Comparative Analysis of Clinical and Histopathological Appearance Between Oral Leukoplakia and Lichen Planus

Transcription

1 Journal of Dental Hygiene Science Vol. 5, No. 4, pp. 199~ 204 (2005) rsk Áw x ûw ew Comparative Analysis of Clinical and Histopathological Appearance Between Oral Leukoplakia and Lichen Planus Mi-Heon Ryu Dept. of Dental Hygiene, Namseoul University, 21 maeju-ri Seongwhan-eup Cheonan city , Korea "#453"$5 Background : Oral leukoplakia(ol) and lichen planus(lp) are common soft tissue lesions characterized by white plaque or striae with erosion. The clinical characteristics of these diseases are similar but the cause and clinical course of them are very different. I compared OL with LP by analysizing clinical and histopathological characteristics and follow up study. Patients and methods : The clinical analysis of 200 patients with OL and LP was performed by review of dental and medical charts. And H/E slides were examined under the light microscope. we examined H/E slides by the light microscope. The follow up study of patients was performed. Statistical analysis was done using the SPSS/PC WINDOWS (version 13.0). Results : The age distribution of OL was in the range of years old being most prevalent in the 5th decade and there was a tendency of male prevalent. The age distribution of LP was in the range of years old being most prevalent in the 4th decade and there was a tendency of female prevalent. The most common site of involvement was the buccal mucosa in both diseases. The most common clinical features of OL and LP were white plaque type and white lesion with striae, respectively. In case of LP, the most common clinical sign was tenderness to palpation. Fifteen cases of OL and eight cases of LP showed epithelial dysplasia. Twelve cases of OL recurred after surgery of oral squamous cell carcinoma and 2 cases of LP were transformed into oral squamous carcinoma. Conclusion : There was statistically significant difference in age, sex, clinical signs of patients, frequency of epithelial dysplasia between OL and LP. The Pearson coefficient correlation efficient was 0.51(p < 0.05). The knowledge of the difference between OL and LP can help understand these diseases.,fz XPSETOral leukoplakia, Lichen planus, Precancerous lesion, Lichenoid dysplasia w w w (oral leukoplakia, OL), rsk(lichen planus, LP), e 1) (candidiasis), (leukoedema). ùkù x, x, yw ü ƒ w 2).,,, w, ù q e úe w, HIV y EBV, Candida albicans w, 3-4) rsk y š. e z w š ew š ew Corresponding author Tel: Fax: apollon@nsu.ac.kr 5.4% rss ww š w, yƒ w ƒw3). rsk v w y, 1869 Wilson w» z 1895 Wickham w p ƒ»š w 1909 Darrier w 3,5). y v wì ew v t 40%ƒ 3) w, 25%. ü x, x, e yw ù x ùkù. d w,. wù w w wš ƒ. rs k ùkù w v x ù x w k x(lichenoid dysplasia) w. k x 0.4~2% rss ww š 3).

2 Comparative analysis of clinical and histopathological appearance between oral leukoplakia and lichen planus rsk, ƒ ù ü ùkù œm ƒ w vw w. ù rsk y z. ü rsk x š wì šƒ ù w z w š. rsk x wš y z w rsk, w š w l ¾ w ew w rsk w. w rsk ƒ ƒ , kƒ yw H/E (hematoxylin and eosin) ƒw w. 2. 1) m rsk y e» mw y,,, j»,, p, y,»w. 2) H/E w w rsk y 10% s 24 šwš 20 w. z p g kwš xylene w qv sw z 3µm t w. t kqvy pg w, H/E ww. 3) w m Digital cameraƒ x (Olympus, BX51T, Tokyo, Japan) w H/E w rsk w v x w. 4) z rsk w» w e» m wš y ww. 5) m rsk y,,, j»,, p, y, v x, y z w w z sƒw. rsk» w t-test w w. v x» w Pearson w. SPSS/PC WINDOWS (version 13.0) m qj w. 1. y 1) ü y s y 13~75š, ƒ w 60~69( s³ ± 15.03) <Table 1>. 51 y 42 û (M/F ratio = 4.67 : 1) <Table 2>. 2) x, x, z e ƒ (retromolar pad), w e e ùkûš, ƒ w x 20(39.2%)<Table 3>. 5BCMFAge distribution of OL and LP Age (year) Diagnosis Cases 10~19 20~29 30~39 40~49 50~59 60~69 70~79 Mean* OL LP Total * : p < 0.05 by t-test 5BCMF Gender distribution of OL and LP Diagnosis Cases Male Female M/F ratio* OL : 1 LP : 2.10 Total * : p < 0.05 by t-test

3 Journal of Dental Hygiene Science Vol. 5, No. 4, pp. 199~204 (2005) 5BCMF Site distribution of OL and LP Diagnosis Cases Buccal mucosa Lower lip Palate Tongue Lower Mn. Ant. Mx. Post. Mx. RMT OL LP Mn. : Mandible, Ant. : Anterior, Mx. : Maxilla, Post. : Posterior, RMT : Retromolar trigone Mouth floor Gingiva 5BCMF Clinical types of OL and LP Diagnosis Cases White plaque Ulceration Speckled type Erosion White lesion with Verruciform striae White lesion with striae and erosion Erythematous lesion Erythematous lesion with white striae Erythematous lesion Unrecorded with erosion OL LP Total BCMF Clinical impressions of OL and LP Diagnosis Cases OL LP LP, OL LP, lichenoid reaction LP, EM OL, lichenoid reaction LP, Malig. OL, Malig. OL, PM, BMMP OL LP Total EM : Erythema multiforme, Malig. : Malignancy, PM : Pemphigus vulgaris, BMMP : Benign mucous membranous pemphigoid Malig. OL, erythroplakia Traumatic ulcer Other benign lesion x x, z e ƒ w ƒ 8 (15.7%). y» rss z ùkù 12(23.5%). p q 34(66.7%), w ƒ 5(9.8%), yww ƒ 3(5.9%), ƒ 3(5.9%), x ùkù ƒ 2(3.9%)<Table 4>. 3) y, y pw ƒ š 5 m h. w ƒ 26 (50.9%), rskù w ƒ ƒƒ 7(13.7%), ƒw ƒ 4 (7.8%), rsk ƒw ƒ 3(5.9%) <Table 5>. 2. rsk y 1) ü y s rsk y ü 20 79¾ š, ƒ w 50( s³ ± 13.25) <Table 1>. 149 rsk y 101 (M/F ratio = 1 : 2.10). y w y m w ƒ (p < 0.05). 2) x, w e e, x, e e, z e ƒ (retromolar pad) š, ƒ w x 129(86.6%) ùkû. ü w x x, w e w ƒ 38(25.5%) <Table 3>. j» 0.5 cml 7 7cm ¾ w, 4. p (erosion) (white striae) w ƒ 66(46.9%), x 36 (24.2%), y x ƒ 27(18.1%), 4(2.7%), w ù kù ƒ 4(2.7%), y w ƒ 3 (2.0%), y ƒ 3(2.0%)<Table 4>. 3) rsk y, 43(28.9%) rsk yƒ m h yw pw ƒ 26(17.%), m ƒ 4(2.7%), ƒ 3(2.0%) <Table 6>. y w m w ƒ (p < 0.05). y» x nw ƒ 3». w ƒw w x Ÿ(DIF) ww ƒ 6. 5BCMF Clinical signs of LP Diagnosis Cases Burning sensation Pain Tenderness Dull sensation No tenderness Unrecorded LP

4 Comparative analysis of clinical and histopathological appearance between oral leukoplakia and lichen planus 5BCMFFrequency of epithelial dysplasia in OL and LP* Diagnosis Cases No dysplasia Mild dysplasia Moderate dysplasia Severe dysplasia OL LP Total * : p < 0.05 by t-test 'JHHistologic appearance of OL 'JHHistologic appearance of LP rsk w ƒ 111 (74.5%), rsk ƒw ƒ 13(8.7%), w ƒ 9(6.0%)<Table 5>. 3. rsk v x y H/E slide w 51 v x 15 (29.4%), w v x 14(27.5%), v x 1(1.9%)<Fig. 1>, <Table 7>. rsk y H/E slide w 149 rsk v x 8(5.4%), w v x 5(3.4%), v x 3(2.0%)<Fig. 2>, <Table 7>. r sk w v x m w ƒ v x ƒ ùkû(p < 0.05). 4. y» rss z ùkù 12(23.5%). ƒw 36 rss z ùkù 12 y w yƒ 11 5» üš ùkû. w rsk e z e,, e z w z. ù ù e z, e z yƒ üw» ù y w. w v x y ù e z y yw üw 2 w w ww. rsk y v x Pearson 0.51 ùkû (p < 0.05). š w 13~75, y 60 ùkû. Eversole 1) û š wš Sapp 3) s ³ 60 û ywš w» w s. s M/F ratioƒ 4.77 : 1 û (82.4%). rsk dù wù 2/ 3 30~60 d wš š š5-6). Tompkin 31~60 d 70~80%ƒ, w %ƒ w šw 7-8). 30~60 131(87.9%)ƒ w» ew ùkü. s Samman û, Sapp û ƒ ƒ š šwš, Dissemond ywš šw w 3, 6, 9-10). M/F ratioƒ 1:2.10 ùkù ƒ ùkû. s û (82.4%), rsk (66.9%) m w w ùkü (p < 0.05). rsk wù y ƒ 60, rsk y ƒ 50 y m w w ùkü (p < 0.05). 60 d û

5 Journal of Dental Hygiene Science Vol. 5, No. 4, pp. 199~204 (2005) š. rsk 50 ùkû. rsk T v w š, ƒ y wùš š ewš ƒ. rsk y x, x, w e e ùkù y ùkü. ƒy w, x x d ƒw, w rsk w. e» m q w w» w». rsk yw x ù, Cx, p 10-11),, ƒ»š. nw z ùkù ƒ 3 ù rsk» ƒ w rsk w lichenoid mucositis k w». ƒ» w v w xÿ(dif) ww. w» pù ƒ»w, rsk. w ƒy ùkù ùkùš rswù nw, Ëš w e, ƒ w. p q ùkù ƒ 66.7% ƒ. rsk w ƒ 52.9%. w rsk ƒƒ rsk ƒ ƒ ù rsk wù rsk wì ƒw ùkû. rsk ƒw ƒ rsk y w». ü rsk x» (Wickham's striae) w y ùkù 3) p. w rsk d ùkù. d w w ù x d ƒ 10). ù rsk 28.9% yƒ m h yw m w w (p < 0.05). y üƒ w»z w üwù e w e ƒ. rsk mù m, h 6, 12) yw. w rsk v w v» 6) y, k, Ÿ ƒy ùkú 3,. w 29.4% v x. ƒw 36. rss z w 23.5% ùkûù v x m w w. š w v x,, w w ƒƒ 3%, 4%, 43%š wù 13)» ew»» ƒ vw ƒ. rsk p mw, v ƒy ƒy v»sd m ƒy Civatte body. w w ew v w. w rsk v x ƒ 5.4%. rsk rss w šƒ 14-15), rs k ùkù v x ù x k x(lichenoid dysplasia) 2-3) w. š w 0.5~2.8% rsk r 13,16) ss wwš w. 1.3% w š ew. v x w, 0.51 ùk ù v x m w w (p < 0.05). k x rs s yw, rsk w ƒ wš rsk ƒ 15) ƒ rss yw ƒ. Krutchkoff Eisenburg rsk w v x k xš w, Lovas k x ùkù x v s w w š w rsk 17-19) w. w rsk w w š. rsk ew ù» e w» vw rsk x wš y z w. w šw., s, p, y, v x, ùkþ. rsk ƒy w, x x d

6 Comparative analysis of clinical and histopathological appearance between oral leukoplakia and lichen planus ƒw, w, rsk x d, mù m, h, v. y w w mw ü. šx 1. Eversole LR: Clinical outline of oral pathology: Diagnosis and treatment. 2nd ed. Lea & Febiger, Philadelphia, pp.12-19, w wz, w ewz: w. 1q, wùq,, pp.71-73, , w wz : w. 2q, ù q,, pp , , w wz : w. 1q, q,, pp , Neville BW, Damm DD, Allen CM, Bouquot JE : Oral & Maxillofacial Pathology. 2nd ed. Saunders, Philadelphia, pp , , v, Ÿx,, : rsk 35. wvwz 33(4): , Tompkins JK : Lichen planus: Statistical study of 41 cases. AMA Arch Derm 71(4): , w, y, k : rsk š. wvwz 15(2): , Samman PD : Lichen planus : an analysis of 200 cases. Trans Rep St. John's¾Hosp. Dermatol Soc London 46: 36-38, Dissemond J : Oral lichen planus : an Overview. J Dermatol Treat 15(3): , Scully C, Porter S: ABC of oral health: Swelling and red, white, and pigmented lesions. BMJ 321(7255): , Regezi JA, Sciubba J : Oral pathology Clinical-Pathological Correlations. 2nd ed. Saunders, Philadelphia, pp , , Reibel J : Prognosis of oral pre-malignant lesions: Significance of clinical, histopathological, and molecular biological characteristics. Crit Rev Oral Biol Med 14(1): 47-62, Kim J, Yook JI, Lee EH, Ryu MH, Yoon JH, Hong JC, Kim DJ, Kim HS: Evaluation of premalignant potential in oral lichen planus using interphase cytogenetics. J Oral Pathol Med 30(2): 65-72, Fabenzadeh M, Rinaggio J, Chiodo T: Squamous cell carcinoma arising in an oral lichenoid lesion. J Am Dent Assoc 135(6): 754-9, Suarez P, Batsakis JG, El-Naggar AK : Leukoplakia : Still a Gallimautry or is progress being made? - A review. Advances in Anatomic Pathology 3(5): , Eisenburg E, Krutchkoff DJ: Lichenoid lesions of oral mucosa. Diagnostic criteria and their importance in the alleged relationship to oral cancer. Oral Surg Oral Med Oral Pathol 73(6): , Krutchkoff DJ, Eisenburg E : Lichenoid dysplasia: a distinct histopathological entity. Oral Surg Oral Med Oral Pathol 60(3): , Lovas JG, Harsanyi BB, ElGeneidy AK. Oral lichenoid dysplasia: a clinicopathological analysis. Oral Surg Oral Med Oral Pathol 68(1): 57-63, (Received November 1, 2005; Accepted November 28, 2005)