Alexandra Sklavounou

Bullous pemphigoid, cicatricial pemphigoid, and pemphigus vulgaris: A comparative clinical survey of 278 cases

The clinical features of bullous pemphigoid (BP), cicatricial pemphigoid (CP), and pemphigus vulgaris (PV), based upon examination of 278 patients during the years 1972 through 1981, are recorded. Data in relation to age, sex, site of onset, duration of the disease at the site of onset, distribution of oral, skin, and extracutaneous lesions, and time of final diagnosis are analyzed for each disease separately, and a detailed discussion in comparison with previous reports follows. Comparative evaluation of all the clinical data permitted identification of similarities and differences in the clinical manifestations within this disease group and provided an opportunity to increase our knowledge and understanding of the overall clinical behavior of these bullous diseases. Greater awareness of these entities, which very often involve the oral mucosa, in correlation with careful clinical observation is of particular importance and leads to early diagnosis and improved treatment.

Direct immunofluorescence in oral lichen planus

Direct immunofluorescent staining (DIF) was performed on biopsy specimens from thirty-five patients with oral lichen planus. The results showed fibrin deposition in all cases at the mucosal-submucosal interface, within colloid bodies (fourteen of thirty-five) and within vascular walls (five of thirty-five). Deposition of IgG, IgA and IgM was detected to a lesser extent, while complement (C3) could not be identified in any case. The significance of these findings was assessed by comparison with the IF results obtained in thirty-five biopsies from various oral diseases other than lichen planus and ten healty persons. Although the presence of fibrin deposition at the mucosal-submucosal junction, within vessels and cytoid bodies, was found to be highly characteristic of lichen planus, these findings were not specifically diagnostic. Morphologically identical deposits were also seen in lupus erythematosus. It is known at present whether immunologic reactions may play a role in the pathogenesis of lichen planus. However, the immunopathologic findings may occasionally be additional suggestive markers in the diagnosis of the disease.

Frequency of desquamative gingivitis in skin diseases

In an attempt to determine the frequency of desquamative gingivitis (DG) in pemphigus vulgaris (PV), bullous pemphigoid (BP), cicatricial pemphigoid (CP), and lichen planus (LP), a large series of patients examined and classified in each group during the years 1972 to 1981 were included in this study. Analysis of the clinical data revealed that, of the four skin diseases, CP manifests as DG in 63.6 percent of the cases. Desquamative gingival lesions are less frequent in LP (25 percent) and in PV (18.4 percent). The great majority of DG patients were females (72.9 percent). Identification of the underlying causes of desquamative gingivitis is of utmost importance and is dependent upon clinical, histologic, and immunologic criteria.

Juvenile pemphigus vulgaris

Abstract Although pemphigus vulgaris is uncommon in adolescence, its occurrence in two patients in this age group is reported. In both cases the lesions were confined to the oral mucosa and the diagnosis was established by the typical histologic picture and positive direct and indirect immunofluorescence. The literature on childhood pemphigus vulgaris is reviewed, and the importance of prompt diagnosis by early biopsy and supportive immunofluorescent tests is emphasized.

Oral Psoriasis: Report of a Case and Review of the Literature

Psoriasis is a chronic inflammatory skin disease which very rarely affects the oral mucosa. In the present article, an interesting case of psoriasis with exclusive oral involvement is described. The patients history, clinical, microscopic features, and HLA typing were consistent with a diagnosis of psoriasis. A review of the 68 reported cases of oral psoriasis is presented in table form.

Eosinophilic ulcer of the oral mucosa

Two additional cases of eosinophilic ulcer of the oral mucosa are presented. Both patients were treated with corticosteroids, with favorable results. A review of the literature provided useful information on the clinical characteristics, histologic features, method of treatment, and benign course of the lesions.

Molluscum contagiosum of the oral mucosa

A case of molluscum contagiosum involving the buccal mucosa is reported. A review of the literature disclosed only two documented cases of this tumor with oral involvement, emphasizing its rare occurrence in the oral cavity.

Evaluation of three methods for retrospective correction of vignetting on medical microscopy images utilizing two open source software tools.

Correction of vignetting on images obtained by a digital camera mounted on a microscope is essential before applying image analysis. The aim of this study is to evaluate three methods for retrospective correction of vignetting on medical microscopy images and compare them with a prospective correction method. One digital image from four different tissues was used and a vignetting effect was applied on each of these images. The resulted vignetted image was replicated four times and in each replica a different method for vignetting correction was applied with fiji and gimp software tools. The highest peak signal‐to‐noise ratio from the comparison of each method to the original image was obtained from the prospective method in all tissues. The morphological filtering method provided the highest peak signal‐to‐noise ratio value amongst the retrospective methods. The prospective method is suggested as the method of choice for correction of vignetting and if it is not applicable, then the morphological filtering may be suggested as the retrospective alternative method.

Parathyroid hormone-related peptide (PTHrP), parathyroid hormone/parathyroid hormone-related peptide receptor 1 (PTHR1), and MSX1 protein are expressed in central and peripheral giant cell granulomas of the jaws

OBJECTIVE Parathyroid hormone-related peptide (PTHrP) binds to the parathyroid hormone receptor type 1 (PTHR1), which results in the activation of pathways in osteoblasts that promote osteoclastogenesis through the RANK/RANKL system. RANK/RANKL expression has been shown in central giant cell granuloma of the jaws but PTHrP/PTHR1 has not. MSX1 protein is a classical transcription regulator which promotes cell proliferation and inhibits cell differentiation by inhibiting master genes in tissues such as bone and muscle. It has been implicated in the pathogenesis of cherubism, and its expression has been reported in a single central giant cell granuloma (CGCG) case. We aimed, therefore, to study the expression of those proteins by the different cellular populations of central and peripheral giant cell granulomas (PGCGs) of the jaws. STUDY DESIGN Twenty cases of CGCG and 20 cases of PGCG of the jaws were retrospectively examined by immunohistochemistry for the percentage of positively staining cells to antibodies for PTHrP, PTHR1, and MSX1, using a semiquantitative method. RESULTS In both CGCG and PGCG of the jaws, PTHrP and PTHR1 were abundantly expressed by type I multinucleated giant cells (MGC) and mononucleated stromal cells (MSC) with vesicular nuclei, whereas type II MGC and MSC with pyknotic nuclei expressed those proteins to a lesser extent. In both CGCG and PGCG of the jaws, MSX1 was abundantly expressed by type I MGC and MSC but type II MGC did not express it. A statistically significant difference (P < .05) was observed between CGCG and PGCG in the expression of PTHrP in type II MGC and MSC with pyknotic nuclei and in the expression of PTHR1 in type II MGC. CONCLUSIONS We suggest that in CGCG and PGCG of the jaws, PTHrP-positive immature osteoblasts activate PTHR1-positive mature osteoblasts to produce RANKL which interacts with RANK on the PTHrP/PTHR1-positive osteoclast-precursor cells found in abundance in the stroma of giant cell lesions and induces osteoclastogenesis through the classic pathway. Cells of the jawbones, the periodontal ligament, or the dental follicle, originating from the neural crest, may be involved in the pathogenesis of giant cell lesions of the jaws. Further study is required for these suggestions to be proved.

TGF-β1, Smad-2/-3, Smad-1/-5/-8, and Smad-4 signaling factors are expressed in ameloblastomas, adenomatoid odontogenic tumors, and calcifying cystic odontogenic tumors: an immunohistochemical study.

OBJECTIVES The TGF-β/Smad signaling pathway regulates diverse cellular functions, including tooth development, and is involved in numerous pathological processes such as tumorigenesis. The aim of this study was to investigate the immunoexpression of the TGF-β/Smad signaling pathway members in ameloblastoma (AM), calcifying cystic odontogenic tumor (CCOT), and adenomatoid odontogenic tumor (AOT). MATERIALS AND METHODS This retrospective cross-sectional study included 65 tissue specimens: 34 AMs, 13 CCOTs, and 18 AOTs. Serial sections were immunohistochemically stained with TGF-β1, Smad-4, Smad-1/-5/-8, and Smad-2/-3 antibodies, and a semiquantitative measurement of the positive cells was carried out by two oral pathologists using a 0-3 scale (0: no immunoreactivity, 1: <20% positive cells, 2: 20-50% positive cells, 3: >50% positive cells). RESULTS All biomarkers studied were found significantly decreased in AM compared to CCOT and AOT. AOT and CCOT expressed Smad-1/-5/-8 more strongly compared to AM (OR = 11.66, P < 0.001 and OR = 5.34, P = 0.013, respectively), and Smad-2/-3 immunostaining was found significantly increased in CCOT (OR = 10.42, P = 0.001) and AOT (OR = 5.16, P < 0.004) compared to AM. Similarly, Smad-4 was expressed more strongly in AOT and CCOT compared to AM (P = 0.001), while AOT demonstrated a fivefold higher chance to express TGF-β1 compared to AM (P = 0.011). CONCLUSION TGF-β/Smad signaling pathway is activated in AM, AOT, and CCOT. The statistically significant reduced TGF-β1/Smad immunoexpression in AM compared to AOT/CCOT could be associated with the more aggressive biological behavior of AM including increased cell proliferation and reduced apoptosis and differentiation. Thus, the biomarkers TGF-β, Smad-4, Smad-1/-5/-8, and Smad-2/-3 could serve as supplementary diagnostic indices between odontogenic tumors of high and low neoplastic dynamics.