Mild leukoplakia: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Soft leukoplakia was first described by B.M. Pashkov and E.F. Belyaeva (1964), differs from the usual forms of leukoplakia by the presence on the mucous membrane of the cheeks, lips and tongue of slightly elevated white foci, covered with soft scales, easily removed by a spatula. Clinical foci are narrow, very soft bands of whitish color, often occupying a considerable part of the oral mucosa, slightly elevating as a result of edema.
Pathomorphology of mild leukoplakia. In the epithelium acanthosis, parakeratosis are observed, the granular layer is absent, there are light, non-color optically "empty" cells with pycnotic nuclei. Inflammatory reaction in the stroma is often absent. Histochemical and electron microscopic studies of foci of soft leukoplakia showed that there are practically no protein in RNA and SH-fusp proteins, enzyme activity of energy metabolism (LDH, G6-PGD, NaOH- and NADPH-tetrazolium reductase, cytochrome oxidase) is sharply reduced, and in some cases not is revealed at all. Electron microscopy revealed that there are few tonofilamentes in these cells, and mitochondria are vacuolated. In the cytoplasm around the nucleus there are no organelles, in the nuclei of some of them, signs of lysis are expressed.
Histogenesis of soft leukoplakia. Histochemical and electron microscopic studies suggest that mild leukoplakia is a form of normal leukoplakia, but complete keratinization with the formation of denuclearized horn cells with soft leukoplakia does not occur. There is no stage of formation of keratogialin. The basis of the process is dyskeratosis with the formation of functionally active cells and the dystrophy of other cellular elements. With mild leukoplakia, unlike the usual one, there is no increase in the mitotic activity of basal cells and an inflammatory reaction in the stroma. This suggests that mild leukoplakia is not the result of inflammation or trauma to the mucosa, but is dystrophic, possibly congenital. This is consistent with the data of K. Hashimoto (1966), who found in embryos and children a normal number of light cells, similar in structure to those with soft leukoplakia. This is also evidenced by the appearance of this type of leukoplakia at a young age.
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