Ph.D. Gruzdeva A.
State Establishment "Dnepropetrovsk Medical Academy
Ministry
of Health of Ukraine"
PERSPÅCTIVES AND POSSIBILITIES OF USE OF EXFOLIATIVE CYTOLOGY IN THE DIAGNOSIS
OF LEUKOPLAKIA
OF
THE ORAL MUCOSA
Leukoplakia is the mouth's reaction to
chronic irritation of the mucous membranes of the mouth.
Violation of
maturation of the epithelium of
the oral mucosa is the leading
element of pathogenesis of leukoplakia. Exfoliative cytology is
a noninvasive procedure, which helped in identifying the cellular changes. The
study revealed a subclinical phase of OHL, where the cellular changes were seen
even before the appearance of the clinical lesion [2]
The degree of maturity of the epithelium
(maturation index) is determined by the balance of epithelial cells. In the
epithelium of the mucous membranes of the mouth are allocated: basal,
parabasal, intermediate and superficial cells, and in the stratum areas - horny
scales.
The basal cells can be in the smear with deep inflammation
of the epithelium by its injury. The presence of parabasal cells shows sharply
expressed atrophy. A sign of maturation of the epithelium is the predominance
of intermediate cells in the smear. In not cornified sites of the oral mucosa
to the maximum level of maturation of the epithelium corresponds the appearance
of the surface cells, and in the cornified - horny scales.
Maturation index (the
ratio of parabasal / intermediate / surface /
horny scales) assess the degree of differentiation of epithelial maturation completeness. As a normal for the
not cornified epithelium is considered to be ratio 0 / 96 / 2,5 / 1,5; for
cornified epithelium – 0 / 60 / 8 / 32 [6]. Oral exfoliative cytology
has 100% specificity [3].
Although it is considered a potentially malignant disorder
the overall malignant progression of oral leukoplakia is of the order of 5% and
even more. Nowadays there are no currently accepted markers to distinguish
those that may progress to cancer from those that may not [5].
Routine
exfoliative cytology may be a reliable, noninvasive, and inexpensive technique
for the diagnosis of hairy leukoplakia [1]. Oral
exfoliative cytology has 100% specificity [3].
The
aim of our study was to determine the degree of
maturity of the epithelium of the oral mucosa in different forms of
leukoplakia.
Materials and methods. We conducted a clinical and
laboratory study of 58 patients with leukoplakia of the oral mucosa. In our
study we used the classification of the oral mucosa by Danilevsky N. F.,
Urbanowich L. I., 1979. The flat form of
leukoplakia was diagnosed in 34 patients (58.62%), rising leukoplakia -
in 16 (27.58%), verrucous leukoplakia - in 5 (8.26%) and erosive form - in 3
(5.17%) .
For the manufacture of the cytological preparations the
fence of the lesion was performed in several ways: direct imprint, impression
smears or scraping. Preparations were fixed in a mixture of Nikiforov. Coloring was performed
by Papanikolau. In smears we had examined the ratio of epithelial cells.
Results and its discussion. In patients with flat form of
leukoplakia among the epithelial cells in the smear prevailed horny
scales (51,5%) and superficial cells (31%). The content of intermediate cells
was reduced to 17.5%. All this can be interpreted as a violation of the
maturation of the epithelium, as hyperkeratosis and chronic inflammation.
In patients with rising leukoplakia the
breach of epithelial differentiation was aggravated: the
ratio of parabasal / intermediate / surface /
horny scales was 0/25/29/46.
The analysis
of the results of cytological research of patients with warty leukoplakia
revealed a severely impaired maturation of the epithelium – so named “left
shift”. In this case, in a smear appeared basal (3%) and parabasal (10,5%)
cells, were observed phenomena of dyskaryosis, that is reflecting the
increasing damaging effect on the oral mucosa.
The results of cytological research in patients with erosive
form of leukoplakia are typical for a significant injury of the epithelium and
for the defeat of it with a deep inflammation. In compare with warty form of
leukoplakia in smears were found the increasing of basal (4%) and parabasal cells
(15,5%).
So, the degree of maturity of the epithelium decreases with
worsening of the forms of leukoplakia. Determining of the degree of
differentiation of epithelium of the oral mucosa with the use of exfoliative
cytology method is the auxiliary diagnostic test for the diagnosis of
"leukoplakia" and can be used in combination with other methods of
research. The method of exfoliative cytology is characterized by simplicity,
security, rapidity of obtaining of results and plays an important role in the
diagnosis of different forms of leukoplakia.
REFERENCES
1.
Migliorati CA, Jones AC, Baughman PA. Use of exfoliative cytology in the
diagnosis of oral hairy leukoplakia
. J
Oral Surg Oral Med Oral Pathol.1993 Dec;76(6):704-10
5.
Parlatescu
I, Gheorghe C, Coculescu E, et al. Oral leukoplakia - an update. [Journal Article]. Maedica (Buchar) 2014 Mar; 9(1):88-93.
6. Áûêîâ Â.Ë. Ãèñòîëîãèÿ è ýìáðèîëîãèÿ îðãàíîâ ïîëîñòè ðòà ÷åëîâåêà. –
Ñ.Ïåòåðáóðã, “Ñïåöèàëüíàÿ ëèòåðàòóðà”, 1996. – 247 ñ.