[Screening for laryngeal disease in patients with gastroesophageal reflux disease]. / Skrining zabolevanii gortani u patsientov s gastroezofageal'noi reflyuksnoi bolezn'yu.

OBJECTIVE: To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS: 171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy. RESULTS: The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases. CONCLUSIONS: Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.

Laryngoscopic characteristics related to the risk of cancerization of vocal cord leukoplakia.

BACKGROUND: The diagnosis of vocal cord leukoplakia mainly relies on laryngoscopy. The morphology of vocal cord leukoplakia under laryngoscope is closely related to the pathological nature of leukoplakia. The specific manifestations associated with high-risk vocal cord leukoplakia remain to be explored. OBJECTIVE: To investigate the characteristics of low-risk and high-risk vocal cord leukoplakia under conventional white light imaging (WLI) laryngoscopy and its correlations with narrow band imaging (NBI) laryngoscopy. METHODS: One hundred and seventy-five cases of vocal cord leukoplakia were divided into low-risk and high-risk groups. The characteristics of low-risk and high-risk vocal cord leukoplakia under WLI laryngoscopy and its correlations with NBI laryngoscopy were analyzed. RESULTS: Logistic regression analysis showed that thickness and hyperemia were independent factors (p < .05). Hyperemia had a strong consistency with the visualization of spots under NBI laryngoscopy (kappa = 0.758). The sign of hyperemia and the NBI classification had equivalent diagnostic efficacy for predicting the risk of cancerization of vocal cord leukoplakia. CONCLUSION: The sign of hyperemia under WLI laryngoscopy is significantly correlated with the visualized spots under NBI laryngoscopy. Hyperemia is an important feature for predicting malignant potential of vocal cord leukoplakia.

Alloimmune Myositis as Paraneoplastic Complication of an Oral Squamous Cell Carcinoma After Severe Chronic Graft vs Host Disease or a Manifestation of Chronic Graft vs Host Disease? A Case Report and Literature Discussion.

A 53-year-old female patient with acute myeloid leukemia developed severe chronic graft vs host disease (cGVHD) of the oral mucosa after allogeneic hematopoietic stem cell transplantation with leukoplakia and relapsing oral squamous cell carcinoma (SCC) of the tongue. cGVHD needed long-lasting immunosuppressive therapy; SCC was treated with radiation and surgery. Acute myeloid leukemia remained in complete remission. The patient developed a myositis with pain of all muscles as well as paraparesis with elevated creatine kinase and C-reactive protein and detection of antiskeletal muscle autoantibodies 3500 days after hematopoietic stem cell transplantation. No other clinical features of chronic GVHD were apparent at this time. Symptoms disappeared after treatment with corticosteroids but relapsed while tapering. Weekly therapy with the B-cell-depleting antibody rituximab was started and administered for 6 weeks. Symptoms disappeared again but partly returned after some weeks, so therapy with azathioprine was started. During therapy with azathioprine slow tapering of corticosteroids was possible and clinical symptoms remained absent. Here we present a case report and review of the literature on alloimmune myositis as paraneoplastic complication of an oral SCC of the tongue after severe chronic GVHD or as late manifestation of chronic GVHD itself.

Is the pepsin immunohistochemical staining of laryngeal lesions an available way for diagnosing laryngopharyngeal reflux.

Backgound: Pepsin immunohistochemical (IHC) staining is a promising diagnostic approach of laryngopharyngeal reflux (LPR). The interarytenoid mucosa has been proved to be an effective biopsy area.Objectives: To investigate whether positive result of pepsin IHC staining in laryngeal lesions can predict LPR.Methods: The study included 136 patients with laryngeal cancer or vocal cord leukoplakia. 24 h multichannel intraluminal impedance-pH (MII-pH) was performed before operation, and pepsin IHC staining was performed on pathological sections after operation. The results of the two methods were compared.Results: Among the 136 patients, 101 with at least one LPR event were regarded as MII-pH positive group, and another 35 were negative. The positive rate of pepsin IHC staining was 93.1% in MII-pH positive group and 54.1% in MII-pH negative group (p < .05). If the MII-pH results were used as a reference, the sensitivity and specificity of pepsin IHC staining in the diagnosis of LPR were 93.1 and 45.7%, respectively. The consistency of pepsin IHC and MII-pH was moderate (Kappa value = 0.452).Conclusions: The sensitivity of pepsin IHC staining in laryngeal lesions for diagnosing LPR is satisfactory. The existence of false negative of MII-pH may be the main reason for the low specificity.

Helicobacter pylori is associated with poor prognosis of laryngeal precancerous lesion.

OBJECTIVES: Previous evidence suggested Helicobacter pylori (H. pylori) promoted tumorigenesis by inducing inflammation in gastric premalignant disease. Whether this organism affected the development of head and neck precancerous lesion remains unknown. We performed this study to assess the prognostic impact of H. pylori infection on patients with laryngeal precancerous lesion. METHODS: In this prospective study, 41 enrolled patients with laryngeal precancerous lesion were arranged into H. pylori-positive group (n=16) and H. pylori-negative group (n=25). Two poor outcomes were recurrence and malignant transformation. Prognostic impact of H. pylori infection was analyzed using the Univariate Cox proportional hazard model and Cochran-Mantel-Haenszel test. We also analyzed the prognostic value of systemic inflammation-based markers. RESULTS: During a median follow-up of 32.9 months, recurrence developed in 8 patients in the H. pylori positive group and 5 patients in the H. pylori negative group (50.0% vs. 20.0%, P=0.026, Log-rank test). Malignant transformation developed in 4 patients in the H. pylori positive group and no patients in the H. pylori negative group (25.0% vs. 0.0%, P=0.005, Log-rank test). H. pylori positive group had a significant higher malignant transformation rate after stratifying on the observed covariates. There was no significant difference of recurrence rate in two groups stratified with laryngopharyngeal reflux, size of lesion, and pathological type (Cochran-Mantel-Haenszel test). The basal levels of lymphocyte counts and neutrophils to lymphocytes ratio were significantly different in patients with H. pylori infection. Moreover, the receiver operating characteristic curve analysis revealed a predictive value of lymphocyte counts and neutrophils to lymphocytes ratio for poor outcomes (areas under the curve, 0.658 and 0.651, respectively). CONCLUSION: The data demonstrate a malignant transformation-relevant role of H. pylori in laryngeal precancerous lesion. H. pylori infection combined with laryngopharyngeal reflux, size of lesion, and pathological type might relate to recurrence of laryngeal precancerous lesion. And changes of lymphocyte counts and neutrophils to lymphocytes ratio associated with H. pylori infection might deserve as predictive indicators for poor prognosis of laryngeal precancerous lesion.

Candidiasis Causing Vocal Fold Leukoplakia: Review of Clinical and Pathological Results of 289 Cases With Vocal Fold Leukoplakia.

OBJECTIVE: In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient's complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. STUDY DESIGN: Retrospective case control study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. RESULTS: Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade (P < .001). The use of inhaled corticosteroids was a significant risk factor (P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. CONCLUSION: Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.

Genomic profile of oral squamous cell carcinomas with an adjacent leukoplakia or with an erythroleukoplakia that evolved after the treatment of primary tumor: A report of two cases.

Oral leukoplakia and erythroleukoplakia are common oral potentially malignant disorders diagnosed in the oral cavity. The specific outcome of these lesions remains to be elucidated, as their malignant transformation rate exhibits great variation. The ability to predict which of those potentially malignant lesions are likely to progress to cancer would be vital to guide their future clinical management. The present study reported two patients with tongue squamous cell carcinoma: Case study 1 was diagnosed with a simultaneous leukoplakia and case study 2 developed an erythroleukoplakia following the primary tumor treatment. Whole genome copy number alterations were analyzed using array comparative genomic hybridization. The present study determined more genomic imbalances in the tissues from leukoplakia and erythroleukoplakia compared with their respective tumors. The present study also identified in tumor and potentially malignant lesions common alterations of chromosomal regions and genes, including FBXL5, UGT2B15, UGT2B28, KANSL1, GSTT1 and DUSP22, being some of these typical aberrations described in oral cancer and others are linked to chemoradioresistance. Several putative genes associated with hallmarks of malignancy that may have an important role in predicting the progression of leukoplakia and erythroleukoplakia to squamous cell carcinoma, namely gains in BNIPL, MCL1, STAG2, CSPP1 and ZNRF3 genes were also identified.

[The expression and significance of pepsin in laryngeal carcinoma].

OBJECTIVE: To evaluate the relationship between pepsin induced by laryngopharyngeal reflux and laryngeal carcinoma. METHODS: Patients with vocal cord leukoplakia(n=18) and laryngeal carcinoma(n=21) encountered in Nanfang Hospital between December 2012 and April 2014 were included and sixteen healthy volunteers were recruited as control. Laryngeal biopsy specimens were taken from the patients with laryngeal carcinoma, or vocal cord leukoplakia and control subjects for the immunohistochemical study of pepsin. The correlation between pepsin expression and reflux events of 24 hour multichannel intraluminal impedance-pH monitoring (MII-pH) was analyzed. RESULTS: The patients with laryngeal carcinoma showed the highest expression of pepsin, followed by the patients with vocal cord leukoplakia and control subjects, with significant difference among the three groups (in strong positive expression, the constituent ratio of each group are 0/16、1/18 and 4/21, P<0.01). The presence of pepsin was associated with upright and total laryngopharyngeal acid reflux (P<0.05), including acid reflux episodes, the percentage of times that the pH was below four, the percentages of acid reflux time and average acid removal time. There was a significant correlation between the pepsin level and the esophageal acid reflux parameters (P<0.05) except supine the percentage of time that the pH was below four. CONCLUSIONS: Pepsin expression in laryngeal tissue increases in patients with vocal cord leukoplakia and laryngeal carcinoma, contributing to the development of laryngopharyngeal carcinogenesis.

Association of the recurrence and canceration rate of vocal leukoplakia with interleukin-10 promoter variants over a 2-year period.

Conclusion This study indicates that IL-10 promoter polymorphism variants, smoking, and alcohol consumption increase the risk of recurrence and canceration in vocal leukoplakia. Objective This prospective, clinical trial was performed to evaluate the association of interleukin (IL)-10 promoter polymorphism variants and canceration and recurrence rates in vocal leukoplakia (a pre-cancerous laryngeal carcinoma lesion) over a 2-year period. Participants and method Sixty-one post-operative patients with vocal leukoplakia were enrolled in this prospective, observational study and genotyped for the IL-10 promoter gene (IL-10-1082 A/G, -819 T/C and -592 A/C) using pyrosequencing, and responded to a 2-year follow-up survey. Recurrence and canceration rates were used to evaluate the association between the genotype variants and the clinical outcome. Results There was an increased canceration rate in the variant genotype group compared to that in the normal genotype group in the 2-year follow-up period (18.4% vs 0%, p-value = 0.038). Compared with the non-smoker group, the smoker group had a higher recurrence rate of vocal leukoplakia (29.3% vs 5%, p-value =0.044). Likewise, the recurrence rate in the alcohol consumption group was also higher (30.6% vs 8%, p-value =0.034). The percentage of cancerization in the alcohol consumption group was significantly higher than that in the non-alcohol consumption group (19.4% vs 0%, p-value =0.035).

[Role of laryngopharyngeal reflux on the pathogenesis of vocal cord leukoplakia and early glottic cancer].

OBJECTIVE: To explore the significance of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GER) in patients with vocal cord leukoplakia and early glottic cancer. METHODS: Patients with vocal cord leukoplakia and early glottic cancer encountered in Nanfang Hospital between December 2012 to January 2014 were included in this study. Ambulatory 24 hour multichannel intraluminal impedance-pH monitoring (MII-pH) was applied to obtain LPR and GER events, as well as the reflux properties of substances. Tobacco and alcohol history was also evaluated. Sixteen healthy volunteers were recruited as normal controls. RESULTS: There were 26.3% (5/19) LPR patients in glottic cancer group, 35.3% (6/17) LPR patients in vocal cord leukoplakia group and 12.5% (2/16) LPR volunteers in normal controls. There was no statistically significant difference in the positive rate of LPR between early glottic cancer patients and normal controls as well as between vocal cord leukoplakia patients and normal controls (P > 0.05). There was statistically significance in numbers of acid reflux events, time of acid exposure, and time of acid clearance between vocal cord leukoplakia patients and normal controls as well as between glottic cancer patients and normal controls (P < 0.05). GER was found in 26.3% (5/19) patients in glottic cancer group and 23.5% (4/17) patients in vocal cord leukoplakia group and 6.3% (1/16) volunteer in normal controls. There was no statistically significant difference in the positive rate of GER between early glottic cancer patients and normal controls as well as between vocal cord leukoplakia patients and normal controls (P > 0.05). However, there was statistically significance in DeMeester scores between glottic cancer patients and normal controls (P < 0.05), while no statistically significance between vocal cord leukoplakia patients and normal controls (P > 0.05). Reflux events were dominated by acid and weakly acidic reflux in upright position. Weakly alkaline reflux events in upright position, acid reflux events in supine position, and weakly alkaline reflux events in supine position in vocal cord leukoplakia patients were significantly more than those in normal controls (P < 0.05). No statistically significant difference existed in positions and contents between early glottic cancer patients and normal controls (P > 0.05). There was also no statistically significant correlation between happening LPR and GER, smoking and drinking in patients with vocal cord leukoplakia and early glottic cancer (P > 0.05). CONCLUSIONS: Reflux events are more in vocal cord leukoplakia patients and early glottic cancer patients, however, the relationship between laryngopharyngeal reflux and canceration of the vocal cord is still needed to be investigated. The significance of mucosal injury induced by nonacid refluxes is needed to be further studies.

[Observation of clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux].

OBJECTIVE: To investigate the correlation between clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux (LRP). METHODS: One hundred and thirty-eight patients with vocal leukoplakia who received laryngeal microsurgeries under suspension laryngoscope were recruited in this study. Reflux symptom index (RSI) and reflux finding score (RFS) were measured. The clinical features, pathological characteristics were collected. RESULTS: There were 129 males and 9 females with a mean age of (53.4 ± 11.5) years. The mean age of patients with severe dysplasia/carcinoma and invasive carcinoma was significantly older than that of inflammation/hyperplasia (F = 6.773, P < 0.05) . In 138 patients, 85 patients (61.6%) were pathologically diagnosed as chronic inflammation or squamous epithelium hyperplasia, 18 patients (13.0%) as mild dysplasia, 10 patients (7.2%) as moderate dysplasia, 15 patients (10.9%) as severe dysplasia/carcinoma in situ and 10 patients (7.2%) as invasive carcinoma. One hundred and twenty-nine patients (93.5%) complained of hoarseness with clinical courses between 7 days and 20 years. 68.5% vocal folds with inflammation/hyperplasia showed nearly normal mucosal waves, and 72.7% to 80.0% vocal folds with moderate or more severe dysplasia showed severe reduced mucosal waves. A correlation existed between the severity of pathological type and the decreased extent of mucosal waves (rank correlation coefficient was 0.427, P < 0.001). The prevalence of LPR diagnosed with RSI > 13 or RFS > 7 was 54.3 %, while the positive rate of RSI was 21.7% and that of RFS was 43.5%. There was no significant differences of the positive rates of RSI and RFS among different pathological types (χ² values 3.537 and 7.619 respectively with both P > 0.05). According to RSI evaluation, the most common reflux symptoms were hoarseness (94.9%), throat clearing (68.8%) and globus sensation (62.3%). The most common RFS findings were posterior commissure hypertrophy (79.7%), thick endolaryngeal mucus (77.5%) and vocal fold edema (70.3%). CONCLUSIONS: The vocal fold leukoplakia consisted of various pathological types including benign, dysplasia and malignancy. There was a correlation between pathological types and the extent of mucosal waves. About half of the patients with vocal fold leukoplakia existed LPR using RFS and RSI evaluation, but no significant difference of LPR positive rates were observed among different pathological types.

The value of the acoustic voice quality index as a measure of dysphonia severity in subjects speaking different languages.

The Acoustic Voice Quality Index (AVQI) is a relatively new clinical method to quantify dysphonia severity. Since it partially relies on continuous speech, its performance may vary with voice-related phonetic differences and thus across languages. The present investigation therefore assessed the AVQI's performance in English, Dutch, German, and French. Fifty subjects were recorded reading sentences in the four languages, as well as producing a sustained vowel. These recordings were later edited to calculate the AVQI. The samples were also perceptually rated on overall dysphonia severity by three experienced voice clinicians. The AVQI's cross-linguistic concurrent validity and diagnostic precision were assessed. The results support earlier data, and confirm good cross-linguistic validity and diagnostic accuracy. Although no statistical differences were observed between languages, the AVQI performed better in English and German and less well in French. These results validate the AVQI as a potentially robust and objective dysphonia severity measure across languages.

Leucoplasia verrucosa proliferativa e carcinoma verrucoso: semelhanças e diferenças histopatológicas e de proliferação celular por Ki67 / Proliferative verrucous leukoplakia and verrucous carcinoma: histopathological similarities and differences and cell proliferation by Ki67

Carcinoma verrucoso e leucoplasia verrucosa proliferativa, estão entre as lesões que apresentam difícil diagnóstico diferencial devido às semelhanças histopatológicas que ocorrem em determinada fase de evolução. Existe, para tanto, a necessidade de somar dados clínico-epidemiológicos ao histopatológico a fim de se estabelecer o diagnóstico final. A leucoplasia verrucosa proliferativa caracteriza-se por seu acometimento multifocal, grande potencial de recidiva e perfil progressivo que resulta em alto risco de transformação maligna. Por outro lado, o carcinoma verrucoso, variante de baixo grau do carcinoma epidermoide, é unifocal e dificilmente recidiva. A importância de novos estudos acerca das suas duas lesões mencionadas vem a agregar conhecimento de modo a facilitar um correto diagnóstico e, consequentemente, um apurado prognóstico. A leucoplasia verrucosa proliferativa, por se tratar de lesão com alto potencial de transformação maligna, pode evoluir para carcinoma epidermoide invasivo, menos diferenciado e mais agressivo com consequente prognostico obscuro, ao passo que, o carcinoma verrucoso não incorre em metástases e apresenta um prognóstico mais favorável. Isso posto, com o objetivo de aumentar a precisão diagnóstica, o presente trabalho propôs identificar e quantificar em porcentagem os critérios histopatológicos encontrados na leucoplasia verrucosa proliferativa e no carcinoma verrucoso visando diferenciar morfologicamente as lesões dos dois grupos.

Também buscamos comparar os dados epidemiológicos referentes aos casos inseridos no estudo, dentre eles vinte e dois casos de leucoplasia verrucosa proliferativa, dezoito casos de carcinoma verrucoso e dois casos apresentando tanto leucoplasia verrucosa proliferativa quanto carcinoma verrucoso, casos esses com diagnósticos estabelecidos previamente (baseando-se nos dados epidemiológicos somados ao histopatológico). A utilização de um marcador imuno-histoquímico da atividade proliferativa celular, o Ki67, também permitiu uma análise comparativa entre o comportamento biológico de ambas as lesões através de um ensaio quantitativo e qualitativo. A marcação mostrou-se escassa, mas evidente em células mitóticas da leucoplasia verrucosa proliferativa, mostrando, no entanto, maior número de células positivas no carcinoma verrucoso, estas visíveis nas camadas basal e parabasal. Os resultados do presente trabalho permitiram concluir então que o marcador Ki67 pode auxiliar no diagnóstico diferencial entre leucoplasia verrucosa proliferativa e carcinoma verrucoso. Foi possível depreender também que, histologicamente, o carcinoma verrucoso apresenta maior alteração em sua conformação epitelial, bem como maior número de atipias cito-arquiteturais quando comparado à leucoplasia verrucosa proliferativa, que, apesar de seu aspecto morfológico, evolui no sentido de uma potencial transformação maligna, apresentando, por sua vez, maior freqüência de projeções em gota.

Verrucous carcinoma and proliferative verrucous leukoplakia, are among the injuries presenting difficult differential diagnosis due to histopathological similarities that occur at some stage of evolution. There is a need to add clinical, epidemiological and histopathological data to achieve the final diagnosis. Proliferative verrucous leukoplakia is characterized by its multifocal involvement, great potential for relapse and progressive profile that results in malignant transformation high risk. On the other hand, the verrucous carcinoma, which is considered low-grade variant of squamous cell carcinoma, is unifocal and unlikely to return. The importance of new studies on its two mentioned lesions is to generate knowledge aiming at a correct diagnosis and prognosis. The proliferative verrucous leukoplakia, since it is a lesion with high potential for malignant transformation, can develop into less differentiated and more aggressive invasive squamous cell carcinoma with subsequent poor prognosis, whereas the verrucous carcinoma incurs no metastases and presents a more favorable prognosis. Thus, aimed to increase the diagnostic accuracy, the present work looked for to identify and quantify in percentage the histopathological criteria found on proliferative verrucous leukoplakia and verrucous carcinoma, aiming morphologically differentiate the lesions from both groups.

We also seek to compare the epidemiological data related to cases included in the study, including twenty-two cases of proliferative verrucous leukoplakia, eighteen cases of verrucous carcinoma and two cases showing both proliferative verrucous leukoplakia as verrucous carcinoma, cases with these diagnoses established previously (based on epidemiological data added to histopathology data). Using a cell proliferation immunohistochemical marker, Ki67, we made a comparative analysis between the biological behavior of both lesions by quantitative and qualitative assay. We saw a few strongly positive mitotic cells in samples of proliferative verrucous leukoplakia, and numerous positive cells observed in the basal and parabasal layers of verrucous carcinoma samples. This study results indicate, then, that the Ki67 marker may help in the differential diagnosis between proliferative verrucous leukoplakia and verrucous carcinoma. It was also possible to conclude that, histologically, the verrucous carcinoma shows greater change in its epithelial conformation and a higher number of cyto-architectural atypia when compared to proliferative verrucous leukoplakia, which, despite its morphological appearance, evolves towards a potential malignant transformation, presenting, in turn, higher drop-shaped rete ridges frequency.

Candida invasion and influences in smoking patients with multiple oral leucoplakias--a retrospective study.

Treating patients with multiple oral leucoplakias (MOLs) who smoke is more difficult and complicated than treating those with single oral leucoplakia (SOL). Removing the aetiological factors causing MOL can effectively prevent its recurrence. The aim was to study the infection by and influences of Candida in smoking patients with MOLs. A retrospective study was conducted on 136 smoking patients who had clinicopathological OLs. Among these patients, 73 lesions in 31 patients were MOLs, while 105 patients had SOLs. All patients were treated by complete resection. All specimens were tested for epithelial dysplasia, and stained with periodic acid-Schiff reagent. The rate of MOL concurrence with candidal infection was higher than that of SOLs. The incidence of Candida associated with MOLs was higher for recurrent than for non-recurrent lesions. The disease-free time was shorter in MOL patients with candidal infection. Moreover, MOLs with candidal infection were more likely to have an increasing ratio to combine with epithelial dysplasia. Candida is an important risk factor in smoking patients with MOLs. Microscopic and fungal examinations of those lesions should permit a detailed diagnosis in such patients and for long-term predictive assessments.

Cytomorphometric analysis of buccal mucosa of tobacco chewers.

OBJECTIVE: The objective of the present study was to assess the effect of tobacco chewing on buccal mucosa by using cytomorphometry. STUDY DESIGN: We compared the cellular diameter (CD), nuclear diameter (ND) and the ratio of nuclear diameter to cellular diameter (N/C) of buccal mucosa squames of normal subjects (N) with buccal mucosa squames of tobacco users without lesion (A), with tobacco-lime lesion (B), leukoplakia (C), and oral squamous cell carcinoma (D). The study group consisted of 125 patients divided into five groups (N, A, B, C and D) between the ages of 21 and 75 years. RESULTS: The mean of the cellular diameter (in micrometers) of group N, A, B, C, and D was 72.86+/-5.26, 68.30+/-3.02, 62.13+/-3.29, 57.75+/-4.66, 54.51+/-4.66 respectively (p<0.01). The mean of the nuclear diameter (in micrometers) of group N, A, B, C, and D was 8.70+/-1.30, 8.98+/-1.08, 9.06+/-0.83, 9.12+/-1.06, and 11.04+/-1.46 respectively (p<0.01). The mean of the ratio of nuclear diameter to cellular diameter of group N, A, B, C, and D was 0.11+/-2.00, 0.13+/-1.82, 0.14+/-1.35, 0.16+/-3.11, 0.21+/-4.51 respectively (p<0.01). Univariate analysis of variance (ANOVA) showed a significant group effect for cellular diameter, nuclear diameter and ratio of nuclear diameter to cellular diameter. Multiple comparison tests by Tukey-HSD procedure revealed a significant decrease in the mean cellular diameter, increase in the nuclear diameter and ratio of nuclear diameter to cellular diameter. CONCLUSIONS: Cytomorphometric changes could be the earliest indicators of cellular alterations. There is progressive decrease in cellular diameter, increase in nuclear diameter and increase in ratio of nuclear diameter to cellular diameter in smears from all tobacco users, as compared to normal subjects. This indicates that there could be cause-effect relationship between tobacco and quantitative alterations.

[Leukoplakia of the anal verge with bleeding hemorrhoids. A case report]. / Leucoplasia del borde anal con hemorroides sangrantes. Informe de un caso.

We present a case of a 45-year-old patient who reported bleeding hemorrhoids. He had grade II hemorrhoids and was found to have a circumferential leukoplakic lesion at the anal verge. The patient had no symptoms of leukoplakia. The hemorrhoids were ablated with an Ellman radiowave device. Histological findings of the incised lesion from the verge showed hyperkeratosis and acanthosis extending cephalad from the anal verge to the dentate line. Follow-up after 5 years revealed no evidence of dysplastic changes in the leukoplakic lesion. Because of the varied opinions regarding the fate of leukoplakia of the anal canal, patients should be followed carefully to detect any malignant transformation of the lesion.