Ege Üniversitesi yüz ve ağız içi lezyonları (EGEYA) konseyinde oral lökoplaki tanısı alan hastaların demografik özellikleri, oral lökoplakilerin klinik ile histopatolojik özellikleri ve birbirleri ile ilişkileri: Retrospektif çalışma
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Tarih
2017
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Oral lökoplaki (OL), "klinik ve histopatolojik olarak diğer tanımlanabilir beyaz hastalık ve rahatsızlıklar dışlandıktan sonra tanı konulabilen kuşkulu davranışa sahip ağırlıklı olarak beyaz lezyon ya da plak" şeklinde tanımlanmaktadır. Oral mukozada en sık karşılaşılan prekanseröz lezyondur. Prevalansı %1,7-2,7 oranlarında bildirilen OL, tütün alışkanlığının getirdiği bir sonuç olarak 40 yaş üzerinde ve erkeklerde daha sık görülmektedir. Etyolojisi multifaktöryeldir. Etyolojide en sık sorumlu tutulan faktör tütün kullanımıdır. Diğer risk faktörleri arasında alkol, Human Papilloma Virüs (HPV), dental restorasyon, mekanik irrtitasyon, Candidiazis, serum A vitamini ve beta karoten düzeylerindeki düşüklük yer almaktadır. Ağız içinde herhangi bir lokalizasyonda yerleşebilmekle beraber en sık karşılaşılan lokalizasyon bukkal mukozadır. OL lezyonlarının yüzey özelliklerine göre başlıca 2 klinik tipi mevcuttur: Homojen ve nonhomojen OL. Homojen lökoplakinin de 2 ana tipi mevcuttur: İnce, düz ve kalın, fissürlü lökoplaki. Nonhomojen OL ise klinik görünümlerine göre eritrolökoplaki, verrüköz ve nodüler olarak gruplandırılmaktadır. Agresif kliniği, multifokal yerleşimi, tedaviye dirençli oluşu, yüksek oranda rekürrens ve malign transformasyon göstermesi ile ayrı bir öneme sahip olan proliferatif verrüköz OL ise verrüköz OL'nin alt tipidir. Klinik olarak OL düşünülen tüm lezyonların histopatolojik örneklemesi yapılmalıdır. OL histopatolojik görünümü displazinin eşlik etmediği skuamöz hiperplaziden şiddetli displaziye dek değişmektedir. Displazi varlığı malign transformasyon açısından en önemli risk faktörü olarak kabul edilmektedir. OL'lerde malign transformasyon %0,13-17,5 oranlarında bildirilmektedir. OL klinik tipi, yerleşim yeri, histopatolojik özellikler gibi faktörlere göre tedavi verilmeksizin yakın takip ile izlenebilir ya da medikal ve cerrahi yöntemlerle tedavi edilebilir. Cerrahi tedavi seçenekleri konvansiyonel cerrahi eksizyon, lazer cerrahi (eksizyon ya da evaporasyon), elektrokoagülasyon ya da kriyoterapidir. Medikal tedavi seçenekleri arasında ise A, C ve E vitaminleri, sistemik Ý karoten, likopen, retinoidler, ketorolak, lokal bleomisin ve fotodinamik tedavi sayılabilir. Çalışmamızda 2007-2015 yılları arasında EGEYA konseyinde değerlendirilip klinik ve histopatolojik olarak oral lökoplaki tanısı alan hastalar hasta bilgi formları ve konsey fotoğraf arşivi üzerinden retrospektif olarak tarandı. Tespit edilen 79 OL hastasının epidemiyolojik, klinik, histopatolojik özellikleri ve bu hastalara uygulanan tedavi yöntemleri değerlendirildi. Çalışmamıza katılan hastaların 40'ı erkek (%50,6), 39'u (%49,4) kadın olup ortalama yaşları 58,73(±17,952)'idi. Çalışmaya alınan hastaların %57'si (n=45) sigara kullanmaktaydı. Sigara kullanım miktarı ortalama 28,44 ± 34,625 paket/yılıydı. Tütün çiğneme alışkanlığı hastaların %3,8'inde (n=3) mevcuttu. Kronik alkol kullanımı hastaların %27,8'inde (n=22) mevcuttu. Oral hijyenin hastaların %68,4'ünde (n=54) kötü olduğu tespit edildi. Amalgam dolgu hastaların %35,4'ünde (n=28) mevcuttu. Hastaların %27,9 (n=22) mikolojik inceleme yapıldı ve %19 (n=15) Candida albicans üremesi saptandı. Çalışmamızda OL lezyonları en sık (%31,6) bukkal mukozada yerleşmekteydi. İkinci sıklıkta dilde (%29,1) sonra sıra ile gingivada (%11,4), sert damakta (%7,6), yumuşak damakta (%6,3), ağız tabanında (%6,3) ve labial mukozada (%2,5) mevcuttu. Çalışmaya katılan hastaların %49,4'ünde (n=39) homojen OL görürken, %50,6'sında (n=40) nonhomojen OL görülmekteydi. Homojen OL'nin %35,4'ü (n=28) kalın fissürlü OL iken %13,9'u (n=11) ince düz OL'idi. Nonhomojen OL hastalarının %22,8'i (n=18) granüler nodüler, %11,4'ü (n=9) verrüköz, %10,1'i (n=8) eritrolökoplaki, %6,3'ü (n=5) proliferatif verrüköz OL tipindeydi. Lezyonlardan alınan biyopsi örneklerinin histopatolojik incelenmesi sonucunda %46,8'inde (n=37) skuamöz hiperplazi (SH) ve hiperkeratoz, %15,2'sinde (n=12) skuamöz intraepitelial neoplazi 1 (SIN1), %21,5'inde (n=17) SIN2, %15,2'sinde (n=12) SIN3, %3,9'unda (n=3) skuamöz hiperplazi+SIN1, %1,3'ünde (n=1) ise SIN2+SIN3 olarak tespit edildi. Bu sonuçlarla hastaların %48,1'ine (n=38) konvansiyonel cerrahi tedavi, %13,9'una (n=11) medikal tedavi, %8,9'una (n=7) kriyoterapi uygulandı. Ek olarak hastaların %6,3'ünde (n=5) sigara bıraktırıldı; %6,3'üne (n=5) amalgam değişimi yapıldı; %3,8'inde (n=3) oral hijyen sağlandı; %3,8'ine (n=3) tedavi verilmeksizin yakın izlem yapıldı; %2,6'sına (n=2) sigara bırakma ve oral hijyenin sağlanması, %2,6'sına (n=2) sigara bırakma ve medikal tedavi, %1,3'üne (n=1) sigara bırakma ve kriyoterapi, %1,3'üne (n=1) sigara bırakma, amalgam değişimi ve oral hijyen sağlandı; %1,3'ünde (n=1) amalgam değiştirildi, oral hijyen sağlandı ve beraberinde medikal tedavi uygulandı. Hastaların %7,8'inde (n=6) alan kanserizasyonu tespit edildi. Alan kanserizasyonu tespit edilen hastaların %5,2'sinde (n=4) dil karsinomu, %1,3'ünde (n=1) akciğer karsinomu, %1,3'ünde (n=1) ise tonsilde karsioma in situ, hipofarinks ve epiglottiste SHK, larinkste ise karsinoma in situ tanısı mevcuttu. Lezyon klinik tipleri ile etyolojik faktörler, histopatolojik sonuç ve uygulanan tedaviler ilişkilendirildiğinde klinik tipler arasında anlamlı farklılık bulunmadı. Bu durum hasta sayısının az ve değerlendirilen parametrelerin çok olması nedeniyle oranların düşmesi ile ilişkilendirildi.
Oral leukoplakia (OL) is defined as “After ruling out other white diseases and disorders as clinically and histopathologically, a predominantly white lesion or plaque which has questionable behavior with a diagnosis can be made”. It is the most common precancerous lesion which is encountered in the oral mucosa. The OL, which is reported prevalence rates are 1,7-2,7%, is more commonly seen in men and in over the age of 40 as a result of the habit of smoking. Its etiology is multifactorial. Smoking is the most frequently held responsible factor in etiology. Other risk factors are located as alcohol, human papilloma virus (HPV), dental restoration, mechanical irritation, Candidiasis, serum vitamin A and the significant decrease in the levels of beta carotene. While it can settle any localization in the mouth, the most frequent localization is the buccal mucosa. According to the surface characteristics of the lesions OL, there are two main clinical types: Homogeneous and Nonhomojen OL. There are two main types of homogeneous lokoplak: Thin, straight and thick, fissured leukoplakia. Nonhomojen OL is grouped as erythroplakia, verrucous and nodular according to their clinical appearance. Proliferative verrucous OL, which is sub-type of verrucous OL, has a separate significance with presenting clinic aggressive, multifocal placement, treatment-resistant, high recurrence rate and malignant transformation. All lesions, which is thought clinically as OL, histopathological sampling should be done. OL histopathological appearance, which is not accompanied by dysplasia, changes from squamous hyperplasia till severe dysplasia. The presence of dysplasia, is accepted as the most important risk factor in terms of malignant transformation. The malignant transformation in OL is reported at the rate of 0,13-17,5%. OL can be monitored without giving treatment according to factors such as clinical type, location, histopathological features or can be treated with medical and surgical methods. Surgical treatment options are conventional surgical excision, laser surgery (excision or evaporation), electrocoagulation or cryotherapy. Medical treatment options regard A, C and E vitamins, systemic β-carotene, lycopene, retinoids, ketorolac, local bleomycin, and photodynamic therapy. In our study, the patients, who are the diagnosed with oral leukoplakia as clinically and histopathologically, were evaluated retrospectively through the patient information forms and the Council photo archives between the years 2007-2015 in EGEYA Council. Epidemiological, clinical, histopathological features and applied treatment methods of this disease were evaluated in detected 79 OL patients. The patients who participated in our study, 40% were male (50,6%), 39% were female (49,4%) and their average age was 58,73(±17,952). 57% (n=45) of the patients, who were taken to the study, were smoking. The amount of average cigarette usage was 28,44 ± 34,625 package/year. The habit of chewing tobacco existed in 3,8% (n=3) of the patients. Chronic alcohol usage existed in 27,8% (n=22) of the patients. The oral hygiene was found to be bad in 68,4% (n=54) of the patients. Amalgam fillings existed %35,4 (n=28) of the patients. Mycological examination was made 27,9% (n=22) of the patients and 19% (n=15) overgrowth of Candida albicans revealed. In our study, OL lesions were most frequently (31,6%) located on the buccal mucosa. Secondly it located to the tounge mostly (29,1%), then, with the addition it occured in gingival (11,4%), hard palate (%7,6), soft palate (6,3%), floor of the mouth (6,3%) and labial mucosa (2,5%). While Homogeneous OL was seen in 49,4% (n=39) of the patients, Nonhomojen OL was seen in 50,6% (n=40) of the patients. While 35,4% (n=28) of Homogeneous OL was thick fissured OL , 13,9% (n=11) percent was thinn and flat OL. Nonhomojen OL patients were the type of 22,8% (n=18) granular nodular, 11,4% (n=9) verrucous, 10,1% (n=8) erythroplakia, 6,3% (n=5) proliferative verrucous. As a result of histopathological examination of biopsy specimens which are taken from the lesions, 46,8% (n=37) squamous hyperplasia (SH) and hyperkeratosis, 15,2% (n=12) squamous intraepithelial neoplasia 1 (SIN1), %21,5% (n=17) SIN2, 15,2% (n=12) SIN3, 3,9% (n=3) squamous hyperplasia + SIN1, and as the result of SIN2 + SIN3 1,3% (n=1) were identified. With these results, 48,1% (n=38) of the patients underwent conventional surgical treatment, 13,9% (n=11) medical treatment and 8,9% (n=7) cryotherapy. In addition, 6,3% (n=5) of the patients were quitted smoking, 6,3% (n=5) amalgam change was made, 3,8% (n=3) oral hygiene was maintained, 3,8% (n=3) was followed up closely without giving treatment, 2,6% (n=2) was quitted smoking and provided oral hygiene, 2,6% (N=2) medical treatment and smoking cessation, 1,3% (n=1) cryotherapy and smoking cessation, 1,3% (n=1) was provided smoking cessation, oral hygiene and amalgam replacement, 1,3% (n=1) amalgam was changed, was maintained and attendantly underwent medical treatment. The area cancerization is detected 7,8% (n=6) of the patients. The patients who is detected with the area cancerization were diagnosed with 5,2% (n=4) carcinoma of the tongue, 1,3% (n=1) lung carcinoma, 1,3% (n=1) carcinoma in situ of tonsil, hypopharynx and SHK in epiglotit, carcinoma in situ of the larynx. There was no significant difference between the clinical types of lesions and the etiologic factors, histopathologic results and treatments applied. This statement is associated with the small number of patients and having a lot of parameter are caused to the reduction of the rate.
Oral leukoplakia (OL) is defined as “After ruling out other white diseases and disorders as clinically and histopathologically, a predominantly white lesion or plaque which has questionable behavior with a diagnosis can be made”. It is the most common precancerous lesion which is encountered in the oral mucosa. The OL, which is reported prevalence rates are 1,7-2,7%, is more commonly seen in men and in over the age of 40 as a result of the habit of smoking. Its etiology is multifactorial. Smoking is the most frequently held responsible factor in etiology. Other risk factors are located as alcohol, human papilloma virus (HPV), dental restoration, mechanical irritation, Candidiasis, serum vitamin A and the significant decrease in the levels of beta carotene. While it can settle any localization in the mouth, the most frequent localization is the buccal mucosa. According to the surface characteristics of the lesions OL, there are two main clinical types: Homogeneous and Nonhomojen OL. There are two main types of homogeneous lokoplak: Thin, straight and thick, fissured leukoplakia. Nonhomojen OL is grouped as erythroplakia, verrucous and nodular according to their clinical appearance. Proliferative verrucous OL, which is sub-type of verrucous OL, has a separate significance with presenting clinic aggressive, multifocal placement, treatment-resistant, high recurrence rate and malignant transformation. All lesions, which is thought clinically as OL, histopathological sampling should be done. OL histopathological appearance, which is not accompanied by dysplasia, changes from squamous hyperplasia till severe dysplasia. The presence of dysplasia, is accepted as the most important risk factor in terms of malignant transformation. The malignant transformation in OL is reported at the rate of 0,13-17,5%. OL can be monitored without giving treatment according to factors such as clinical type, location, histopathological features or can be treated with medical and surgical methods. Surgical treatment options are conventional surgical excision, laser surgery (excision or evaporation), electrocoagulation or cryotherapy. Medical treatment options regard A, C and E vitamins, systemic β-carotene, lycopene, retinoids, ketorolac, local bleomycin, and photodynamic therapy. In our study, the patients, who are the diagnosed with oral leukoplakia as clinically and histopathologically, were evaluated retrospectively through the patient information forms and the Council photo archives between the years 2007-2015 in EGEYA Council. Epidemiological, clinical, histopathological features and applied treatment methods of this disease were evaluated in detected 79 OL patients. The patients who participated in our study, 40% were male (50,6%), 39% were female (49,4%) and their average age was 58,73(±17,952). 57% (n=45) of the patients, who were taken to the study, were smoking. The amount of average cigarette usage was 28,44 ± 34,625 package/year. The habit of chewing tobacco existed in 3,8% (n=3) of the patients. Chronic alcohol usage existed in 27,8% (n=22) of the patients. The oral hygiene was found to be bad in 68,4% (n=54) of the patients. Amalgam fillings existed %35,4 (n=28) of the patients. Mycological examination was made 27,9% (n=22) of the patients and 19% (n=15) overgrowth of Candida albicans revealed. In our study, OL lesions were most frequently (31,6%) located on the buccal mucosa. Secondly it located to the tounge mostly (29,1%), then, with the addition it occured in gingival (11,4%), hard palate (%7,6), soft palate (6,3%), floor of the mouth (6,3%) and labial mucosa (2,5%). While Homogeneous OL was seen in 49,4% (n=39) of the patients, Nonhomojen OL was seen in 50,6% (n=40) of the patients. While 35,4% (n=28) of Homogeneous OL was thick fissured OL , 13,9% (n=11) percent was thinn and flat OL. Nonhomojen OL patients were the type of 22,8% (n=18) granular nodular, 11,4% (n=9) verrucous, 10,1% (n=8) erythroplakia, 6,3% (n=5) proliferative verrucous. As a result of histopathological examination of biopsy specimens which are taken from the lesions, 46,8% (n=37) squamous hyperplasia (SH) and hyperkeratosis, 15,2% (n=12) squamous intraepithelial neoplasia 1 (SIN1), %21,5% (n=17) SIN2, 15,2% (n=12) SIN3, 3,9% (n=3) squamous hyperplasia + SIN1, and as the result of SIN2 + SIN3 1,3% (n=1) were identified. With these results, 48,1% (n=38) of the patients underwent conventional surgical treatment, 13,9% (n=11) medical treatment and 8,9% (n=7) cryotherapy. In addition, 6,3% (n=5) of the patients were quitted smoking, 6,3% (n=5) amalgam change was made, 3,8% (n=3) oral hygiene was maintained, 3,8% (n=3) was followed up closely without giving treatment, 2,6% (n=2) was quitted smoking and provided oral hygiene, 2,6% (N=2) medical treatment and smoking cessation, 1,3% (n=1) cryotherapy and smoking cessation, 1,3% (n=1) was provided smoking cessation, oral hygiene and amalgam replacement, 1,3% (n=1) amalgam was changed, was maintained and attendantly underwent medical treatment. The area cancerization is detected 7,8% (n=6) of the patients. The patients who is detected with the area cancerization were diagnosed with 5,2% (n=4) carcinoma of the tongue, 1,3% (n=1) lung carcinoma, 1,3% (n=1) carcinoma in situ of tonsil, hypopharynx and SHK in epiglotit, carcinoma in situ of the larynx. There was no significant difference between the clinical types of lesions and the etiologic factors, histopathologic results and treatments applied. This statement is associated with the small number of patients and having a lot of parameter are caused to the reduction of the rate.
Açıklama
Anahtar Kelimeler
Oral Lökoplaki, Epidemiyoloji, Histopatoloji, Tedavi, Alan Kanserizasyonu, Oral Leukoplakia, Epidemiology, Histopathology, Treatment, Area Cancerization
