Role of reflectance confocal microscopy for in vivo investigation of oral disorders: White, red and pigmented lesions
Chiara FranceschiniVictor Desmond MandelGary PetersonValentina MancioccoPascale GuiteraMilind RajadhyakshaMarco Ardigò
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Abstract:
Abstract In vivo reflectance confocal microscopy (RCM) is poorly investigated in oral pathology due to the peculiar anatomical and topographical oral mucosa features. A dedicated handheld confocal microscope with an intra‐oral probe was developed for oral mucosa imaging. The main objective was to describe the healthy oral mucosa and the cytoarchitectural findings detectable in different oral disorders by means of the newly designed handheld confocal microscope. Secondary aim was to identify the main RCM criteria that differentiate oral lesions in order to provide algorithm for a rapid non‐invasive evaluation. This observational retrospective study included all consecutive patients with oral disorders and volunteers with healthy oral mucosa who underwent RCM examination in our outpatient clinic from September 2018 to December 2021. Three different investigators examined together the RCM images to detect the key features and secondary criteria for each type of oral lesion collected. The study population included 110 patients affected by oral lesions and seven volunteers with healthy oral mucosae. A total of 15 oral disorders were imaged and divided in three main groups: white, red and pigmented lesions. Key features and secondary criteria were identified for every single type of oral disease. RCM permits a cytoarchitectural evaluation of the oral mucosae affected by inflammatory, dysplastic and neoplastic diseases, thus orienting the clinicians towards non‐invasive diagnosis and enhancing the diagnostic management. The “tree diagrams” proposed allow a schematic and simplified view of confocal features for each type of oral disease, thus drastically reducing the diagnostic timing.Keywords:
Oral mucosa
Oral Lichen Planus
The purpose of our research is to identify causative metals by using particle-induced X-ray emission (PIXE) method to directly analyze trace elements in the oral mucosa with oral lichen planus (OLP). Subjects were 72 patients with OLP, and the patients are 25 men and 47 women, with a mean age of 60.1 years (OLP group). The control is elemental analysis data by PIXE method of 100 cases of the oral mucosa of healthy persons (control group). Seventeen essential elements and 12 contaminating elements were detected from the oral mucosa of the OLP and control groups. As to appearance ratio of elements in oral mucosa, among the contaminating elements, levels of Al, Ga, Sb, Hg and Pb were significantly lower, whereas Au and Y were significantly higher in the OLP group than in the control group. About concentration of elements in oral mucosa, the contaminating elements in the oral mucosa of the OLP group had a lower appearance ratio than in the control but each of the contaminating elements was more abundant. Among 25 subjects in the OLP group and seven in the control group, serum, oral mucosa and saliva were collected from the same individual. Abundance in serum and saliva varied depending on the element, but in general, a tendency was seen for contaminating elements to be more abundant in saliva than in serum and for essential elements to be more abundant in serum than in saliva.
Oral Lichen Planus
Oral mucosa
Trace element
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Oral lichen planus (OLP) is a relatively common oral disorder which shares clinical and histopathological features with other lichenoid lesions, leading to considerable inter-observer disagreement. This negatively impacts understanding of the pathogenesis and malignant transformation potential of this condition.Artificial intelligence was employed to create a machine-learning artificial neural network to identify and quantify mononuclear cells and granulocytes within the inflammatory infiltrates in digitized hematoxylin and eosin microscopic slides. Twenty-four regions of interest were extracted from OLP cases for learning purposes and validated on a retrospective cohort of 130 cases. All cases were related to patients with confirmed diagnoses of OLP, oral lichenoid lesions (OLLs), or oral epithelial dysplasia (OED) with lichenoid host response.The number of inflammatory cells was statistically significantly higher in OLP compared to OLLs or OED with lichenoid host response (p < 0.0005). The proposed machine-learning method was reliably capable of detecting OLP cases based on the number of inflammatory cells and the number of mononuclear cells with an area under the curve of 0.982 and 0.988, respectively. Identifying a cut-off point between OLP and other lichenoid conditions based on the number of mononuclear cells showed a sensitivity of 100% and an accuracy of 94.62%.Artificial intelligence has shown promising outcomes and provides a robust approach to enhance the accuracy of anatomical pathologists in accurately diagnosing OLP using features of disease pathogenesis.
Oral Lichen Planus
Pathogenesis
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The aim of the work was to study the permeability of hematosalivary barrier for mineral elements and the assessment of its role in the pathogenesis and clinical course of lichen planus of the oral mucosa. A total of 231 people were surveyed, which are divided into 6 groups depending on the clinical form of the disease and a control group. The concentrations of the mineral elements (zinc, copper and magnesium) in the blood serum and oral liquid are identified by atomic-absorption spectrophotometry. For each mineral element calculated coefficient ratio to reflects the operation of the hematosalivary barrier, which is the ratio of the concentration in the blood serum and oral fluid. Patients with oral lichen planus were found a violation of the permeability of hematosalivary barrier for some mineral elements, which is important in the pathogenesis of the disease. It appears as opposite changes of the mineral composition of blood serum and oral fluid, which have correlation with the severity of the clinical course of the disease. With increasing severity of the clinical course observed a significant decreasing of zinc, copper and a statistically significant increasing of magnesium in blood serum and oral fluid, which aggravates the severity of the clinical course of the oral lichen planus.
Oral Lichen Planus
Oral mucosa
Pathogenesis
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Introduction: Oral lichen planus is a chronic inflammatory disease that affects the
mucosa of the oral cavity. Oral lichenoid reactions/ lesions share many clinical and
histopathological features with oral lichen planus, and represent a response to extrinsic or
causative factors (drugs, allergens). Aim: The purpose of this study was to evaluate the
clinical and histopathological features of oral lichen planus and oral lichenoid reactions/
lesions. Objectives: The objectives of this study were to assess the clinical and
histopathological features of patients diagnosed with oral lichen planus and oral lichenoid
reaction/ lesions. This study also sought to investigate the association between
clinicopathological characteristics and patients with/ without exposure to causative
factors. Finally, this study compared the ratio of plasma cells to lymphocytes in patients
with/ without exposure to causative factors. Methods: This study was conducted in a
retrospective manner in patients who have been diagnosed with oral lichen planus and
oral lichenoid reaction/ lesions in Faculty of Dentistry, University of Malaya. A total of
122 patients that met the inclusion criteria were studied. Socio-demographic and clinical
data for each case were obtained from clinical folders in Oral medicine clinic and
histopathology reports in Oral Pathology Research and Diagnostic Laboratory (OPDRL).
Histopathological data was extracted from the archived hematoxylin and eosin stained
slides in OPDRL. Histopathological scoring of plasma cells and lymphocytes was done
using 3D Histech and QuPath softwares. Data was analyzed using chi-square, logistic
regression, and receiver operating curve analysis. Results: There were significant
differences in plasma cells to lymphocytes ratio between patients who were exposed to
causative factors and those who were not (p=0.043 and p=0.031). Plasma cells to
lymphocytes ratio in patients exposed to causative factors was higher than those who were
not (p=0.048 and p=0.032). Presence of eosinophils was significantly associated with
exposure to causative factors (p=0.016 and p=0.011), deeper inflammatory infiltrate
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(p=0.016), and epithelial atrophy (p=0.043). Conclusion: This study demonstrated
association between the presence of eosinophils and exposure to causative factors, which
were consumption of medications that had been associated with oral lichenoid reaction,
and also presence of restorative materials adjacent to lesions. Moreover, this study
demonstrated higher plasma cells to lymphocytes ratio in patients exposed to causative
factors than those who were not. These findings strongly support the role of causative
factors, mainly the drugs and dental restorative materials in the etiology of oral lichenoid
reactions/ lesions, although it is difficult to pinpoint. Thus, in clinical settings, together
with proper history and clinical findings, these features may facilitate clinicians in
planning appropriate management for patients.
Oral Lichen Planus
Histopathology
Oral mucosa
Oral medicine
Clinical pathology
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Oral Lichen Planus
Confusion
Oral medicine
Oral leukoplakia
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Conventional methods for writing case notes detailing the progress of oral lichen planus (OLP), a precancerous condition that requires long-term surveillance, is both time-consuming and tedious for the busy clinician.To design and perform a simple surveillance on OLP patients based on colour-coded topography mouth maps (TMM).Three colour-coded TMM were employed: red for OLP in high risk oral mucosal sites, yellow for cases showing improvement and green for asymptomatic lesions at each recall visit. In this preliminary study, these were applied on 30 histologically confirmed OLP individuals attending the Oral Medicine Clinic at the Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya. The sites and extent of OLP lesions were charted on either red, yellow or green TMM based on defined criteria. This surveillance evaluated OLP in relation to patientandapos;s age, race, gender, underlying systemic conditions, oral habits, initial onset of OLP, oral manifestations and presence/absence of clinically suspicious areas.Study sample comprised 4 (13.3%) Malays, 9 (30.0%) Chinese and 17 (56.7%) Indians. Most OLP patients belong to the green TMM (n= 14, 46.6%) group followed by red (n= 11, 36.7%) and yellow (n= 5, 16.7%) groups. Of the 11 cases with red TMM, rebiopsy was performed on 4 cases but no dysplasia was detected. Any local confounding factors namely periodontal disease or faulty dental restorations were managed accordingly.TMM is simple to use and aided the clinicians in terms of time saving and patient management. Hence, follow-up of OLP patients can be carried out more efficiently and appropriately. TMM can be used for surveillance of other oral precancerous lesions and conditions.
Oral Lichen Planus
Oral medicine
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Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa which is considered by the World Health Organization (WHO) as a premalignant condition. One step in malignant development is so called epithelial mesenchymal transition (EMT), a process whereby epithelial cells acquire mesenchymal characteristics. A factor known to induce EMT is the transforming growth factor-β (TGF-β), which uses the Smad proteins as mediators for its signaling. The aim of this study was to compare the expression of Smad 3 in Oral Lichen Planus and normal oral mucosa. This descriptive analytic study was performed on 30 patients with OLP (21 women and 9 men with mean age of 45.23± 2.44 years) and 20 normal oral mucosa (14 women and 6 men with mean age of 46.95± 2.21 years). The samples were studied by immunohistochemical staining. Data were analyzed with paired T-test and Wilcoxon test by SPSS software. Expression of Smad3 in OLP samples and normal oral mucosa was different. This difference was statistically significant (P<0.001). The apparently higher expression of Smad 3 in oral lichen planus compared to normal oral mucosa might help to discuss its higher potential for malignant transition.
Oral Lichen Planus
Oral mucosa
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Oral Lichen Planus
Amalgam (chemistry)
Feature (linguistics)
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Objective : To establish the two-dimensional Gel electrophoresis profiles with high resolution and reproducibility from human oral lichen planus and paired normal oral mucosa tissues ,and identify the differential expression proteins. Method : The total proteins of oral lichen planus and paired normal oral mucosa tissues were separated by means of immobilized pH gradient-based two-dimensional gel electrophoresis(2-DE).After AgNO3 staining,the differential expression proteins were ana1yzed by using ImageMaster image ana1ysis software. Result :(1)The well-resolved,reproducible 2-DE patterns of oral lichen planus and normal oral mucosa tissues were obtained. The results showed that average spots were 1576±67, 1608±73 in oral lichen planus and normal oral mucosa tissues respectively.(2) The 13 differential protein spots were identified by Image Master image analysis software. There were 7 protein spots in oral lichen planus were higher expression than that in normal oral mucosa. 6 protein spots in oral lichen planus were lower expression than that in normal oral mucosa. Conclusion : In this study, the well-resolved reproducible 2-DE patterns of oral lichen planus and normal oral mucosa tissues were established and some differential proteins were characterized.These data will be further used to screen special biomarkers of oral lichen planus .
Oral Lichen Planus
Oral mucosa
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Oral Lichen Planus
Buccal mucosa
Oral mucosa
Medical record
Clinical pathology
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