Leukoplakia ( الطلاوة )

Leukoplakia ( الطلاوة  )
white patch or plaque that cannot be characterized clinically or pathologically as any other disease.

رقعة بيضاء لا يمكن تمييزها وتوثيقها سريريا ومجهريا

Etiology ( المسببات) :
- tobacco
- ultraviolet light
- trauma
- alcohol

التبغ ، الأشعة الفوق البنفسجة ، الإصابة ، الكحوليات وغيرها

Pathophysiology
the primary pathologic change present within leukoplakia is that of abnormal epithelial differentiation with increased surface keratinization producing the clinical appearance of a whitened mucosa. This may be accompanied by alterations in the epithelial thickness.

التغير المرضي الأساسي الموجود بالطلاوة هو خلل في تمايز خلايا الظهارة مع زيادة التقرن ، مؤدية إلى تبيض الأنسجة المخاطية ، قد تكون مصاحبة إلى تغيرات في سمك الظهارة .

Clinical Features (( العلامات السريرية  

-                    white lesion in the oral mucosa

-                     more than 40 years.

-                    are found on the lip vermilion, buccal mucosa, and gingiva.

-                    thin leukoplakia appears as a flat to slightly elevated, gray or white plaque.

-                    Unscrapped

أكثر علامة تميز الطلاوة أنها غير قابلة للكشط إكلينيكيا

 

Incidence and Prevalence

Leukoplakia is by far the most common oral precancer, representing 85% of such lesions. In addition, more than one-third of oral carcinomas exhibit leukoplakia in close proximity.

الطلاوة تكون الأكثر شيوعا لاحتمالية تسرطن الفم  ممثلا 85% ، أكثر من ثلث تسرطنات الفم تظهر الطلاوة على مقربة شديدة

 Histopathological features / Dysplastic features

- hyperkeratosis (thickend keratin layer )
- acanthosis ( thickend spinous layer )

dysplastic epithelial features
- enlarged nuclei and cells
- large and prominent nucleoli
 - Increased nuclear to cytoplasmic
- Hyper chromatic
- Pleomorphic ( abnormal shape of nuclei and cells )
- Dyskeratosis ( premature keratinization of individual cells )
- Abnormal mitotic figures
- teardrop rete ridge
- loss of polarity
- keratin pearls
- loss of typical epithelial cell cohesiveness

Investigations and Management

- multiple Biopsies

- smoking cessation
- surgical excision ( depending in degree of epithelial dysplasia )
- electrosurgery  ( depending in degree of epithelial dysplasia )
- cyrosurgery ( depending in degree of epithelial dysplasia )
- laser ( depending in degree of epithelial dysplasia )
- long term follow up after removal because recurrence may develop
no need to excisions if there is no epithelial dysplasia