hyperkeratosis

dyskeratosis

acanthosis

epithelial atrophy

Epithelial abnormality (dysplasia)

Vaculation and liquefaction of basal cell

acantholysis

Vesicle

erosion

ulcer

It refers to a white plaque that occurs on the surface of the oral mucosa and cannot be diagnosed clinically or pathologically as any other disease, and its risk of cancer is increased. It is the most common potential malignant lesions of oral mucosa

Causes: local long-term chronic stimulation, smoking; alcohol consumption, infection, malnutrition, sun exposure, etc.

Clinical manifestations: Location: Any part of the oral mucosa, the cheek and tongue mucosa are the most common. Gender: Male Type: Homogeneous type: Generally clear boundary, the entire lesion is uniform and flat, and the surface can be smooth, wrinkled, fine granular or pumice Heterogeneous type: irregular surface, wart-like, nodule-like, or mixed with erythema, ulcers, etc.

The main pathological changes are epithelial hyperplasia It can be divided into incomplete or normalized. A distinct particle layer can be seen during normalization. In addition to excessive keratosis, the histological manifestations of the leukoplakia epithelial can be simple or abnormal hyperplasia of the epithelial. The epithelial supergenesis is mainly spiny hyperplasia, and the epithelial nail process elongates and becomes thicker, but the epithelial cells from the basal layer to the keratinous layer are arranged neatly, and the cell morphology has not changed significantly. The incidence of abnormal hyperplasia in white spots is about 1% to 30%, which is manifested as atypical epithelial cells and the disorder of normal maturation and stratification of complex squamous epithelials. It usually starts from the basal layer and the subbasal layer and gradually affects the entire epicort layer upward. Different degrees of chronic inflammatory cell infiltration can be seen in the lamina propria. In rare cases, the spinous layer can manifest as atrophy. The surface of the wart-like white spots is papillary or finger-like protrusions, and the nail projection is wide and blunt.

Compared with normal clinically normal mucosa, the risk of white spots developing into squamous cell carcinoma is higher, which is a potential malignant lesion, accounting for about 60% to 70% of all potential malignant lesions of the oral mucosa.

It refers to those who appear bright red and velvet-like plaques in the oral mucosa and cannot be diagnosed as other diseases clinically and pathologically. Erythema is a high-risk potential malignant lesions, most of which are accompanied by abnormal epithelial hyperplasia, and some lesions have developed into cancer at the first biopsy.

Cause: The cause is unknown, which may be similar to the pathogenesis of oral squamous cell carcinoma, including smoking, alcoholism, unhealthy eating habits, etc.

Clinical manifestations: More common in middle-aged and elderly people over 50 years old. The onset of the disease is often the soft palate, the bottom of the mouth and the mucosa, and sometimes there are frequent lesions. The erythema has clear boundaries, flat or slightly sunken, bright red, soft and velvet-like. Generally, the scope is relatively limited and there are no obvious symptoms. Sometimes, red and white spots may appear mixed with red and white

Pathological changes: Epithelial atrophy is common, and the surface often has no keratosis or reduced keratosis due to abnormal cell maturation process. It also causes vascular hyperplasia and dilation due to inflammation of the lamina propria, so it appears as clinically red. Most erythema has abnormal epithelial hyperplasia, 40% are severe abnormal hyperplasia, and 50% have shown carcinoma in situ or invasive cancer.

Prognosis Erythema is a highly dangerous potential malignant lesion and must be diagnosed and treated as early as possible.

It is a chronic inflammatory disease that leads to gradual atrophy and fibrosis of the connective tissue of the oral mucosa, and eventually the tissue contracture becomes hard and the dynamic level decreases. The lesions are often related to betel nut chewing habits, which are chronic progressive and irreversible, and are also potentially malignant lesions.

Cause: This disease is highly related to betel nut chewing habits

Clinical manifestations: It is more common in young adults aged 20 to 40, and often involves bilateral buccal mucosa, soft palate and lip mucosa. Early mucosa blisters, redness and peeling, and burning sensation. The damaged area was then pale due to fibrosis and vascular reduction, and the surface was mottled and marble-like. Fibrosis starts from the bottom of the epithelium and progresses deeper, the tissue loses elasticity, and can touch the submucosal hard cord. At this time, the epithelium atrophy, becomes thin and smooth, and eventually the chewing muscle is involved, the mouth opening is restricted, which affects eating. In severe cases, it can affect the pharynx and upper esophagus.

Pathological changes: The main pathological manifestations are epithelial atrophy and subepithelial fibrosis. Subepithelial blisters and hyperkeratosis can be seen in early stages. The epithelium becomes thinner and atrophy in the late stage The collagen fiberglass-like changes in connective tissues, and the blood vessels and fibroblasts are significantly reduced, and the chronic inflammation cell infiltration is mild to moderate. The deep muscle tissue gradually atrophy and is replaced by dense fibers.

Prognosis: This disease is progressive and unreproducible. Even if you stop chewing coconut, the fibrotic lesions will be difficult to resolve. At the same time, there is a high risk of cancer. The cancer rate in different reports is about 4% to 13%, so regular review is required.

It is a rare hereditary abnormality, mainly affecting the oral mucosa, and white plaques with bilateral symmetrical distribution, generally do not require treatment.

Cause: Autosomal dominant genetic disease

Clinical manifestations: Often found in childhood and adolescence, no gender differences. Patients generally have no conscious symptoms. The most typical lesion sites are the bilateral buccal mucosa, the tongue abdomen, lip mucosa, the bottom of the mouth, the vestibule groove, the soft palate and other parts. Other mucosa diseases are relatively rare. Clinical examination shows that the oral mucosa is symmetrically distributed white patches, with wrinkled or velvet-like surfaces, and irregularly thickened; the texture is softer, like a sponge. The plaque has unclear boundaries and gradually merges with normal tissues. Unlike white edema, pulling the buccal mucosa increases tissue tension, and the white plaques still do not disappear.

Pathological changes: The anacyclyl strata increases, causing the epithelium to thicken significantly. The surface is excessively incomplete, and the spinous cells are generally edema and become transparent and clear, forming the so-called basket-like morphology. The most characteristic manifestation is that the eosinophilic cytoplasm is concentrated in the aprix cells and gathers around the nucleus. Under electron microscope, these substances are keratin filaments wrapped into clusters. There is no abnormal hyperplasia in the epithelium, and there is generally no obvious inflammation in the lamina propria.

Prognosis: The lesions can occur from infancy and to the peak of adolescence and will not develop in the future. The patient has no obvious symptoms and is a benign process and generally does not require treatment.

It is a change in the oral mucosa with mild whitening and decreased transparency, which mainly occurs in the buccal mucosa. It is often seen in the population and is generally considered to be a normal variant.

[Cause] The cause is unknown, and may be related to smoking, chewing tobacco, drinking, bacterial infections, electrochemical reactions, etc., but there is no definite evidence, and may also be related to genetics.

[Clinical manifestations] Most of them occur in the mucosa and can sometimes be seen on the lingual margin. The patient had no conscious symptoms. The examination showed that the buccal mucosa was diffuse grayish white or milky white, and was distributed symmetrically on both sides, and sometimes extended to the lip mucosa. When the mucosa is pulled, the opaque changes will become weak and disappear. When the performance is significant, the whitening area may also have texture changes, which are film-like or wrinkled and cannot be erased.

[Pathological changes] The epithelium becomes thicker, the surface is incomplete, the spinous layer is hyperplasia, and the nail process is elongated and widened. The edema in the cells of the spinous layer is obvious, the cells become larger, and the cytoplasm becomes transparent, and the small cell nucleus that is solidified and contracted are seen.

[Prognosis] White edema has no harm and will not be transformed into malignant lesions and does not require treatment.

It is a common chronic mucosal skin disease and is an inflammatory disease mediated by immune response. It often affects the skin, oral mucosa and genital mucosa. Oral lesions are common and can only be seen in the oral mucosa in some cases.

[Etiology] The cause of Liquid Flax is unknown, but it is generally believed that its inflammatory process is mediated by T lymphocytes, which is histologically similar to allergic reactions. It may be a group of lesions with different initiation factors and similar clinical and histological manifestations.

【Clinical manifestations】Liquid planus is relatively common, Age: Most patients are 30 to 60 years old. Gender: Women are more common, and the ratio of men to women is about 2:3. Location: Oral mucosal lesions are often bilaterally symmetrical, most commonly found in the buccal mucosa, especially the posterior part of the buccal mucosa; secondly, the tongue, mainly the lateral margin of the lingual; also occur in the lips and gums, and the palate is less affected. This disease is clinically diverse, and can change in white or red, and with different changes in mucosal texture, it can be roughly divided into reticular and erosive types. The reticular type is the most common, with interlaced white reticulum, which is more common in the bilateral buccal mucosa; when the reticulum is not obvious, it forms white patches, which are difficult to distinguish from white spots, and are common in the back of the tongue. Erosion is relatively rare, but patients often see the doctor for pain symptoms. Mucosal atrophy, red patches, erosion and ulcers, and white lines can be seen at the edges of the lesion. It affects the atrophy and erosion of the gums, and the gums are bright red and bright. Skin damage: Small purple-blue papules with flat tops and small white patterns visible.

[Pathological changes] The basic lesion process of lichen planus is that T lymphocytes gather at the junction of epithelial and connective tissue and trigger the destruction of basal cells. The most characteristic pathological changes are basal cell liquefaction degeneration and lymphocytes infiltrate in the lamina propria immediately adjacent to the epithelium. Observation under the microscope, it can be seen that the epithelial surface is excessively keratinized, which is more common; the spinous layer can proliferate or shrink or coexist with both, which is more common; the epithelial nail process can disappear or extend irregularly, and sometimes becomes serrated and serrated; the basal cell vacuole changes and liquefaction degeneration, the basal membrane and basal cell layers are blurred, and sometimes even form subepithelial blisters; scattered or clustered eosinophilic colloids can be seen at the junction of the basal layer and the propria, which are apoptotic basal cells; the dense lymphocyte infiltration zone of the propria are limited to the subepithelial layer and generally do not involve the submucosal layer; in addition, lymphocytes often wander between epithelial cells, and these cells are directly related to the destruction of basal cells. Direct immunofluorescence detection, 90% to 100% of lichen planus lesions may experience fibrinogen deposition in the basement membrane area, but there are fewer immunoglobulin and complement.

[Prognosis] Liver Planus is a chronic lesion that often persists once it occurs. Its range and severity fluctuate with time, but it is a benign lesion and can be in a state of asymptomatic and without treatment for a long time. There has been many controversy about whether oral lichen planus is a potential malignant lesion. Currently, most scholars believe that it has a slight risk of malignancy, with an annual malignancy rate of less than 0.2%. There is no definite supporting evidence yet.

Also known as chronic lupus erythematosus, it mainly affects the skin and oral mucosa. Patients may have joint pain, but internal organs will not be affected, and the prognosis is good.

【Cause】It is autoimmune disease, and humoral immunity and cellular immunity are involved.

[Clinical manifestations] It is mainly seen in middle-aged people, mostly women. Generally, there are no systemic symptoms, and the lesions are limited to the skin and oral mucosa. Skin damage: The most common areas are the face and scalp, which can aggravate after sunset. The typical lesions are round erythema, with dry and rough surfaces and more scales. Oral mucosa: It is rare for patients with oral cavity to occur alone. Common areas are the buccal mucosa, gums and lip redness. The lesions are similar to erosive lichen planus, forming white and red lesions with diverse manifestations. The white lesions are reticular stripes, but they are often scattered and asymmetrical. They can also be seen in the palatial fornix area that is generally not affected by lichen planus. The red lesions show irregular erythema with atrophy or superficial erosion, and white pinstrips with radially arranged slim stripes at the edges, which are characteristic manifestations of discoid lupus erythematosus. Gingival damage can manifest as exfoliating gingival lesions.

[Pathological changes] Excessive keratosis on the epithelial surface, excessive keratosis is common, and the granular layer is obvious, and keratin embolism can be seen. The atrophy and growth of the spinous layer alternately occur The basement layer is damaged and the basement membrane is not clear. Lymphocyte infiltration of lamina propria often affects submucosal layer There is obvious edema in the subepithelial connective tissue, and even subepithelial blisters are formed. Collagen fibers have edema, fracture, and degeneration, and sometimes have weak basophil- homogeneous shapes, which are called basophil-ic degeneration. Capillary dilation, irregular lumen

[Prognosis] The prognosis of discoid lupus erythematosus is much better than that of systemic lupus erythematosus. The lesions are chronic and are limited to the skin and mucous membranes. About 50% of patients can recover after several years and rarely progress to systemic lupus erythematosus. Disopaeal lupus erythematosus is considered to be a potential malignant lesion, and there are reports of epithelial malignant changes into squamous cell carcinoma in the lesion area, which often occurs in the lip and buccal mucosa.

It is a reactive proliferative lesion characterized by hyperplasia of lymphatic tissue in the mucosal lamina propria and the formation of lymphatic follicles. In nature, it should be potential malignant lesions of the oral mucosa. [Etiology] The cause is unclear, which may be the hyperplasia of reactive lymphoid tissue caused by some unknown antigen stimulation. Currently, immunopathological examinations do not support this disease and autoimmune. [Clinical manifestations] The onset age is more common between 21 and 40 years old, and there are slightly more men than women. It is commonly found in the mucosa of the lower lip, frequency, palate, tongue, etc. There are two main clinical manifestations. 1. Erosive lesions, gray or red or white in the erosion area, which occurs on the lower lip, are prone to rupture and bleeding and scabs, and wart-like growth may occur locally on the basis of erosion; 2. Papilloma-like proliferation, with a papillary, polyp or granular surface. Patients may experience spontaneous pain and local itching.

[Pathological changes] The main feature is that the lymphatic follicles appear in the lamina propria of the mucosa, and there are polychromic bodies in the cytoplasm of the germinal tissue cells. They are round bodies of varying numbers and sizes, and HE staining is bichromophilic. Eosinophilic mass can still be seen in the center of the follicle. Diffuse infiltration of inflammatory cells of varying degrees in the tissues around the lymphatic follicles, mainly lymphocytes, plasma cells and eosinophils can also be seen. In addition, there are inflammatory changes in collagen fibers and blood vessels. The lesional epithelium can show a variety of changes, such as hyperplasia, rhombus contraction, erosion, and ulcers, and sometimes mixed. Some cases may experience abnormal epithelial hyperplasia and even cancer.

[Prognosis] According to case studies, some scholars found that this disease was accompanied by abnormal epithelial hyperplasia and 10% of them were found to be cancerous. Therefore, it should be regarded as a potential malignant lesion.

It is a common opportunistic oral infection, mainly caused by Candida albicans infection, and its clinical manifestations are diverse.

[Cause] Candida albicans is a permanent oral bacteria, and its pathogenicity is weak. It will only cause disease when susceptibility factors are present throughout the body or locally. Candida infection is generally superficial and affects the oral mucosa or skin surface. It can only spread to the esophagus, bronchus, lungs or other organs when the body's immune function is extremely low, forming disseminated and fatal candidiasis.

[Clinical manifestations] Oral candidiasis has various clinical manifestations, which can be divided into acute and chronic according to the course of the disease, and can be divided into pseudomembrane type, erythema type (ripple-condensation type) and hyperplasia type according to the disease manifestations. 1. Acute pseudomembranous candidiasis, also known as thrush, is commonly found in the buccal mucosa, palate and the back of the tongue. Soft and fragile white curd-like patches on the surface of the mucosa, which can be wiped off with gauze, leaving behind congestive, erosive and painful base. 2. Acute erythematosus candidiasis can occur due to pseudo-membrane detachment, or it can begin as erythematosus. It is common in the back of the tongue, palate, etc. Sometimes the entire mouth is diffusely congested and red, local erosion, and obvious burning pain. 3. Chronic erythematosus candidiasis often occurs on the mucosal surface below the maxillary general denture, which is velvet-shaped or hyperplasia-shaped like pebbles. 4. Chronic hyperplastic candidiasis, also known as candidal leuko-plaka, candidal leuko-plaka, white plaques can be seen on the surface of the congested mucosa, similar to ordinary white plaques, often heterogeneous, with rough surfaces, papillary, nodules or granular. Sometimes there is a mixed lesion between red and white. 5. Candida angular stomatitis is manifested in congestion and erosion of the skin and mucosa in the corner of the mouth, accompanied by pain, and chapped, scabs and desquamation can be seen on the side of the skin. 6. Median rhomboid glossitis is manifested as a chronic red lesion in the middle and posterior part of the tongue. It was once considered a defect in the combination of glossy protrusion and odd nodules during tongue development. It is currently believed that it is caused by Candida infection. Candida hyphae can be found in about 85% of biopsy specimens in the lesion area.

[Pathological changes] Epithelial growth and edema in the lesion area, and inflammatory cells are infiltrated between epithelial cells, mainly neutrophils, especially at the junction of the keratinous layer and the spinous layer, obvious inflammatory infiltration and exudation are seen. Neutrophils can form microabscesses. The lamina propria is mainly lymphocyte and plasma cell infiltration.

[Prognosis] Since epithelial abnormality can be seen in some cases, it is considered to be a potential malignant lesion. The relationship between Candida infection and abnormal epithelial hyperplasia is not clear. Some people believe that white spots are secondary to infections, while others believe that Candida can produce nitrosamines, causing epithelial hyperplasia and abnormal hyperplasia.