口腔结核11例临床病理分析

目的 探讨口腔结核的临床表现、诊治方案和预后。方法 回顾分析本科2012年11月—2016年6月收治的11例口腔结核患者的临床、病理及预后情况,包括性别、年龄、症状、辅助检查、治疗方案、病理检查和随访结果等。结果 11例患者中,男6例,女5例;年龄48~78岁,平均年龄59.1岁。5例表现为口腔黏膜溃疡（牙龈4例、颊部1例）,5例为口腔肿物（牙龈1例、颊部3例、唇部1例）,1例为颌骨骨髓炎;仅1例伴有颈部淋巴结肿大。辅助检查中,5例患者胸片检查提示伴有陈旧性结核灶。11例患者的治疗方案中,2例行切取活检后药物治疗,1例行切取活检后观察,8例行切除活检手术治疗。病理诊断为结核后,6例患者接受结核菌素试验（PPD）检查,其中4例为阳性,并且接受抗结核药物治疗。随访8~48个月,平均24.9个月,1例失访。随访期间,口腔病灶均无复发及新病灶形成。结论 口腔结核比较少见,临床上无特异性表现,确诊有赖于病理及相关辅助检查,治疗方案以手术或手术联合药物治疗为主,疗效较好。     

Tuberculosis cutis orificialis with both gingival involvement and underlying pulmonary tuberculosis

Tuberculosis cutis orificialis is a rare manifestation of cutaneous tuberculosis which occurs in the oral, perianal and adjacent mucosa. The most frequent orificial lesion location is the tongue. We report a case of a 35-year-old female with tuberculosis cutis orificialis with gingival involvement. She had a six-month history of a moderately painful gingival ulceration. Histopathological examination showed granulomatous infiltrates composed of epithelioid cells, Langhans giant cells and caseating necrosis. A purified protein derivative test was positive. Sputum culture was positive for Mycobacterium tuberculosis. Chest X-ray and high resolution computed tomography showed active pulmonary tuberculosis in both upper lung zones. The gingival specimen was positive for M. tuberculosis polymerase chain reaction. A complete resolution was achieved after six months of anti-tuberculosis therapy. Dental identification of M. tuberculosis may serve as an important aid in the first line of control of this dangerous infectious disease.     

Methotrexate‐related lymphoproliferative disorder arising in the gingiva of a patient with rheumatoid arthritis

Methotrexate (MTX) is the primary drug used in the management of rheumatoid arthritis (RA) and other immune‐mediated inflammatory diseases. MTX is a strong immunosuppressive agent and has been reported to cause iatrogenic immunodeficiency‐associated lymphoproliferative disorders (LPDs). Stomatitis caused by MTX‐related cytotoxicity may occur, but gingival MTX‐related LPDs are rare. In this article we present a case of gingival MTX‐related LPD in a 60‐year‐old male with RA. The local findings of the gingival ulceration and alveolar bone exposure were similar to those of bisphosphonate‐related osteonecrosis of the jaw. However, he had never received bisphosphonate therapy. The biopsy specimen of the gingival lesion was diagnosed as diffuse large B‐cell lymphoma with Epstein‐Barr virus positivity. Immediate withdrawal of MTX resulted in marked remission of the LPD.     

Oral events related to low-dose methotrexate in rheumatoid arthritis patients

Low-dose methotrexate (MTX) is frequently used for patients with rheumatoid arthritis (RA). High doses of MTX frequently produce side effects. The aim of this study was to explore oral complications of low-dose MTX therapy in a population of RA patients. This is a cross-sectional study in which oral examination was performed on a population of RA patients. Patients undergoing MTX therapy (5-20 mg weekly) for at least six months were included in the study group, and RA patients being treated under another regimen were used as controls. The frequency of oral lesions was compared between groups. The chi-square test was used to compare frequencies. Relative risk (RR) and its confidence interval (CI) were established. Significance level was set at 0.05. Twenty-eight RA patients on a low-dose MTX regimen and 21 controls were enrolled in the study. Oral lesions were found in 22 patients (78.6%) undergoing MTX therapy, and in 5 patients (23.8%) undergoing other therapies (p < 0.001). There were no significant differences regarding age, gender or dosage. The most common oral events observed in patients in the MTX group were ulcerative/erosive lesions (60.7%) and candidiasis (10.7%). Patients in the control group presented lower prevalence of the same lesions (p < 0.001). The RR for developing oral lesions was 11.73 (CI 2.57 - 58.98), with low-dose MTX therapy. In conclusion, the prevalence of oral mucosa lesions in RA patients receiving low doses of MTX therapy is higher than in RA patients not receiving the drug.     

Primary oral tuberculosis: a report of a case diagnosed by polymerase chain reaction

We present a case of primary oral tuberculosis, affecting the maxillary gingiva and causing alveolar bone loss in a 34-year-old Colombian female patient. Definitive diagnosis was facilitated by polymerase chain reaction analysis, a useful modern tool for the diagnosis of infectious diseases. The location and clinical presentation of this lesion is unusual and underlines the importance of considering tuberculosis in the differential diagnosis of oral lesions that affect the gingiva and alveolar bone.     

Primary pharyngeal tuberculosis presenting as a submucosal tumour

We describe a rare case of primary pharyngeal tuberculosis without pulmonary involvement in which the lesion was thought to be a submucosal tumour with overlying intact mucosa. A 58-year-old male attended the outpatient ward due to a globus sensation in the throat of 2-month duration. A swelling of the posterior oropharyngeal wall was found. The lesion was thought to be a submucosal tumour on computed tomography and magnetic resonance imaging. Primary pharyngeal tuberculosis was confirmed by histopathological examination and polymerase chain reaction (PCR) analysis. The patient underwent 26 weeks of treatment with anti-tuberculous agents. He has been followed up for 12 months without any signs of disease recurrence.     

老年人口腔颌面部结核11例临床分析

目的：探讨老年人口腔颌面部结核的临床特征，旨在对老年口腔颌面部结核患者的早期发现及早期治疗。方法：对11例老年口腔颌面部结核患者均行胸部X线摄片、病理检查、分析。结果：老年人口腔颌面部结核症状不明显，发病部位多在口腔黏膜，溃疡是其主要形式。72．7％（8／11）伴有肺结核，36．4％（4／11）误诊为肿瘤。11例全部转入结核病医院，经系统抗结核治疗，10例临床治愈，痰菌榆查阴性；随访1-2年无复发；1例临床症状明冠得到控制。结论：老年口腔颌而部结核临床表现不典型，应引起临床医生重视，对疑有口腔颌而部结核的老年患者应及时行活体组织病理检查。     

三氧化二砷抑制口腔鳞癌细胞增殖的研究

目的:体外试验研究三氧化二砷对口腔鳞癌的可能治疗作用。方法:以人舌鳞状细胞癌细胞系Tca8113细胞为研究对象之一,采用台盼蓝拒染法计数活细胞,观察三氧化二砷作用于Tca8113细胞的量效关系、时效关系。采用平皿法姬姆萨染色观察三氧化二砷对Tca8113细胞的克隆形成抑制作用。以舌鳞状细胞癌临床新鲜标本组织块为研究对象之二,消化后细胞悬液与各浓度三氧化二砷、一定浓度的MTX、5Fu、PYM体外培养后MTT法测定临床舌癌细胞生长抑制率。结果:三氧化二砷对Tca8113细胞、临床舌癌细胞均有显著生长抑制作用。1μmolAs2O3台盼蓝染色活细胞计数Tca8113细胞生长抑制率28.57%,克隆形成抑制率31.01%;3μmolAs2O3浓度Tca8113细胞生长抑制率58.36%,克隆形成抑制率76.63%;5μmolAs2O3浓度Tca8113细胞生长抑制率86.03%,克隆形成抑制率91.30%。体外药敏测定:1μmol浓度As2O3的临床舌癌细胞的生长抑制率39.5%,3μmol浓度As2O3为47.2%,5μmol浓度As2O3为89%,MTX为36.5%,5Fu为41.3%,PYM为58.16%。临床药敏标准一般大于30%为敏感,PYM大于50%为敏感。结论:体外试验表明三氧化二砷可显著抑制人舌鳞状细胞癌细胞系Tca8113细胞的生长,对临床癌细胞也表现了良好的抗增殖作用,三氧化二砷可能成为治疗口腔鳞癌的有效药物     

Tumor necrosis factor (TNF) inhibitor therapy for rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disorder characterized by inflammation involving large and small joints. Systemic manifestations as well as involvement of paraoral tissues contribute to morbidity. Tumor necrosis factor (TNF) plays a central role in RA by amplifying inflammation in multiple pathways that lead to joint destruction. Tumor necrosis factor inhibitors were first licensed for clinical use in 1998; 3 have been approved for the treatment of RA: Iinfliximab, etanercept, and adalimumab. The purpose of this paper is to review the pathogenesis of RA, the state of the art of therapy, and the most current information on the safety and efficacy of TNF inhibitors for treatment of RA.     

Tuberculous ulcer of the tongue: report of case.

In the case presented, the patient sought treatment for a painful ulcer on the right lateral border of the tongue. In the absence of any other significant finding, the clinical features of the lesion suggested malignancy. Histopathologic examination of a biopsy specimen was an important aid in the diagnosis of tuberculosis. Pulmonary lesions were subsequently detected and the patient was treated accordingly. The ulcer on the tongue was believed to be secondary to the pulmonary tuberculosis.     

Tuberculosis of the oral cavity: a systematic review

Kakisi OK, Kechagia AS, Kakisis IK, Rafailidis PI, Falagas ME. Tuberculosis of the oral cavity: a systematic review. Eur J Oral Sci 2010; 118: 103–109. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci The recent increase in the incidence of tuberculosis, combined with an emerging global resistance to antituberculous drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in persistent or atypical lesions in the oral cavity. We sought to review the published reports of mycobacterial infection of the oral cavity found in the literature in otherwise uncompromised patients, from 1950 to the present day, and analyzed the documented manifestations. M. tuberculosis infects all parts of the mouth (soft and hard palate, uvula, buccal mucosa, gingivae, lips, tongue, maxilla, and mandible) more often in men than in women, appearing predominantly in the form of ulcerative lesions. It was found as a secondary infection in 58% (54% pulmonary, 4% extrapulmonary) of patients and as a primary infection in 42% of patients. Carcinomas are found to co‐exist in the same lesion site in 3% of patients. In approximately 50% of patients, an oral manifestation of TB has led to the diagnosis of a previously unknown systemic infection, which resulted in a timely and effective treatment. The investigation for tuberculosis should therefore be actively pursued in the dental surgery. Diagnostic work‐up for systemic involvement and control of healthcare‐associated spread is important, while therapeutic options are still considered adequate.     

Oral tuberculosis: a clinical evaluation of 42 cases

OBJECTIVES: A retrospective review of a large series of oro-facial cases of tuberculosis to analyse clinical, histopathological, and radiological aspects, as well as those of chemotherapy. MATERIALS AND METHODS: A total of 42 cases of tuberculosis of the oro-facial region were examined. Thirteen patients had a primary form and 29 a secondary form of the disease. Diagnosis was based on careful clinical examination, Mantoux reaction, histopathological examination, microbiological cultures and immunological investigation with the detection of antibodies against Mycobacteria in the patients' serum (ELISA). RESULTS: Cases examined consisted of 27 males and 15 females. The age range was 3 to 73 years (mean age 31 years). Clinical manifestations comprised oral ulcers in 69.1%, bone involvement in 21.4%, and salivary gland and/or lymph node involvement in 14.3%. A total of 79.4% patients with secondary disease had pulmonary lesions, 15 of whom showed clinical and radiological signs of activity; there was one case of bilateral renal lesions and two of skin lesions. CONCLUSIONS: Oro-facial tuberculosis is often difficult to diagnose and it should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity. The most important diagnostic tools remain a careful clinical evaluation, biopsy for histologic study, as well as acid-fast stains, culture, and immunological assays, and skin testing.     

Primary tuberculosis: an unusual finding in the oral cavity

The unusual involvement of the oral cavity in tuberculosis and the non-specific nature of its presentations mean that diagnosis of tuberculosis is often delayed and is an unexpected finding. The aim of this paper is to present a case of primary tuberculosis and discuss the implications of the manifestations and diagnosis of oral tuberculosis. This paper presents an unusual case of a painless, papillary, erythematous lesion in the anterior region of a maxillary edentulous ridge. When the patient concerned was first seen by the author, the lesion had been present for six months. There was cervical lymphadenopathy and it was diagnosed initially as a malignant lesion. Eventually, after biopsy and ultrasound examination, the diagnosis of primary oral tuberculosis was reached. The patient was managed solely by anti-tubercular drug therapy.     

口腔颌面肿瘤活检标本对化疗药物敏感性的研究

目的 检测口腔颌面部癌肿活检标的体外化疗药物敏感性，明确临床常用各种化疗药物对口腔癌敏感性差别。方法 150例口腔癌化疗前活检新鲜组织标本行改变MTT药敏检测。检测用药是顺铂、5－氟尿嘧啶、平阳霉素、紫杉醇、替尼泊苷、表阿霉素、长春地辛和甲氨蝶呤8种常用化疗药物。结果 150例标本成功完成MTT药敏检测的有140例，检测成功率是93.33%。MTT药敏检测所用药物浓度是各药物峰血浆浓度的5倍。结果表明，8种药物对口腔癌细胞体外平均生长抑制率分别是：替尼泊苷63.76%、顺铂25.93%、表阿霉素25.86%、紫杉醇23.52%、平阳霉素22.97%、氟尿嘧啶22.08%、长春地辛18.42%、甲氨蝶呤18.93%；替尼泊苷对口腔颌面恶性肿瘤体外抗瘤效果显著高于其他7种化疗药物（P＜0.05)。＞40％的口腔鳞状细胞癌标本对替尼泊苷、顺铂、表阿霉素3种药物中度以上敏感；＞40％的腺源性口腔癌标本对替尼泊苷、紫杉醇和表阿霉互中度以上敏感。结论 大多数口腔颌面部癌肿对替尼泊苷敏感，顺铂、表阿霉素和紫杉醇敏感性也较高。替尼泊苷、表阿霉素和紫杉醇是口腔颌面部恶性肿瘤有潜力的化疗药物，其敏感性强于长春地辛、氟尿嘧啶和甲氨蝶呤。临床上应用改良MTT药敏检测法，筛选口腔颌面部癌肿化疗的有效药物是可行的。     

Tuberculosis of the tongue. A case report with immunologic study.

A case of tuberculosis of the tongue in a 59-year-old woman with active pulmonary tuberculosis is described. The lingual tuberculosis was considered to be a secondary infection from the pulmonary disease, but the oral lesions were, in fact, noticed prior to recognition of the pulmonary lesion. This case was marked by a multiplicity or oral lesions arising on the bilateral surfaces of the tongue. Immunologic investigation revealed that cell-mediated immune responses in the patient were within the normal range in terms of the PPD skin test, DNCB skin test, lymphocyte transformation test, and subpopulation of the peripheral blood lymphocytes. Rosette-forming assay on the frozen sections disclosed that T-lymphocytes and macrophages were predominant in the lymphoid cells infiltrating the tuberculous lesion.     

口腔颌面部结核误诊原因临床分析

目的：分析口腔颌面部结核的误诊原因。方法：对13例口腔结核病误诊病例的误诊原因进行分析。结果：口腔颌面部结核病发病部位、临床表现多样化，容易导致误诊。结论：口腔颌面部结核病确诊主要靠病理检查，复杂病例需多种方法综合分析，必要时应进行抗结核诊断性治疗。     

Human immunodeficiency virus-associated Kaposi sarcoma as an immune reconstitution inflammatory syndrome: a literature review and case report

BACKGROUND: Kaposi sarcoma (KS) is the most common human immunodeficiency virus (HIV)-associated neoplasm (HIV-KS). Highly active antiretroviral therapy (HAART) results in a decrease in the incidence and prevalence of HIV-KS as well as in clinical improvement. However, in a subset of subjects who are HIV seropositive, KS may recrudesce early following the introduction of HAART as an immune reconstitution inflammatory syndrome (IRIS). METHODS: The management of a patient who is HIV seropositive with rapid clinical worsening of oral KS lesions shortly after the initiation of HAART was documented. Repeated serologic testing for CD4(+) T-cell count and microscopic examination of two biopsy specimens of the oral lesion, one taken before and the other taken after cytotoxic chemotherapy, followed by surgical excision was the treatment modality used. RESULTS: Microscopic examination of the incisional biopsy specimen taken from the oral lesion at the time of the initial consultation confirmed the clinical diagnosis of KS. The sequential serological tests showed a progressive increase in CD4(+) T-cell counts that paralleled the rapid clinical worsening of the KS disease. This was consistent with the diagnosis of IRIS-associated HIV-KS. Subsequent cytotoxic chemotherapy brought about resolution of the IRIS and regression of the HIV-KS lesions. Microscopic examination of a biopsy specimen obtained after cytotoxic chemotherapy did not show any of the original KS. The residual palatal exophytic mass was excised. CONCLUSIONS: IRIS-associated HIV-KS is not a disease, but rather a temporary paradoxical immunoinflammatory reaction brought about by improvement in immune status following HAART. IRIS-associated HIV-KS can be controlled effectively by limited systemic cytotoxic chemotherapy in the setting of HAART.     

Oral manifestations of disseminated Cryptococcus neoformans in a patient with acquired immunodeficiency syndrome

A palatal lesion was the initial manifestation of disseminated cryptococcosis in a patient with acquired immunodeficiency syndrome (AIDS). The diagnosis was initially verified with cytologic smears in situ and later confirmed with pathologic findings from an excisional biopsy specimen. As cryptococcosis is one of the major opportunistic infections in persons with AIDS, an increased incidence of oral manifestations of cryptococcosis can be expected.     

Fluoride-releasing elastomeric ligatures assessed with the in situ caries model

The in situ caries model was used to assess the clinical benefit of fluoride-releasing elastomeric ligatures. The design of the experiment was a longitudinal, prospective, randomized, crossover clinical trial. Fourteen individuals starting orthodontic treatment with fixed appliances were recruited. Three in situ enamel specimens, with preformed subsurface carious lesions, were prepared for each patient, from human premolars. Two were placed in customized holders and one was retained as a control specimen. A crossover design was used so that patients had two experimental periods of six weeks with either fluoridated or non-fluoridated elastomerics, and a washout between. Elastomerics were randomly allocated at the first visit and one enamel specimen was placed at the beginning and collected at the end of each experimental period. The specimens were sectioned and ground to 100 microns, and transverse microradiography was carried out. They were analysed using dedicated computer software. The outcome measure was the change in the parameters of the pre-formed carious lesion, expressed as mineral loss (delta Z), lesion depth (ld), lesion width (lw), and ratio (delta Z/ld) between the three specimens. The mean mineral loss (vol %.micron) for the control specimen was 403.7 (+/- 139.5), compared with 599.3 (+/- 515.4) for the non-fluoridated ligatures and 477.2 (+/- 298.4) for the fluoridated ligatures. A one-factor within subjects ANOVA showed no statistical difference between the groups (P = 0.376). Fluoride-releasing ligatures do not provide a significant anti-cariogenic benefit in patients undergoing orthodontic treatment. This may be due to the short-term nature of the fluoride release. However, they might affect the local environment surrounding the bracket.     

Intralesional corticosteroid injection for treatment of central giant-cell granuloma

BACKGROUND: The central giant cell granuloma, or CGCG, is a benign intraosseous lesion of the jaw. It is found predominantly in children and young adults. It is an asymptomatic lesion, which often becomes evident on routine radiographic examination. Giant cell lesions have been described as both nonaggressive and aggressive in nature, with recurrence noted in cases of aggressive lesions. Central giant cell lesions present as unilocular or multilocular radiolucent defects on radiographs. Multinucleated giant cells within a collagenous stroma are the characteristic histopathologic feature of CGCG. CASE DESCRIPTION: The authors describe a 10-year-old girl with an expansile lesion of the mandible. The panoramic radiograph showed a well-circumscribed mixed radiolucent-radiopaque lesion of the left mandibular body. An incisional biopsy of the lesion was performed to establish a histologic diagnosis. The specimen was submitted for frozen-section examination, and a diagnosis of CGCG was made. Serum calcium, parathyroid hormone and phosphorous levels were normal. The patient was treated successfully with intralesional corticosteroid injections. CLINICAL IMPLICATIONS: Central giant cell lesions have been treated surgically with aggressive curettage. More aggressive and recurrent lesions require resection, which leads to major defects of the jaws. This form of surgical treatment can be particularly disfiguring for a child or young adult. An alternative nonsurgical approach is the intralesional administration of corticosteroids, which have been effective in the treatment of CGCG. If a dentist suspects a patient may have CGCG, he or she should refer the patient to an oral surgeon for follow-up.