leukoplakia]. / Osobennosti molekulyarno-geneticheskoi diagnostiki verrukoznoi leikoplakii.

OBJECTIVE: To evaluate the initial molecular genetic signs of malignancy of verrucous leukoplakia (VL). MATERIALS AND METHODS: The study of VL was carried out on biopsies of 21 patients with the diagnoses of verrucous hyperplasia (VH) (15 cases - 71.4%) and verrucous carcinoma (VC) (6 cases - 28.5%). Tissue antigens were determined using mouse monoclonal antibodies to the Ki-67 protein (MM1, Diagnostic Biosystems). Telomerase activity was determined using rabbit immunoglobulin (TRT, Abbiotec). The amplification of the TERC (Telomerase RNA Component) portion of the RNA of the third chromosome was studied by the FISH method. RESULTS: In the studied groups, high cell proliferation and significant differences between HC and VC were revealed. The amplification of TERC by the FISH method made it possible to carry out differential diagnostics between VG and VC. According to the results of the study, the amplification of the TERC gene was detected in 100% in VC and in 20% in VG. CONCLUSION: The FISH method makes it possible to detect VL malignancy at an early stage. Amplification of the TERC gene is characteristic of malignant transformation of epithelial cells in VC. In IG, as a rule, there was no amplification, which can serve as evidence of the benign nature of the pathology of COP.

[The use of photodynamic therapy in patients with severe forms of leukoplakia]. / Primenenie fotodinamicheskoi terapii u patsientov s tyazhelymi formami leikoplakii.

OBJECTIVE: The aim the study is to increase the effectiveness of the treatment of severe forms of leukoplakia with the use of photodynamic therapy. MATERIAL AND METHODS: 120 patients with severe forms of leukoplakia were examined. 30 patients were diagnosed with Cr and carcinoma in situ, and therefore they were excluded from the study. In 90 patients, the diagnosis was confirmed by histological and IHC studies. Before the use of photodynamic therapy, the degree of saturation of pathological foci with a photosensitizer was determined by the method of fluorescent diagnostics using the LED device «RFS-400¼. RESULTS: As a result of treatment with photodynamic therapy using a 2nd generation photosensitizer («Photoditazine¼ 0.5% gel penetrator), a significant improvement in the epithelization of lesion elements was observed: in 92% of patients with verrucous leukoplakia and in 83% of patients with erosive leukoplakia. CONCLUSION: The use of photodynamic therapy for the treatment of patients with complicated forms of leukoplakia is an effective method of treatment for this pathology.

[The study of microbiota in patients with bullous lesions of the oral mucosa]. / Izuchenie mikrobioty slizistoi obolochki rta u patsientov s bulleznymi porazheniyami.

THE AIM OF THE STUDY: The study by the method of tissue polymerase chain reaction of the species composition of the microbiota of lesions of the oral mucosa in patients with bullous lesions. MATERIAL AND METHODS: Biopsy specimens of the oral mucosa of 51 patients were studied by the polymerase chain reaction method, of which 14 patients with pemphigus vulgaris, 17 patients with pemphigoid bullosa, and 20 patients with the bullous form of ruber lichen planus. 4 types of microorganisms have been identified - Fusobacterium, Streptococcus pneumoniae, Candida albicans, Ureaplasma spp. and viruses - Human Papillomavirus 16, Epstein-Barr virus and Citomegalovirus. RESULTS: In the study of the microbiota of bullous lesions, associations of microorganisms and viruses were established in a significant number of cases. Associations of Str.pneumoniae and C. albicans were quite common in patients with pemphigus vulgaris in 26.3%, pemphigoid bullosa in 20.0%, and in patients with the bullous form of ruber lichen planus in 14.3% of cases. In patients with pemphigus vulgaris, the association of Str.pneumoniae, C. albicans and EBV was noted in 31.6% of cases. In patients with the bullous form of ruber lichen planus in a high percentage of cases (28.6%), the associations of Str. pneumoniae, EBV and CMV. CONCLUSION: Identification at earlier stages of management of patients with bullous lesions Str. pneumoniae, Candida albicans, and Fusobacterium associated with herpes viruses should be regarded as one of the triggering mechanisms of an autoimmune conflict, which subsequently causes a specific clinical picture of these diseases.

[The creative legacy of Professor Gennady Vladimirovich Banchenko and the prospects for scientific research in the field of pathology of the oral mucosa (dedicated to the 85th anniversary of the birth of Professor G.V. Banchenko)]. / Tvorcheskoe nasledie professora Gennadiya Vladimirovicha Banchenko i perspektivy nauchnykh issledovanii v oblasti patologii slizistoi obolochki rta (posvyashchaetsya 85-letiyu so dnya rozhdeniya prof. G.V. Banchenko).

G.V. Banchenko was born on July 11, 1936. After graduating from Moscow Medical Dentistry Institute in 1959, he worked in the N.N. Burdenko Main Military Clinical Hospital - first as a resident of the 13th sto- sion. N.N. Burdenko - first as a resident of the 13th stomatological department, therapist and then as maxillofacial surgeon.

[Optimization of the diagnosis of precancerous diseases of the oral mucosa and lips (Manganotti's abrasive precancerous cheilitis and erythroplakia)]. / Optimizatsiya diagnostiki predrakovykh zabolevanii slizistoi obolochki rta i krasnoi kaimy gub (abrazivnyi prekantseroznyi kheilit Manganotti i eritroplakiya).

OBJECTIVE: To optimize the identification of precancerous diseases of the oral mucosa, such as Manganotti's abrasive precancerous cheilitis and erythroplakia of the oral mucosa using markers Ki-67 and keratin 15. MATERIAL AND METHODS: The study group included 17 patients with Manganotti's abrasive precancerous cheilitis and 8 with erythroplakia of the oral mucosa. A histological analysis was carried out to scrutinize the biopsy material of the oral mucosa of the patients. Ki-67 protein and keratin 15 were used to assess the proliferative activity of epithelial cells and the severity of neoplasia. Results. Thirteen patients with Manganotti's cheilitis had dysplasia of varying degrees, and 4 had signs of malignancy. A high proliferative activity of the Ki-67 protein was found in the stratum basal and stratum spinosum of the epithelium. In 5 patients with erythroplakia, according to histological examination, grade 2-3 intraepithelial neoplasia was revealed and 3 patients had cancer in situ. The expression of keratin 15 in all patients with Manganotti's abrasive precancerous cheilitis and erythroplakia in the basal layer tended to decrease with an increase in the degree of dysplasia, however, the appearance of keratin 15 in the cytoplasm of cells located above the basal layer was discovered. CONCLUSION: The use of Ki-67 protein and keratin 15 as immunohistochemical markers in the study of diseases such as Manganotti's abrasive precancerous cheilitis and erythroplakia of the oral mucosa makes it possible to identify the initial signs of malignancy more accurately in the epithelium.

[Immunohistochemical diagnosis of necrotizing sialometaplasia]. / Immunogistokhimicheskaya diagnostika nekroticheskoi sialometaplazii.

The article presents a clinical case of an immunohistochemical study of a rare disease: necrotizing sialometaplasia in the hard palate. Due to the complexity of the differential diagnosis between necrotizing sialometaplasia and squamous cell carcinoma, an immunohistochemical method was used with antibodies to proteins Ki-67, P53, P63 and cytokeratins-7 and Immunohistochemical study established low proliferative activity of glandular cells in excretory ducts and metaplastic squamous epithelium for Ki-67 protein, significant expression of protein P63 was detected both in the ductal epithelium nuclei and in metaplastic areas and expression of the mutant protein P53 was approximately absent. Marked expression of cytokeratin-7 in the ducts cells and weak expression in necrotic acini of the glands and metaplastic epithelium was noted. It was shown that cytokeratin-15 homogeneously stains the peripheral zone of metaplastic epithelium, which is characteristic of a benign lesion. Thus, the panel of antibodies to proteins Ki-67, P53 and cytokeratins-7 and 15 allows to verify necrotizing sialometaplasia.

[Immunomorphology of bullous lesions of the oral mucosa]. / Immunomorfologiya puzyrnykh porazhenii slizistoi obolochki rta.

The article is devoted to the study of immunohistochemical parameters in patients with bullous lesions of the oral mucosa. The biopsy samples of the oral mucosa were studied in 57 patients, including patients with pemphigoid bullosa (38 people) and pemphigus vulgaris (19 people). The results of immunohistochemical studies indicate the cellular mechanisms of damage to the epithelium, in which IL-1, IL-6 and HPV16 are involved.

[To the question of proliferative verrucous leukoplakia malignant potential]. / K voprosu o zlokachestvennom potentsiale proliferiruyushchei verrukoznoi leikoplakii.

AIM OF STUDY: To study of neoplastic transformation of the epithelial cells of the oral mucosa with verrucous hyperortokeratosis, verrucous carcinoma and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Oral mucous membrane biopsies of 33 patients with clinical diagnosis of proliferative verrucous leukoplakia were investigated. Histologically in 19 cases (57.6%) was revealed verrucous hyperorthokeratosis, in 8 cases (24.2%) - verrucous carcinoma and in 6 cases (18.2%) - oral squamous cell carcinoma. Tissue antigens were determined using mouse monoclonal antibodies to Ki-67 and mouse monoclonal antibodies to cytokeratin 15. RESULTS OF THE STUDY: In comparison with the proliferative activity of epithelial cells in the malpighian layer in verrucous hyperorthokeratosis (17.2±8.1%) was detected increasingof cell proliferation in epithelial growth zone in verrucous carcinoma (33.8±8.1%) and in peripheral zone of solid areas in oral squamous cell carcinoma (51.2±35.7%). A significant decrease in the expression of cytokeratin 15 in the cytoplasm of tumor cells was noted inverrucous carcinoma and oral squamous cell carcinoma in comparison with verrucous hyperorthokeratosis. CONCLUSION: The obtained results proclaim that there is no stage of epithelial dysplasia during tumor transformation of proliferative verrucous leukoplakia into verrucous carcinoma and oral squamous cell carcinoma. Verrucous carcinoma by the nature of proliferative activity, cell atypia and expression of cytokeratin 15 corresponds to carcinoma in situ.

[Epidemiology, etiology and pathogenesis of oral mucosa bullous lesions]. / Épidemiologiia, étiologiia, patogenez bulleznykh porazhenii slizistoi obolochki rta.

OBJECTIVE Based on the data available in modern literature, to conduct a study on the epidemiology, etiology and pathogenesis of bullous lesions of the oral mucosa (pemphigus vulgaris, pemphigoid bullosa, lichen ruber planus). MATERIAL AND METHODS: The article is based on the study of materials of foreign and domestic research databases Pubmed and Elibrary. Used literature data over the past 15 years. RESULTS: According to domestic and foreign studies, among dermatological diseases, the most frequently detected diseases are: lichen ruber planus, pemphigoid bullosa and pemphigus vulgaris. The initial signs of these diseases are often neglected, both in patients and doctors, which leads to irreversible changes and severe course of the pathological process. In this connection, the number of patients with these lesions of the oral mucosa increases every year in all countries of the world. Bullous lesions of the oral mucosa are inflammatory and destructive diseases characterized mainly by recurrent course, variety of clinical manifestations, resistance to various therapeutic drugs. The specific features of the course of these diseases are explained both by the anatomical and physiological features of the oral mucosa, and by the etiologic and pathogenetic mechanisms of development. Currently, autoimmune processes play a leading role in the genesis of diseases, developing in response to changes in the antigenic structure of epidermal and epithelial cells under the influence of various damaging agents. CONCLUSION: Thanks to the study, it was found that currently there are no data confirming the presence of microbial contamination of the tissues of the oral mucosa in the pathology under study. Not enough information on the factors of the immune response, in particular, on proinflammatory cytokines in the tissues of the oral mucosa.

[Diagnostic value of optical coherence tomography for oral leukoplakia assessment]. / Diagnosticheskaia tsennost' metoda kogerentnoi tomografii u bol'nykh s leikoplakiei slizistoi obolochki rta.

The article presents a comparative analysis of the results of in vivo scanning of oral mucosa leukoplakia with optical coherence tomography (OCT) method and pathological studies in 15 patients (9 females and 6 males aged 27-82). The study revealed specific OCT signs of leukoplakia: even disorder of tissue layering and less clear visualization of lamina propria. OCT is an important stage in the differential diagnosis of leukoplakia of the oral mucosa and significantly complements the clinical and pathomorphological study.

[Leukoplakia: clinical and pathological diagnosis]. / Leikoplakiya: klinicheskii i patomorfologicheskii diagnoz.

Leukoplakia is one of the most common obligate precancerous lesions of the oral mucosa. leukoplakia treatment is carried out in conjunction with surgery. Removed tissues are sent to pathological examination. The article describes clinical signs and corresponding pathological processes most often revealed by histological study.

Photodynamic therapy in treatment of severe oral lichen planus. / Lechenie patsientov s tyazhelymi formami krasnogo ploskogo lishaya slizistoi obolochki rta s primeneniem fotodinamicheskoi terapii.

The aim of the study was to elaborate the rationale for the application of photodynamic therapy in complex treatment of patient with severe oral lichen planus. Complex clinical and laboratory examination and treatment was performed in 54 patients divided on 3 groups. Diagnosis of oral lichen planus was based on clinical, histological and immunohistochemical features. Group 1 received standard treatment, in the second group photodynamic therapy was conducted in addition to conventional treatment, patients in the third group received only photodynamic therapy. The study results proved photodynamic therapy to be useful tool in complex treatment of severe oral lichen planus.

[Immunomorphology of oral lichen planus].

The article is devoted to immunohistochemical study of reticular and erosive forms of oral lichen planus. Morphological examination of the reticular form revealed the increased number of Langerhans cells (CD1a), mast cells (CD25) and T lymphocytes (CD4, CD8, CD16) in the oral epithelium. Activation of these cells leads to the secretion of TNF-α and destruction of basal keratinocytes, which manifests as a focal reduction of intercellular protein expression of E-cadherin. Destruction of basal keratinocytes in a reticular form of oral lichen planus is accompanied by a significant decrease in proliferative activity of the basal cell layer (21.7±10.2%) compared with normal mucosa (33.6±7.0%), p=0.0045. In erosive form along with the above changes IgG and C3d complement's elements are revealed, which confirms the activation of immune complex mechanisms in the erosion area.

[Analysis of comprehensive treatment of oral leukoplakia by laser ablation]. / Analiz khirurgicheskogo lecheniya patsientov s leikoplakiei slizistoi obolochki rta metodom ablyatsii.

The article presents data statistics of surgical treatment of leukoplakia by laser ablation for 2014 were examined and operated on 12 patients with verrucous and erosive forms of leukoplakia of the oral mucosa using a diode laser. Only 5 (42%) showed positive results in 7 (58%) patients had recurrent disease, often in the localization of the lesion on the tongue. It is possible that relapse may be associated with incomplete excision of the lesion due to anatomical and morphological features of the oral mucosa in various topographical areas. The study emphasizes the need to find alternative methods of modern surgical excision, one of which can be radiofrequency excision.