INFLAMMATORY DISEASES PART I. Immunopathology Part I

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Randell Melton
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1 INFLAMMATORY DISEASES PART I Immunopathology Part I

2 Nonspecific & T Cell Mediated

3 Mucosal Inflammatory Lesions Nonspecific and Idiopathic Mucositis Hypersensitivity and Autoimmune T cell mediated Immunoglobulin mediated (autoantibodies)

4 NonSpecific Mucositis Pizza burn Wintergreen mints aspirin

5 Benign Migratory Glossitis Geographic Tongue All ages can be affected Clinical features: red circinate lesions with a white border that evolve, resolve and evolve yet again in another location. May be asymptomatic or mild burning may occur Etiology:? Histopathology: Neutrophilic infiltration of the parakeratin layer, mononuclear infiltration in the submucosa Erythema migrans is the equivalent condition that occurs on extraglossal mucosa, usually buccal mucosa and lips Tx: None

6 Benign Migratory Glossitis

7 Erythema Migrans

8 Foreign Body Gingivitis

9 Uremic Stomatitis Salivary ph Acidosis

10 T Cell Mediated Inflammatory Diseases

11 LICHEN PLANUS

12 Cutaneous Lichen Planus

13 Lichen Planus Midlife Females>Males Reticular, Atrophic/Erosive, Hypertrophic 0.5% Prevalence T cell Mediated Process Idiopathic Metal allergy Food allergy (Cinnamon) DIF - Basement membrane fibrinogen

14 OLP and Hepatitis C Virus Italian and Japanese patients (Gandolfo et al, JOPM 1994;23:119, Nagao et al, Eur J Clin Invest 1996;26:495) HCV is more prevalent in Southern Europe and Japan (van der Poel 1994) No association in Northern Europe/USA (Dupin et al, Ann Derm 1997;133:1052, Ingafou et al Int J Oral Maxillofac Surg 1998;27:65)

15 Reticular Lichen Planus Stria of Wickham

16 Lichen Planus Reticular Hypertrophic (Plaque form) Erosive

17 Erosive Lichen Planus Histopathology Sub-basal fibrinogen, DIF

18 Erosive Lichen Planus

19 Erosive Lichen Planus

20 Lichenoid Lesions Chronic Interface Mucositis T cell delayed, contact type IV allergy Chronic Ulcerative Stomatitis with antiepithelial nuclear antibodies Systemic drugs Au salts, antimalarials, antihypertensives Contact dental materials Hg, Ni, Acrylic Foodstuff antigens cinnamon

21 Patch Testing for Contact Lichenoid Lesions Positive reaction to zinc

22 Chronic Ulcerative Stomatitis with Antiepithelial Nuclear Antibodies Lichenoid (erosive, ulcerative) lesions clinically Painful Interface mucositis DIF IgG antinuclear antibodies

23 CUS with Antiepithelial Nuclear Abs Clinical Lichenoid infiltrate Antinuclear Abs

24 Contact Lesions Clinical Chronic interface mucositis

25 Cinnamon Lichenoid Stomatitis Clinical Lymphoid Aggregates

26 Lichen sclerosis et atrophicus Lichenoid lesion of skin or genitalia, extremely rare in oral mucosa Microscopically, there is an interface lymphocytic mucositis with extensive subepithelial hyalinized scarring

27 Lichen sclerosis et atrophicus tongue and lip

28 Recurrent Aphthae Minor Major Herpetiform Systemic Disease Associations Gluten Enteropathy B Vitamin and Folate Deficiency HIV Cyclic Neutropenia

29 Minor Aphthae

30 Recurrent Aphthae Minor Silver Nitrate

31 Recurrent Aphthae Major

32 Recurrent Herpetiform Aphthae

33 Agranulocytosis Idiopathic Pancytopenia/Aplastic Anemia Chemotherapy

34 Agranulocytosis Clinical WBC 2800 PMNS 30% LYMPHOCYTES 60% MONOCYTES 6% EOSINOPHILS 3% BASOPHILS 1%

35 HIV Oral Ulceration

36 Lupus Erythematosus Discoid form: cutaneous lesions Systemic form: cutaneous and visceral organs, renal disease (Kimmelsteil Wilson) Red, scaley lesions of skin, butterfly rash of face Autoantibodies: anti-nuclear, anti-dna DIF: IgM antibasement membrane May have other autoimmune conditions (Mixed Collagen Diseases)

37 Lupus Erythematosus Butterfly Rash

38 Lupus Erythematosus Gingival Erythema Discoid Lesion Anti-BM IgM

39 Autoimmune Sialadenitis Detailed in chapter on Salivary Disesaes Dry eyes (xerophthalmia) Dry mouth (xerostomia) Primary Sjogren Syndrome (sicca complex) Secondary Sjogren Syndrome Association with other autoimmune diseases such as rheumatoid arthritis, lupus, scleroderma

LESIONS OF THE ORAL CAVITY ORAL CAVITY. Oral Cavity Subsites 4/10/2013 LIPS TEETH GINGIVA ORAL MUCOUS MEMBRANES PALATE TONGUE ORAL LYMPHOID TISSUES

LESIONS OF THE ORAL CAVITY ORAL CAVITY. Oral Cavity Subsites 4/10/2013 LIPS TEETH GINGIVA ORAL MUCOUS MEMBRANES PALATE TONGUE ORAL LYMPHOID TISSUES LESIONS OF THE ORAL CAVITY David I. Kutler, MD, FACS Associate Professor Division of Head and Neck Surgery Department of Otolaryngology HNS Weill Cornell Medical Center ORAL CAVITY LIPS TEETH GINGIVA ORAL