Andrea Schmidt-Westhausen

Oral keratinocyte immune responses in HIV-associated candidiasis

INTRODUCTIONnCandidiasis is the most commonly encountered opportunistic infection among HIV-positive subjects. The purpose of this study was to assess specific keratinocyte immune parameters in the pseudomembranous and erythematous forms of HIV-associated oral candidiasis.nnnMATERIAL/METHODSnThis collaborative study from three centers analyzed 25 HIV-positive and 10 HIV-negative subjects with either pseudomembranous or erythematous candidiasis. Oral biopsy specimens from lesional tissues were procured, and histopathologic features were correlated with immunohistochemical and in situ hybridization investigations for the expression of interleukin 1 alpha, interleukin 8, antimicrobial calprotectin, lymphocyte populations, and Candida antigen.nnnRESULTSnBoth pseudomembranous and erythematous candidiasis among HIV-infected subjects showed a mild interface lymphocytic mucositis with the presence of neutrophilic subcorneal abscesses in the latter. Erythematous candidiasis cases that failed to show surface mycelia, did yield positive results for Candida antigens in the parakeratinized layer. The expression of inflammatory chemokines were positive in all groups and calprotectin appeared to serve as a keratinocyte barrier to hyphal penetration.nnnCONCLUSIONSnThe erythematous form of candidiasis is often devoid of hyphae yet the presence of Candida antigens in the surface epithelium implicates an immune or allergic process. The intactness of chemokines and antimicrobial calprotectin in keratinocytes may explain why disseminated candidiasis is rarely encountered in HIV-infected patients.

Clear cell calcifying epithelial odontogenic tumor

Clear cell variants of odontogenic tumors are rare. A case of clear cell calcifying epithelial odontogenic tumor of the mandible in a 38-year-old Caucasian male is described. This case is compared to 8 previously reported cases. The origin of clear cells in odontogenic tumors is still unknown. En bloc resection of the tumor is recommended.

Odontogenic myxoma--characterisation of the extracellular matrix (ECM) of the tumour stroma.

In order to elucidate the origin of the odontogenic myxoma, the composition and the structural organisation of the extracellular matrix (ECM) of this tumour were characterised. Collagen type I, VI, procollagen type III, undulin, tenascin and fibronectin were demonstrated in biopsy material of 4 cases by polyclonal antibodies. The tumour stroma showed a pronounced reaction for collagen type I. Fibroblasts displayed an intense intracytoplasmatic reaction for procollagen type III, and collagen type I was not found in the fibroblasts of the adjacent normal oral mucosa. In contrast to the surrounding connective tissue, label for collagen type VI was weak, as was the reaction for fibronectin and tenascin. Undulin was almost undetectable. The immunohistochemical results suggest that the odontogenic myxoma is characterised by an as yet unobserved structural organisation of ECM proteins, a secretion defect of fibrillar collagens type I and III with no resemblance to physiological tooth development.

Klinische und histopathologische Charakterisierung oraler Leukoplakien bei Patienten mit HIV-Infektion

Ziel der Studie war, die Prävalenz der oralen Leukoplakie (oL) bei Patienten mit HIV-Infektion zu ermitteln, die klinischen und histopathologischen Charakteristika und Kofaktoren wie Herpes-simplex-Virus 1 und 2, Humane Papillomviren, Epstein-Barr-Virus und Zytomegalievirus mittels immunhistochemischer Nachweismethoden (APAAP) sowie Candidahyphen (PAS) zu evaluieren. 269 HIV-seropositive Patienten, (222 Männer, Altersmedian: 36,7 Jahre und 47 Frauen, Altersmedian 32 Jahre) wurden anhand standardisierter Protokolle erfaßt. 20/269 (7,4%) Patienten (Männer, Raucher, Medianwert des Alters 38 Jahre) wiesen eine orale Leukoplakie auf (11% inhomogene Form). Bei 8/20 wurde eine Biopsie entnommen: Dysplasien wurden nicht nachgewiesen, Candidahyphen waren in 2/8 Fällen vorhanden, HPV und CMV wurde jeweils in einem, EBV und HSV1/ 2 in keinem Fall nachgewiesen. Die Prävalenz der oL mit 7,4% scheint im Vergleich zur Normalbevölkerung (0,9–2,2%) höher zu liegen, auch ist diese bei HIV-Infizierten schon 25 Jahre früher zu diagnostizieren. The aim of this study was to assess the prevalence of oral leukoplakia (OL) in HIV-positive patients and to evaluate the clinical and histopathological features and the presence of Candida hyphae and viral infections (HSV 1, 2, HPV, EBV and CMV) by immunocytochemical methods using mono- or polyclonal antibodies. A total of 269 HIV-seropositive patients, (222 men, median age 36.7 years and 47 women, median age 32 years) were registered. OL occurred in 20/269 (7.4%) patients (men, smokers, median age 38 years); the non-homogeneous form was observed in 11%. A lesional biopsy specimen was obtained from 8/20 patients. Specimens did not show signs of epithelial dysplasia. Candida hyphae were evident in 2/8 cases. Two patients tested positive for HPV and CMV; antibodies against EBV, HSV1 and 2 were negative. In conclusion, the prevalence of OL is comparatively high in this group of HIV-seropositive patients (7.4% vs. 0.9–2.2%). Moreover, the mean age of the study group at the time of diagnosis for oL was lower (38 years vs. 60 years).

HIV-assoziierte Speicheldrüsenerkrankungen

HIV-associated salivary gland disease (HIV-SGD) includes lymphoepithelial lesions and cysts involving the salivary gland tissue and/or intraglandular lymph nodes, and Sjögren-like conditions. Three cases of salivary gland disease occurring in HIV-infected patients are reported. Histopathological examination showed squamous epithelium-lined cysts. In the walls of the cysts lymphoid tissue, epitheloid granulomas and giant cells were found. The clinical and histopathological criteria as well as magnetic resonance imaging and therapy are discussed.HIV-assoziierte Speicheldrüsenerkrankungen (HIV salivary gland disease, HIV-SGD) sind histologisch durch eine Hyperplasie der Parotislymphknoten, eine lymphozytäre Sialadenitis undloder benigne lymphoepitheliale Zysten charakterisiert, In dieser Untersuchung werden 3 Fälle der HIV-assoziierten Speicheldrüsenerkrankungen bei 2 Patienten mit Voll-bild AIDS und 1 Patienten mit einer primären HIV-Infektion vorgestellt. Klinische und histopathologische Aspekte sowie die Darstellung mittels Magnetresonanztomographie werden diskutiert. HIV-associated salivary gland disease (HIV-SGD) includes lymphoepithelial lesions and cysts involving the salivary gland tissue and/or intraglandular lymph nodes, and Sjögren-like conditions. Three cases of salivary gland disease occurring in HIV-infected patients are reported. Histopathological examination showed squamous epithelium-lined cysts. In the walls of the cysts lymphoid tissue, epitheloid granulomas and giant cells were found. The clinical and histopathological criteria as well as magnetic resonance imaging and therapy are discussed.