Oral Pathology: Actual Diagnostic and Prognostic Aspects

252 Pages·1996·6.13 MB·English

by  D. M. Williams (auth.)

Current Topics in Pathology
90
Managing Editors
C.L. Berry E. Grundmann
Editorial Board
W. Boeker, H. Cottier, P.J. Dawson, H. Denk
C.M. Fenoglio-Preiser, P.U. Heitz, O.H. Iversen
U. Lohrs, F. Nogales, U. Pfeifer, N. Sasano
G. Seifert, J.C.E. Underwood, Y. Watanabe
Springer
Berlin
Heidelberg
New York
Barcelona
Budapest
Hong Kong
London
Milan
Paris
Santa Clara
Singapore
Tokyo
Gerhard Seifert
(Ed.)
Oral Pathology
Actual Diagnostic and Prognostic Aspects
Contributors
A. Burkhardt, J.K. Field, N.W. Johnson
R.C.K. Jordan, P.A. Reichart, A.G.M. Scholes
C. Scully, P.J. Slootweg, P.M. Speight
K.A.A.S. Warnakulasuriya, D.M. Williams
, Springer
GERHARD SEIFERT, Prof. Dr. med.
Institute of Pathology
University of Hamburg
Martinistr. 52 UKE
20246 Hamburg, Germany
With 44 Figures, Some in Colour, and 16 Tables
ISBN-13:97S-3-642-S0171-6 e-ISBN-13:97S-3-642-S0169-3
DOl: 1O.1007/97S-3-642-S0169-3
Library of Congress Cataloging-In-Publication Data. Oral pathology: actual diagnostic and
prognostic aspects/Gerhard Seifert, ed.; contributors, A. Burkhardt ... [et al.). p. em. - (Current
topics in pathology;v.90)lncludes bibliographical references and index.ISBN-13:978-3-642-80171-6(ha
rdcovet:)1. Mouth - Pathophysiology. I. Seifert. Gerhard, 1921-". II. Burkhardt, Anne.
III. Series. [DNLM: 1. Mouth Diseases - diagnosis. 2. Mouth - pathology. 3. Mouth -
virology. 4. Head and Neck Neoplasms - genetics. 5. Oral Manifestations. WI CU821H v. 90
1996/WU 140 0628 1996) RBI. E6 vol. 90 [RC815) 616.07 s - dc20 [616.3'107) DNLM/DLC for
Library of Congress 96-18025
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List of Contributors
BURKHARDT, A., Prof. Dr. Pathologisches Institut
Kreiskrankenhaus Reutlingen
Steinenbergstr.31
72764 Reutlingen, Germany
FIELD, J.K., MA PhD, Molecular Genetics and Oncology Group
BDS, MRCPath Department of Clinical Dental Sciences
School of Dentistry
The University of Liverpool
Liverpool L69 3BX, England
JOHNSON, N.W., Prof. Dr. Royal College of Surgeons
Department of Dental Sciences/
Department of Oral Medicine and
Pathology
King's College
School of Medicine and Dentistry
Caldecot Road
London SE5 9RW, England
JORDAN, R.C.K., Department of Dentistry
DDS, Diplo 0 Path, MSc, Sunnybrook Health Sciences Centre
PhD, FRCD( C) University of Toronto
2075 Bayview Avenue
Toronto, Ontario M4N 3M5, Canada
REICHART, P.A., Prof. Dr. Abteilung fur Oralchirurgie
und Zahnarztliche Rontgenologie
U niversitatsklinikum Charite
Medizinische Fakultat der
Humboldt-Universitat zu Berlin
Zentrum fUr Zahnmedizin,
Fohrerstr. 15
13353 Berlin, Germany
VI List of Contributors
SCHOLES, A.G.M., Dr. Molecular Genetics and Oncology Group
Department of Clinical Dental Sciences
School of Dentistry
The University of Liverpool
Liverpool L69 3BX, England
SCULLY, c., Eastman Dental Institute for
Prof. Dr., MD, PhD, MDS, Oral HealthCare Sciences
FDSRCPS, FFDRCSI, University of London
FDSRCS, FRCPath 256 Gray's Inn Road
London WCIX 8LD, England
SLOOTWEG, P.J., Prof. Dr. Department of Pathology, H 04.312
University Hospital
3508 GA Utrecht, The Netherlands
SPEIGHT, P.M., Department of Oral Pathology
BDS, PhD, FDSRCPS, Eastman Dental Institute for Oral
MRCPath Health Care Sciences
256 Gray's Inn Road
London WCIX 8LD, England
W ARNAKULASURIY A, Royal College of Surgeons
K.A.A.S., Department of Dental Sciences!
BDS, PhD, FDSRCS Department of Oral Medicine and
Pathology
King's College
School of Medicine and Dentistry
Caldecot Road
London SE5 9RW, England
WILLIAMS, D.M., Department of Oral Pathology
BDS, MSc, PhD, FRCPath, Faculty of Clinical Dentistry
FDSRCS St. Bartholomew's and
The Royal London
School of Medicine
and Dentistry
Turner Street
London El 2AD, England
Preface
Oral pathology is a field of pathology which is well established in the
United States, in Japan and, within Europe, in the United Kingdom and
Scandinavia. In these countries, oral pathology is practised in insti
tutes and departments of oral pathology which are mostly integrated in
a special faculty of dentistry, a dental school or a dental institute. In
many other countries, oral pathology is integrated as a special field in
institutes of general pathology and as part of a faculty of medicine.
These different patterns have led to the different development of sci
ence and practice in this area. The scientific expansion of oral pathol
ogy is documented by the foundation of new scientific societies of oral
pathology, such as the International Association of Oral Pathologists
(IAOP), and new journals, such as the Journal of Oral Pathology and
Medicine, Oral Oncology (as Part B of the European Journal of Cancer)
and Oral Diseases. Recently, oral pathology has also been recognised as
a part of head and neck pathology, an interdisciplinary field of science.
Many new methods have been integrated into the scientific work and
diagnostic repertoire of oral pathology.
In this volume, a comprehensive review of the importance of new
methods in the diagnosis and prognosis of non-malignant disease and
malignant tumours in this area is provided. Eight reputed specialists of
oral pathology give a concise survey concerning new aspects of dis
eases of the oral mucosa. The oral mucosa is not only the point of
attack in local injuries, but also reflects many systemic diseases of the
organism. It is therefore a valuable indicator of diagnosis and progno
sis of various pathological processes.
The chapter by D.M. WILLIAMS deals with mucocutaneous condi
tions affecting the mouth. Most of these diseases are either auto-im
mune or immunologically mediated. This chapter will review the
advances in the understanding of their aetiology and suggests an ap
proach to systematic diagnosis.
The chapter by C. SCULLY gives a survey of the great number and
the diversity of oral viral diseases. The past decade has seen intense
and increasing interest in the oral health care consequences of viral
infection, particularly the possible relationships between viruses and
oral diseases, such as malignant neoplasms, the possible infectivity of
saliva and oral secretions and, more recently, the oral consequences of
infection with the human immunodeficiency viruses (HIV).
VIII Preface
The third chapter is a supplement to the previous one and reviews
the numerous connections between oral mucosa, acquired immunode
ficiency syndrome (AIDS) and oro-facial Kaposi's sarcoma. The diag
nostic criteria for both the clinical and histopathological aspects are
considered to be of particular importance.
The fourth chapter concerns the new concept of extranodal non
Hodgkin's lymphomas (NHL) of the oral cavity. The head and neck
area is the second most common site of extranodal NHL after the
gastro-intestinal tract. The importance of identifying the subtle histo
logical features of each, coupled with immunological and molecular
biological studies of biopsy tissues, has been discussed.
The fifth chapter focuses on the importance of proliferation mark
ers in oral pathology as indicators of the clinical aggressiveness of
human neoplasms. The value of the different methods and their clini
cal application in the diagnosis and prognosis of oral lesions are com
pared.
The sixth chapter analyses the special role of the suppressor pro
tein p53 and its occurrence in oral tumours. This contribution focuses
on the occurrence of p53 alterations in oral tumours and their signifi
cance as well as on the various means currently available for analysis of
the p53 gene.
The seventh chapter gives new insights into genomic instability in
head and neck cancer. In this chaper, potentially important chromo
some regions identified by cytogenetic and loss of heterozygosity
analysis in squamous cell carcinomas of the head and neck are re
viewed.
The eighth chapter rounds off the volume with a contribution
about oncogenes and growth factor receptors as diagnostic and prog
nostic markers in precancers and cancers of the oral mucosa.
In all the chapters, the most recent methods of immunocytochem
istry, in situ hybridisation techniques and molecular pathology are
integrated in the classification of the different types of precancerous
lesions and cancers, and their value in diagnosis and prognosis is
discussed. This volume is an important source of information about
new scientific results in the field of oral medicine and pathology. Illus
trations, tables and references to the most important literature make
this volume a valuable publication for all readers interested in the field
of oral medicine.
The editor would like to thank all the authors for their excellent
cooperation in completing their manuscripts accurately and carefully;
thanks are also due to Mrs. STEPHANIE BENKO of Springer-Verlag,
Heidelberg, for her continued support during the planning, prepara
tion and completion of this volume in the present version and to Mrs.
MONIKA SCHACHT for her excellent work in the extensive correspon
dence with the authors and the publisher.
Hamburg, May 1996 GERHARD SEIFERT
Contents
Mucocutaneous Conditions Affecting the Mouth
D.M. WILLIAMS ....................................... .
New Aspects of Oral Viral Diseases
C. SCULLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Oral Pathology of Acquired Immunodeficiency Syndrome
and Oro-facial Kaposi's Sarcoma
P.A. REICHART. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 97
Extranodal Non-Hodgkin's Lymphomas of the Oral Cavity
R.C.K. JORDAN and P.M. SPEIGHT. . . . . . . . . . . . . . . . . . . . . . . .. 125
Importance of Proliferation Markers in Oral Pathology
K.A.A.S. WARNAKULASURIYA and N.W. JOHNSON. . . . . . . . . . .. 147
Suppressor Protein p53 and Its Occurrence in Oral Tumours
P.J. SLOOTWEG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 179
Genomic Instability in Head and Neck Cancer
A.G.M. SCHOLES and J.K. FIELD .......................... , 201
Oncogenes and Growth Factor Receptors
as Diagnostic and Prognostic Markers
in Pre cancers and Cancers of the Oral Mucosa
A. BURKHARDT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 223
Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 241
Mucocutaneous Conditions Affecting the Mouth
D.M. WILLIAMS
1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Pemphigus Vulgaris. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 Epidemiology.......................................................... 2
2.2 Oral Manifestations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.3 Skin Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.4 Histopathological Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.5 Pathogenesis.......................................................... 5
2.6 Treatment............................................................ 6
3 Mucous Membrane Pemphigoid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.1 Epidemiology and Oral Manifestations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.2 Skin and Ocular Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.3 Histopathological Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.4 Pathogenesis.......................................................... 9
3.5 Treatment............................................................ 10
4 Linear Immunoglobulin A Bullous Dermatosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
5 Dermatitis Herpetiformis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
6 Epidermolysis Bullosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
6.1 Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
6.2 Oral Involvement in Epidermolysis Bullosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
6.3 Pathogenesis.......................................................... 13
7 Erythema Multiforme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
7.1 Oral Manifestations.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . 14
7.2 Skin Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
7.3 Histopathological Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
7.4 Pathogenesis.......................................................... 17
7.5 Treatment............................................................ 18
8 Lichen Planus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
8.1 Epidemiology.......................................................... 19
8.2 Oral Manifestations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
8.3 Skin Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
8.4 Histopathological Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
8.5 Pathogenic Mechanisms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
8.6 Treatment............................................................ 23
9 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
1 Introduction
Diseases affecting the oral mucosa are divisible into neoplasms and conditions
which are either auto-immune or immunologically mediated. This chapter is prin-
Current Topics in Pathology
Volume 90, G. Seifert (Ed.)
© Springer-Verlag Berlin Heidelberg 1996