Case Study: Diagnosis of Epithelial Dysplasia in the Oral Mucosa
A 45-year-old male patient presented with a persistent white lesion on the lateral border of his tongue. The lesion had been present for about six months and had not responded to initial treatments, including antifungal therapy. The patient reported occasional pain and a burning sensation in the area.
Clinical Examination
During the clinical examination, a
biopsy of the lesion was taken and sent for histopathological examination. The lesion appeared as a slightly raised, irregular white patch, measuring approximately 1.5 cm in diameter. There were no signs of ulceration or bleeding.
Histological Findings
The histological examination revealed several key features indicative of
epithelial dysplasia. The following characteristics were observed:
Nuclear pleomorphism: The nuclei of the epithelial cells varied in size and shape, indicating abnormal cellular activity.
Increased mitotic activity: There was a higher than normal number of mitotic figures, suggesting rapid cell division.
Loss of polarity: The normal orientation of cells was disrupted, with cells appearing disorganized.
Basal cell hyperplasia: An increase in the number of basal cells was noted, contributing to the thickened appearance of the epithelium.
Keratin pearls: Small, round structures composed of keratin were observed within the lesion, indicative of abnormal keratinization.
Questions and Answers
What is the significance of nuclear pleomorphism in epithelial dysplasia?
Nuclear pleomorphism refers to the variability in the size and shape of the nuclei of cells. In the context of epithelial dysplasia, it indicates abnormal cellular activity and is a marker of dysplastic changes that could potentially progress to malignancy.
Why is increased mitotic activity concerning in this case?
Increased mitotic activity suggests that the cells are dividing more rapidly than usual, which is a hallmark of dysplastic or pre-cancerous conditions. This rapid division can lead to the accumulation of genetic mutations, increasing the risk of progression to
oral cancer.
What does the loss of polarity indicate about the epithelial cells?
The loss of polarity means that the cells are no longer oriented in their normal organized manner. This disorganization is a characteristic feature of dysplasia and reflects the loss of normal cellular function and structure.
How does basal cell hyperplasia contribute to the appearance of the lesion?
Basal cell hyperplasia is the increased proliferation of basal cells, which leads to a thickening of the epithelium. This thickening gives the lesion its raised appearance and may contribute to the persistence of the lesion.
What are keratin pearls and what do they signify?
Keratin pearls are small, round structures composed of concentric layers of keratin. Their presence in the lesion indicates abnormal keratinization, which is often seen in dysplastic and neoplastic lesions. They are a marker of abnormal differentiation within the epithelial cells.
Conclusion
The histological features observed in the biopsy confirmed the diagnosis of epithelial dysplasia. Given the potential for dysplastic lesions to progress to malignancy, the patient was referred to an oral surgeon for further evaluation and management, which may include surgical excision and regular follow-up to monitor for any signs of progression.
