Esophageal Epidermoid Metaplasia: Clinical Characteristics and Risk of Esophageal Squamous Neoplasia.

INTRODUCTION: Esophageal epidermoid metaplasia (EEM) is a rare disease. METHODS: Patients with EEM diagnosed between 2014 and 2020 were reviewed. RESULTS: Forty EEM cases were identified. EEM occurred in 9 (23%) patients before, concordant, or after esophageal squamous cell carcinoma (ESCC). EEM was associated with previous esophageal lichen planus in 5 patients, Barrett's esophagus 7, and esophageal adenocarcinoma 1. EEM was focal in 28 (70%) or diffuse in 12 (30%) and not detected in 45% on recent previous endoscopy. DISCUSSION: EEM is a premalignant underrecognized condition associated with multiple conditions. Close follow-up or endoscopic treatment may be warranted because of its ESCC association.

Common benign and malignant oral mucosal disease.

BACKGROUND: Mucosal diseases of the oral cavity are relatively common, and patients often seek initial assessment from their general practitioner. OBJECTIVE: The aim of this article is to provide an overview of common oral mucosal diseases to help with formulating a differential diagnosis and stratifying the urgency of referral. DISCUSSION: Pathological mucosal conditions of the oral cavity and jaws commonly present as a mucosal ulcer or a white, red or pigmented lesion. In this review, the authors outline the most common conditions organised according to their clinical presentation and describe their typical appearance and management.

Transurethral resection in women with symptomatic keratinizing squamous metaplasia of urinary bladder: A retrospective study of 92 cases.

OBJECTIVES: To investigate the efficacy of transurethral resection (TUR) on relieving urinary symptoms in patients with keratinizing squamous metaplasia (KSM) of the urinary bladder. METHODS: Data were analyzed from a retrospective study of patients receiving transurethral bipolar plasma resection (bi-TUR) treatment for symptomatic KSM. Urinary symptoms were assessed by the International Prostate Symptom Score (IPSS) and a numeric rating scale pain score. Efficacy was assessed using the IPSS to determine changes from baseline in lower urinary tract symptoms (LUTS). Self-reported quality of life (QoL) was assessed by the last question of the IPSS questionnaire. RESULTS: A total of 92 female patients were included in the analysis. The median age was 42 years. LUTS, pain, and hematuria were the most common symptoms that affected patients. The median follow-up duration was 51 months. There were significant improvements in LUTS from baseline IPSS after TUR (P < .001). The percentage of the patients with moderate to severe LUTS went down from 52.2% to 18.5%. The median Numeric Rating Scale (NRS)-11 pain score reduced from 3 at baseline to 0 at the last visit. Twenty-one out of 40 patients reported that the pain symptoms disappeared completely. No patients reported hematuria symptoms at the final follow-up. Improvement of self-reported QoL was significant (P < .001). A total of 57.6% of patients reported an improvement, 26.1% of patients reported no improvement, and 16.3% reported deterioration. CONCLUSIONS: Bi-TUR therapy significantly relieved urinary symptoms in women with KSM. Improvement of QoL was acceptable with a success rate of 57.6%. Considering the very low complication rate, our study supported bi-TUR as an alternative treatment for patients who are resistant to medical therapy.

Use Videostrobokymography to Quantitatively Analyze the Vibratory Characteristics Before and After Conservative Medical Treatment of Vocal Fold Leukoplakia.

OBJECTIVES: To quantitatively analyze the vibratory characteristics of vocal folds before and after conservative treatments to evaluate the outcomes of conservative treatments for vocal fold leukoplakia using videostrobokymography (VSK). STUDY DESIGN: This is a prospective study. METHODS: Twenty patients and 20 controls were enrolled into the study. All patients received conservative treatments for 3 weeks and received VSK examination before and 3 weeks after the treatments. All controls only received VSK examination once. Vocal fold lengths of 25%, 50%, and 75% were chosen as the line-scan positions to evaluate the vocal fold vibration. Open quotient (OQ) and asymmetry index (AI) were obtained using VSK. RESULTS: Significant improvements in the main symptoms including voice hoarseness were found. Videostroboscopic findings showed that the white lesions on the vocal folds almost completely disappeared in all patients, and the vocal fold flexibility returned to normal. All OQs and AIs at each line-scan position in patients before the treatments were larger than those in controls (P < 0.017), whereas all OQs and AIs at each line-scan position decreased 3 weeks after conservative treatments (P < 0.017). No significant differences in OQs and AIs at each line-scan position were detected between patients after the treatments and controls (P > 0.017). CONCLUSIONS: VSK could quantitatively evaluate the vibratory characteristics of vocal folds before and after the treatments, and conservative treatment could improve VSK measurements to normal control values, suggesting that VSK is a tool to assess the outcomes of the conservative treatments for vocal fold leukoplakia.

Quantification of Vocal Fold Vibration in Various Laryngeal Disorders Using High-Speed Digital Imaging.

OBJECTIVE: To quantify vibratory characteristics of various laryngeal disorders seen by high-speed digital imaging (HSDI). METHODS: HSDI was performed on 78 patients with various laryngeal disorders (20 with polyp, 16 with carcinoma, 13 with leukoplakia, 6 with vocal fold nodule, and 33 with others) and 29 vocally healthy subjects. Obtained data were quantitatively evaluated by frame-by-frame analysis, laryngotopography, digital kymography, and glottal area waveform. RESULTS: Overall, patients with laryngeal pathologies showed greater asymmetry in amplitude, mucosal wave and phase, smaller mucosal wave, and poorer glottal closure than vocally healthy subjects. Furthermore, disease-specific vibratory disturbances that generally agreed with the findings in the literature were quantified: comparing polyp with nodule, differences were noted in longitudinal phase difference, amplitude, and mucosal wave. In comparison with leukoplakia and cancer, nonvibrating area was more frequently noted in cancer. CONCLUSIONS: The HSDI analysis of various voice disorders using multiple methods can help phonosurgeons to properly diagnose various laryngeal pathologies and to estimate the degree of their vocal disturbances.

Positive therapy of andrographolide in vocal fold leukoplakia.

PURPOSE: Vocal fold leukoplakia is a premalignant precursor of squamous cell carcinoma. Although many efforts have been contributed to therapy of this disease, none exhibits a satisfactory result. The aims of this study were to investigate the effectiveness and feasibility of andrographolide therapy in vocal fold leukoplakia and to explore the preliminary mechanism underlying. MATERIALS AND METHODS: Forty-one eligible patients were enrolled in the study. The patients were treated for 10-minute exposures of 5 ml (25mg/ml) andrographolide injection aerosols twice a day, and 2 weeks was considered as one treatment course. Electronic laryngoscope was used to observe the condition of vocal fold leukoplakia during the treatment. Every patient received one or two treatment courses, and the follow-up was carried out for 12 months. Toxic reactions of treatments were evaluated on the basis of the standards of the United States MD Anderson Cancer Center. Moreover, laryngeal carcinoma cell line Hep2 was applied to explore the mechanism of effect of andrographolide. Anti-proliferative effect on Hep2, cell nuclear morphology, express of mitogen-activated protein kinases (MAPK) and pro-apoptotic protein were detected after andrographolide treatment. RESULTS: We found that andrographolide exhibited significant curative effects on treatments, which were accompanied by thinning of the lesion of leukoplakia, reduction in the whitish surface area, and return of pink or red epithelium. A complete response up to 85% was observed, and no toxic side effect events occurred during the study. No patient with a complete response had a recurrence in the follow-up. Moreover, cellular experiments in Hep2 indicated that andrographolide activated MAPK pathway and caspase cascade, and finally induced apoptosis in laryngeal carcinoma cell. CONCLUSIONS: The advantages of andrographolide are connected with minimally invasive and localized character of the treatment and no damage of collagenous tissue structures, which are more convenient and less painful for patients. These results suggest that andrographolide treatment is a viable strategy for curing vocal fold leukoplakia.

Pacientes remitidos por el Programa de Detección de Cáncer Bucal: Facultad de Estomatología de La Habana: 1999-2006 / Patients referred by the Program for Detection of buccal cancer: Stomatology Faculty of La Habana, 1999-2006

Nos propusimos caracterizar los pacientes remitidos por el Programa de Detección de Cáncer Bucal (PDCB) a la Clínica de Patología Bucal de la Facultad de Estomatología de febrero de 1999 a julio de 2006. Se realizó un estudio transversal, descriptivo, observacional de los pacientes inscritos en el registro de remitidos por el PDCB a la Clínica de Patología de la Facultad de Estomatología de La Habana. Se estudiaron 1 008 pacientes, el diagnóstico presuntivo y definitivomás mayormente representado fue el de otra lesión, con 33,7 por ciento de presentación, seguido por la leucoplasia con 33,7 por ciento. La coincidencia entre el diagnóstico presuntivo y el definitivo fue de 69,0 por ciento, el carrillo estaba afectado en un 25,8 por ciento. El carcinoma epidermoide representó un 85,0 por ciento de las neoplasias malignas diagnosticadas. No hubo diferencias entre los sexos de los pacientes remitidos y el rango de edades más afectado fue el de 34 a 59 años de edad. La mitad de los pacientes remitidos tenían hábito de fumar, mucho más elevado en los pacientes con leucoplasia y neoplasias malignas. Las localizaciones anatómicas más afectadas por las lesiones motivo de remisión fueron carrillo, encía y paladar. El carcinoma epidermoide grado I y la etapa clínica I mostraron los mayores porcentajes(AU)

The aim of present paper was to characterize the patients referred by the Program for Detection of Buccal Cancer (PDBC) to Clinic of Buccal Pathology of the Stomatology Faculty from February, 1999 to July, 2006. An observational, descriptive and cross-sectional study was conducted in patients inscribed in Referred Registry by PDBC to Clinic of Pathology from the Stomatology Faculty of La Habana. A total of 1 008 patients were studied, the more numerous presumptive diagnosis and the definitive diagnosis of other lesion with 33,7 percent followed by leucopenia with 33,7 percent, coincidence between the presumptive diagnosis and the definitive one was of 69,0 percent, the cheek was involved in the 25,9 percent. Epidermoid carcinoma accounted for the 85,0 percent and the diagnosed malignant neoplasm. There were not differences among sexes of referred patients and the more involved age rank was that from 34 to 59 years. The half of referred patients had smoking being higher in patients presenting with leukoplakia and malignant neoplasms. The anatomical locations more involved by the lesions were cheeks, gingiva and palate. The Grade I epidermoid carcinoma and the grade I clinical stage showed the higher percentages. Are needed further studies allowing to emphasize the success of PDBC and to correct the deficiencies preventing to fulfill appropriately the objectives(AU)

[Relationship between vocal fold leukoplakia and gastropharyngeal reflux:analysis of 15 cases].

OBJECTIVE: To explore the possible relationship between vocal fold leukoplakia and gastropharyngeal reflux. METHODS: Fifteen patients with vocal fold leukoplakia confirmed by pathology, all males, aged (53 +/- 14) (20-88), underwent esophageal and laryngopharyngeal 24-hour pH monitoring before operation. The rate and characteristics of reflux were recorded. Semi-open-ended questionnaire was used to assess the symptoms. RESULTS: Nine of the 15 patients (60%) showed pathologic intra-esophageal reflux. The time of total acid reflux of the positive re intra-esophageal reflux group was 104.6 min +/- 42.1 min, significantly longer than that of the negative group [(10.9 min +/- 11.5 min), P = 0.001]. The frequencies of intra-esophageal acid reflux of the positive group was (30.1 +/- 16.2) times, significantly higher than that of the negative group [(4.8 +/- 3.4) times, P = 0.006]. The intra-esophageal acid reflux percentage of the positive group was 7.9% +/- 2.9%, significantly higher than that of the negative group [(1.0% +/- 0.6%), P = 0.01]. and the rate in esophageal pH <4 of total fraction time between reflux positive and negative patients (P < 0.01). The scores of heartburn and acid regurgitation of the positive group were significantly higher than those of the negative group (both P < 0.05). Two of 15 patients (13.3%) had pathologic laryngopharyngeal reflux. One patient also had obstructive sleep apnea hypopnea syndrome. CONCLUSION: The patients with vocal fold leukoplakia had more pathologic intra-esophageal reflux compared to the normal individuals. Reflux may be a risk factor of mucosa leukoplakia. Leukoplakia;

Leukoplakia of oral mucosa: pathogenesis and possible correction with phytoadaptogen.

Leukoplakia of the oral mucosa is characterized by impairment of the epithelial differentiation program. The use of complex phytoadaptogen in the treatment of patients with leukoplakia normalized expression of Fas-APO-1 antigen and keratin 17; increased expression of CD54 attested to activation of immune effectors. The clinical effect manifested in involution or shrinkage and loosening of the pathological focus and complete epithelialization of erosive surfaces. The phytopreparation exhibited adaptogenic effects normalizing the immune and IFN status and improving the state of adaptation systems in the body.

[Endogenous factors in the development of leukoplakia and kraurosis vulvae]. / Nekotorye éndogennye faktory v razvitii leikoplakii i krauroza vul'vy.

Levels of tropic hormones of the pituitary, glucocorticoids and male and female sex hormones were assayed in 17 cases of kraurosis and leukoplakia of the vulva prior to treatment. Most patients revealed an abnormally high androgen/estrogen ratio, elevated level of glucocorticoids and low concentrations of thyrotropic hormone, prolactin and T3. The above disturbances are closely related and interdependent.