What element of the lesion is erosion? Oral mucosa

Primary elements of the lesion 1 page

Spot (macula)- a limited area of discolored oral mucosa. There are spots of inflammatory and non-inflammatory origin. A distinctive feature of the spots is that they are not felt upon palpation. An inflammatory spot with a diameter of up to 1.5 cm is defined as roseola, more than 1.5 cm - as erythema. Spots occur as a result of a burn, injury, or as a manifestation of common diseases - measles, scarlet fever, hypovitaminosis B 12. Spots of non-inflammatory origin: pigment spots as a result of melanin deposition (congenital staining of areas of the mucous membrane), intake medicines containing bismuth and lead.

Nodule (papula)- this is a cavity-free element of inflammatory origin up to 5 mm in size, rising above the level of the mucous membrane, capturing the epithelium and surface layers of the mucous membrane itself. Small cell infiltration, hyperkeratosis, and acanthosis are morphologically determined. A typical example of papules on the oral mucosa is red lichen planus. Merged papules, if their size reaches 5 mm or more, form 1 plaque.

Node- differs from a nodule in its larger size and the involvement of all layers of the mucous membrane in the inflammatory process. The formation of nodes may be a consequence inflammatory process(tuberculosis, syphilis, leprosy, etc.), tumor growth(both benign and malignant), and the result of the deposition of calcium, cholesterol, etc. in the thickness of tissues. Depending on the disease, the infiltrate that forms the node resolves, becomes necrotic, or purulently melts. The ulcers formed at the site of the nodes heal with a scar.

Tuberculum- is an infiltrative, cavityless, hemispherical round element of pink-red, bluish-purple color, up to the size of a pea, rising above the surrounding surface. It is dense on palpation, painful, the mucous membrane is hyperemic and swollen. Histologically, the tubercles represent an infectious granuloma. The tubercle is prone to decay with the formation of an ulcer. When healing occurs, a scar forms. The tubercles are formed during tuberculosis, syphilis, leprosy, etc.

Blister (urtica)- is a cavityless, flat itchy formation of pasty consistency, rising above the surrounding skin: quite sharply limited, resulting from acute limited swelling of the dermis. It is observed during an allergic reaction (Quincke's edema), etc. It occurs suddenly, and after some time (from ten minutes to 2-3 hours) disappears without a trace. It occurs extremely rarely on the oral mucosa.

Vesicula- this is a cavity formation round shape(up to 5 mm), protruding above the level of the mucous membrane and filled with serous or hemorrhagic contents. It is located intraepithelially and is easily opened. Typically the vesicle has serous contents. Subsequently, the bubbles burst and in their place a small erosion forms, located at the level of the upper part of the spinous or granular layer. Blisters form as a result of ballooning and vacuolar degeneration and spongiosis. Occurs when viral lesions: herpes zoster, foot and mouth disease, herpes.

Bubble- different from a bubble large sizes, can be located intraepithelially as a result of stratification (acantholysis) of epithelial cells (for example, with acantholytic pemphigus) and subepithelial, when detachment of the epithelial layer occurs (with multiforme pemphigus). exudative erythema, allergies, etc.). In a bubble, there is a tire, a bottom and contents. The contents of the bladder are usually serous, less often hemorrhagic. In the oral cavity, blisters are observed very rarely (almost visible), since they open and erosion forms in their place. Often, a bubble tire is noted along the edges of the erosion.

Pustula- similar to a blister, but with purulent contents, observed on the skin and red border of the lips. An abscess forms in the thickness of the epidermis as a result of the death of epithelial cells under the influence of infection.

Cyst- This is a cavity formation that has an epithelial lining and a connective tissue membrane.

Secondary elements of the lesion

Pigmentation and depigmentation (pigmentatio, depigmentatio)- can form in place of any element as a result of temporary accumulation or disappearance of the pigment - melanin. In addition, pigmentation can occur as a result of the deposition of hemosiderin in the skin when the walls of blood vessels are damaged.

Erosion (erosio)- damage to the mucous membrane within the epithelium that occurs after the opening of a vesicle, blister, or develops at the site of a papule, plaque, or as a result of injury. Heals without scar formation.

Aphta- erosion oval shape, covered with fibrinous plaque and surrounded by a hyperemic rim.

Ulcer (ulcus)- a defect that involves all layers of the oral mucosa. In contrast to erosion, an ulcer has a bottom and walls. Ulcers occur due to injury, tuberculosis, syphilis, or during the disintegration of a neoplasm; after healing, a scar is formed.

Crack (rhagades) is a linear defect that occurs when tissue loses elasticity.

Scale (squama)- these are the upper rows of cells of the stratum corneum that are rejected (in the oral cavity - only with leukoplakia); arise as a result of hyper- and parakeratosis; when scales are rejected in layers, they speak of exfoliative peeling; are formed at the sites of resolving or emerging spots, papules, tubercles, etc.

Crust (crysta)- this is dried exudate; formed as a result of drying of the contents of blisters, as well as on the surface of erosions and ulcers; the color of the crusts depends on the nature of the exudate; the thickness of the crusts is determined by the nature of the pathological process and the duration of existence of the crusts; the equivalent of crusts on the oral mucosa is fibrinous or purulent-fibrinous plaque, formed in some diseases on the surface of erosion and ulcers.

Tripe (cicatrix)- replacement of mucosal defect connective tissue; consists mainly of collagen fibers, there are no elastic fibers; the size of the scars is determined by the area of tissue damage; if scar tissue forms when lesions resolve without prior ulceration, then they speak of scar atrophy.

Pigmentation- changes in the color of the mucous membrane or skin at the site of the pathological process due to the deposition of melanin or other pigment.

Physiological - among residents of the south,

Pathological - when salts of heavy metals (lead, bismuth) enter the body, when hemosiderin is deposited due to hemorrhages.

Vegetation (Vegetatio) - occurs as a result of the proliferation of the dermal papillae with simultaneous thickening of the spinous layer of the epithelium, especially the interpapillary epithelial processes; macroscopically: lumpy, soft growths resembling cockscombs or cauliflower, the surface is usually eroded, red, often separating a large amount of serous or serous-purulent exudate; often forms on the surface of erosions and papules, but can also occur primarily (genital warts).

Lichenization, or lichenification (Lichenificatio)- changes in the skin and red border of the lips associated with the development of acanthosis, as well as with the simultaneous elongation of the papillae in combination with chronic inflammatory infiltration of the upper dermis; develops either primarily under the influence of prolonged skin irritation during scratching, or secondarily against the background of various inflammatory infiltrates.

CLASSIFICATION OF DISEASES OF THE ORAL MUCOSA

(E.V. Borosky, A.L. Mashkilleyson, 1984)

I. Traumatic lesions due to the action of mechanical factors, high and low temperatures, radiation, adverse meteorological factors (meteorological cheilitis, cracked lips), chemical substances, etc. Form of manifestation: hyperemia, erosion, ulcers, hyperkeratosis (leukoplakia).

II. Infectious diseases:

A. Lesions of the oral mucosa in acute and chronic infectious diseases (measles, scarlet fever, chicken pox, tuberculosis, syphilis, leprosy, etc.);

1) viral (herpes, warts, etc.);

2) fusospirochetosis;

3) bacterial (strepto- and staphylococcal, gonorrheal, etc.);

4) fungal (candidiasis, actinomycosis, etc.).

III. Allergic and toxic-allergic diseases:

1) contact allergic stomatitis, gingivitis, glossitis, cheilitis (from medications, plastics and other materials used in dentistry, dyes, toothpastes, elixirs and other chemicals in contact with the mucous membrane or red border of the lips, ultraviolet rays);

2) fixed and widespread toxic-allergic lesions (from medications, nutrients and other allergens entering the body in various ways);

3) dermatoses with damage to the oral mucosa of toxic-allergic origin (erythema multiforme exudative, Stevens-Johnson syndrome, Lyell's syndrome, primary systemic vasculitis, including Wegener's syndrome).

IY. Diseases with an autoimmune component of pathogenesis:

1) recurrent aphthous stomatitis, including scarring aphthae;

2) Behcet's syndrome, including Touraine's major aphthosis;

3) Sjögren's syndrome;

4) dermatoses with damage to the oral mucosa (pemphigus, pemphigoid, Dühring's disease, lupus erythematosus, scleroderma).

Y. Mucocutaneous reaction - lichen planus.

YI. Changes in the oral mucosa during exogenous intoxication.

YII. Changes in the mucous membrane of the mouth and the red border of the lips due to pathology of various organs and systems of the body and metabolic disorders:

1) with visceral and endocrine pathology;

2) with hypo- and avitaminosis;

3) for blood diseases and hematopoietic organs;

4) with pathology of the nervous system;

5) during pregnancy.

Yiii. Congenital and genetically determined diseases:

1) nevi and epithelial dysplasias: vascular nevi, including Sturge-Weber syndrome, warty and pigmented nevi, epidermoid cyst, Fordyce's disease, white spongy nevus (soft leukoplakia, "cheek biting", etc.), hereditary benign intraepithelial dyskeratosis;

2) folded and rhomboid glossitis;

3) glandular cheilitis;

4) dermatoses with damage to the mucous membrane of the mouth and lips, epidermolysis bullosa, atopic dermatitis (cheilitis), psoriasis, ichthyosis, Darier disease, Peutz-Jeghers-Touraine syndrome, congenital paronychia, anhydrotic epithelial dysplasia.

IX. Precancerous diseases, benign and malignant neoplasms:

1) obligate precancer: Bowen's disease, warty precancer, limited hyperkeratosis of the red border of the lips, abrasive precancerous cheilitis of Manganotti;

2) optional precancer: leukoplakia, keratinizing papilloma and papillomatosis, keratoacanthoma, cutaneous horn and etc;

3) benign neoplasms;

PRE-TUMOR DISEASES OF THE ORAL MUCOSA

Candidiasis

The disease is caused by yeast-like fungi of the genus Candida; it is an opportunistic pathogen, an aerobe, widely distributed in environment(it is found on the surface healthy skin and mucous membranes, in secretions human body). Children suffer from candidiasis, starting from the first days of life, and adults, usually elderly and weakened, most often women. There are two ways for candidiasis to occur - infection from a patient with candidiasis and the transition of one's own opportunistic fungi into pathogenic ones under the influence of factors favorable for the development of the fungus. In the development of candidiasis, especially chronic, a significant role is played by: defects in cellular immunity, diseases of the endocrine system, severe debilitating diseases, tuberculosis, anacid gastritis, long-term hypovitaminosis, especially group B, taking corticosteroids, cytostatics, antibiotics, acute and chronic injuries of the oral mucosa .

Classification by N.D. Shelakov: 1) superficial candidiasis of the skin, mucous membranes and nails; 2) chronic generalized (granulomatous) candidiasis in children; 3) visceral (systemic) candidiasis.

When the oral cavity and lips are affected, they are distinguished: according to the course - acute and chronic forms of candidiasis; by localization - stomatitis, cheilitis, glossitis, stoles, seizures.

Acute candidiasis(candidosis acuta - soor) occurs in the form of thrush (acute pseudomembranous candidiasis) or acute atrophic candidiasis. Macroscopically: on the unchanged or more often hyperemic mucous membrane of the tongue, cheeks, lips, and palate, dotted white deposits appear, which increase, forming whitish films resembling curdled milk or cottage cheese. At first, the plaque is easily removed, but later the pathogen penetrates the epithelium, and then the plaque is removed with difficulty, exposing an eroded bleeding surface.

When going to chronic form Chronic hyperplastic candidiasis or chronic atrophic candidiasis.

Chronic hyperplastic candidiasis (candidosis chronica hyperplastica). Large white spots or papules appear on the hyperemic mucous membrane, which can merge into plaques; the plaque is only partially removed. Localization: mucous membrane of the cheeks near the corners of the mouth, on the back of the tongue and the back of the palate. On the palate it looks like papillary hyperplasia. It is a precancerous disease.

Chronic atrophic candidiasis (candidosis chronica atrophica) - affects the mucous membrane of the prosthetic bed when wearing removable plastic dentures. The triad is typical: 1) damage to the hard palate under the prosthesis (hyperemia, erosion, often papillomatosis); 2) tongue damage (hyperemia, papillary atrophy, papillomatosis) and 3) jams. Sometimes isolated areas of the lip (candidal cheilitis), corners of the mouth (jams), and tongue (candidal glossitis) are affected.

Abrasive precancerous cheilitis Manganotti – more common in men over the age of 50, localized on the red border mainly of the lower lip; The course is slow, over the years, spontaneous healing is periodically observed with the occurrence of relapse. This is a typical obligate precancer.

Macroscopically on the red border of the lip, usually on the side of the midline, an irregularly shaped erosion appears with a smooth red surface, non-bleeding, painless, its base without compaction. Over time, crusts appear on the surface of the erosion, the removal of which leads to bleeding. Sometimes several erosions form. They can spontaneously epithelialize, then the red border acquires a grayish-pink color. After 1-3 weeks, erosion may form again, sometimes even in a different area of the red border. Gradually increasing in size, erosion can cover most of the red border.

Microscopically an epithelial defect is determined, at the bottom of which there is a picture of chronic productive inflammation. Along the edges of the defect in the integumentary multilayered squamous epithelium there is atrophy, in some places - hyperplasia of the cells of the basal and spinous layers with acanthosis, para- and hyperkeratosis and areas of dysplasia.

Electron microscopic the process is characterized by disintegration of the basement membrane and the basal layer of the epithelium.

Leukoplakia

Leukoplakia - chronic illness mucous membranes, characterized by keratinization of the epithelium. The predominant localization is the red border of the lips and mucous membranes. The disease mainly occurs in middle-aged and older people, mainly in men, which is apparently due to the high prevalence in them bad habits, primarily smoking. Leukoplakia is an optional precancer.

Local irritants play a major role in the occurrence of leukoplakia. Keratinization of the epithelium occurs as a protective reaction of the mucous membrane. General diseases and constitution create the background for the development of leukoplakia. A significant role is played by: smoking tobacco, a tendency to very hot or spicy foods, strong alcoholic drinks, chewing tobacco, drinking nas, unfavorable meteorological conditions (cold, wind, strong insolation), long-term mild mechanical injuries, professional factors (aniline paints and varnishes , pitch vapors and dust, products of dry distillation of coal, coal tar, phenol, formaldehyde, gasoline vapors, some benzene compounds, etc.). Endogenous factors create a background, a predisposition. Genetic factors, hypovitaminosis A, and gastrointestinal diseases are important. In some patients apparent reason There is no leukoplakia.

Simple leukoplakia (leucoplakia plana) occurs most often. Macroscopically: a spot that is an uneven opacification of the epithelium with fairly clear edges. The spot does not protrude above the level of the surrounding areas of the mucous membrane. One or more of these white or grayish-white spots are located on the apparently unchanged mucous membrane. Areas of flat leukoplakia look like a lapis burn or thin tissue paper stuck on that cannot be scraped off.

Verrucous leukoplakia (leucoplakia verrucosa) develops from a flat form. This is facilitated by local irritants. The process of keratinization intensifies, the stratum corneum thickens. The area of leukoplakia begins to protrude significantly above the level of the mucous membrane and differ sharply in color from the surrounding tissues. Verrucous leukoplakia occurs as limited white plaques with an uneven surface (plaque form) or as dense white warty growths (warty form).

Erosive form . Erosion and cracks occur against the background of a flat or verrucous shape under the influence of trauma. The most frequently eroded foci of leukoplakia are in the corners of the mouth, on the lips, and on the lateral surfaces of the tongue.

Microscopically: diffuse chronic inflammation with infiltration in its upper part by lymphocytes and histiocytes. The number of epithelial layers increases sharply with the verrucous form of leukoplakia. keratinization of the epithelium, parakeratosis develops, and acanthosis often occurs.

Lichen planus

Lichen planus (lichen ruber planus) is an inflammatory disease of the skin and mucous membranes, which is characterized by a rash of small keratinized papules. This disease occurs mainly in women over 30 years of age, and often develops gradually, less often acutely. In 40% of patients, the oral mucosa is affected simultaneously with the skin. Isolated lesions of the mucous membrane are quite common. Lichen planus is one of the most common diseases of the oral mucosa, but it can also be localized on other mucous membranes: genitals, anus, conjunctiva, esophagus, stomach, urethra. Sometimes the nails are affected. The etiology is not clear. The existing neurogenic, viral and toxic-allergic theories have not yet received sufficiently convincing evidence. Lichen planus is usually combined with chronic diseases that weaken protective properties body (diseases of the gastrointestinal tract, diabetes, hypertonic disease, neurosis, etc.). They affect the severity of lichen planus. In most patients, general nonspecific reactivity is reduced, permeability is increased vascular walls. Local trauma plays a significant role in the severity of the disease on the oral mucosa, and possibly in its occurrence.

The main morphological element of the lesion is a keratinized papule of round or polygonal shape measuring 0.2-5 mm. On the skin, lichen planus rashes are most often localized on internal surfaces forearms, in the area wrist joints, legs, sacrum, genitals. Papules on the skin have a pink-violet color and a characteristic waxy sheen; inflammation is mild. Lichen planus rashes on the skin are usually accompanied by itching or are asymptomatic. On the mucous membrane of the oral cavity, papules of lichen planus, due to constant maceration, have a whitish-pink or whitish-gray color, standing out against the background of normal or hyperemic mucous membrane. Therefore, many foreign authors call this disease lichen planus. A characteristic feature of lichen planus is the tendency of papules to merge in the form of a pattern resembling a lace mesh, a bizarre plant pattern, sometimes rings, stripes. Papules slightly rise above the level of the mucous membrane, giving it roughness. On the tongue, areas of lichen planus resemble leukoplakia, the papillae in the lesions are smoothed. In smokers, papules look coarser, thicker, and are often covered with leukoplakia spots. Lichen planus is localized in the oral cavity mainly on the cheeks at the junction of the molars with the capture of transitional folds and on the lateral surfaces of the tongue, with a transition to the back and bottom surface in the molar area. The lips, gums, palate, and floor of the mouth are less commonly affected. Lichen planus on the red border and mucous membrane of the lips often leads to secondary glandular cheilitis.

Distinguish 5 clinical forms lichen planus on the oral mucosa and red border of the lips: typical, exudative-hyperemic, erosive-ulcerative, bullous and hyperkeratotic.

Typical shape. Most common. Papules are located on the apparently unchanged mucous membrane. Often the disease is asymptomatic and is discovered accidentally or during examination by a doctor.

Exudative-hyperemic form. It is observed less often than the typical form. Papules are located on the inflamed mucous membrane, its color is bright red. At severe inflammation the pattern of papules may lose the clarity of their outlines and even partially disappear. In the process of reverse development, when swelling and hyperemia decrease, the pattern is revealed again.

Erosive-ulcerative form. This is the most severe of all forms, characterized by the presence of erosions, less often ulcers of irregular shape in the center of the lesions. Erosions are covered with fibrinous plaque or “naked”. The inflammatory process is severe, erosions and ulcers are secondarily infected by oral flora, are extremely painful, and bleed easily. Around them the typical pattern of lichen planus remains. Trauma plays a major role in the occurrence of erosions and ulcers. Such erosions and ulcers last a long time, sometimes for months, even years, and often recur, especially with insufficient treatment. With this form, the symptom of perifocal subepithelial detachment can sometimes occur. Long-term existence of erosions and ulcers can lead to atrophy and superficial scarring of the mucous membrane.

Bullous form. It is observed very rarely. Her hallmark- the appearance of vesicles or blisters with a diameter of 1-10 mm in or near areas of lichen planus. Blisters with serous or hemorrhagic contents burst quickly. In contrast to the erosive-ulcerative form, erosions in the bullous form quickly epithelialize.

Hyperkeratotic form. It is also rare. It is characterized by severe hyperkeratosis, when papules merge into large plaques that rise significantly above the level of the mucous membrane. The plaques have sharp boundaries and are covered with folded horny masses. Most often, this form of lichen planus is localized on the mucous membrane of the cheeks and the back of the tongue. Around hyperkeratotic lesions, papular rashes typical of lichen planus can be found.

This division of red lichen into forms is arbitrary; one form can transform into another. Various clinical course of this disease depends not only on general, but also on local factors aggravating the disease. Sharp edges of teeth and dentures, amalgam fillings, dissimilar metals, dental anomalies and deformations, other diseases of the oral cavity (periodontitis, caries and its complications, tonsillitis) worsen the course of lichen planus and contribute to its transition from the typical form to more severe ones.

Lichen planus is a long-term chronic disease that can last for many years, decades with periods of activation and stabilization of the process. In the progressive period, local injuries can provoke the appearance of papules or erosions and ulcers (positive Koebner's sign). Severe general diseases and intoxications worsen the course of lichen planus. Malignancy of lichen planus in the oral cavity is observed in approximately 1% of cases, more often in elderly people who have long suffered from an erosive-ulcerative or hyperkeratotic form of the disease. Signs of malignancy are a sharp increase in keratinization, the appearance of thickening of the edges or the base of the lesion.

Histology. In the epithelium, acanthosis is usually hyperkeratosis and parakeratosis; granulosis is observed in half of the cases. Edema is detected in the stroma, diffuse directly under the epithelium inflammatory infiltrate(mainly from lymphocytes and plasma cells), the cells of which penetrate through basement membrane into the epithelium (exocytosis), as a result of which the boundary between the basal layer and the connective tissue is not clearly distinguishable. In the hyperkeratotic form, hyperkeratosis is pronounced. In the erosive-ulcerative form, a picture of a chronic nonspecific inflammatory process is detected at the site of the defect. In the bullous form, the blisters are located subepithelially, underneath them there is a massive round cell infiltrate. In the last two forms, the pathohistological picture characteristic of lichen planus is determined in areas bordering on erosion or a blister.

Erythroplakia – occurs rarely, mainly in men of different ages.

Macroscopic picture- a clearly defined focus of bright red color with a velvety surface, on which there are areas of cloudiness in the form of a gray-white coating. With prolonged existence, atrophy of the mucous membrane develops, and the focus of erythroplakia seems to sink. The affected area is irregular in shape, painless on palpation, the underlying tissues are not compacted. Regional lymph nodes do not enlarge. No spontaneous regression is observed. Typically, a lesion of erythroplakia cannot be cured by eliminating irritating local factors. The disease can stabilize for a certain time, then erosions and ulcers appear on the surface, the underlying tissues are infiltrated and the process becomes malignant.

TUMORS OF THE ORAL MUCOSA

Squamous cell papilloma – benign tumor, appears on the oral mucosa in the form of a single formation on a stalk with a whitish villous surface, sometimes reminiscent of cauliflower. It grows slowly and does not cause pain. It is often injured and becomes inflamed, then increases in size and becomes painful.

Microscopically consists of proliferating epithelium, which is located on a connective tissue stalk, the surface layer of the epithelium with symptoms of hyperkeratosis. In inverting papilloma, the tumor epithelium is characterized by deep immersion of endophytic epithelial processes, and hyperkeratosis is determined on the surface.

Cancer of the oral mucosa – as a rule, develops on the basis of a precancerous lesion, occurs mainly in older people, more often in men than in women.

When localizing the lesion, the lower lip is in first place, the tongue is in second, the floor of the mouth is in third, then the mucous membrane of the cheeks, palate, jaws, etc.

According to the histological picture, the following forms of oral cancer are distinguished: intraepithelial cancer, squamous cell carcinoma and its varieties - verrucous carcinoma, spindle cell and lymphoepithelioma.

For intraepithelial cancer Characteristic signs of malignancy of the epithelium with preserved basement membrane.

Squamous cell carcinoma microscopically represents accumulations of malignant epithelial cells infiltrating the underlying connective tissue.

For Lymphoepitheliomas characterized by lymphoid stroma, localization - predominantly posterior section tongue and tonsils, has the worst prognosis.

The course of cancer of the oral mucosa is characterized by its clinicopathological features influencing the outcome of the disease. So, when the tumor is localized in anterior section mouth, a more favorable course is observed compared to lesions in the back of the mouth, despite the identical histological type. The extent of the lesion is important: a neoplasm with a diameter of up to 1 cm is less dangerous than one of large size.

Clinically, oral cancer manifests itself as endophytic form by type of ulcer, infiltrate and exophytic, growing outward. Endophytic tumor has the most malignant course.

Histological grade of malignancy tumors also play a role in the prognosis of the disease. There are I, II and III degree malignancy. At 1st degree a more favorable course is observed than with II and III. This depends on the varying severity of cell proliferation and differentiation. It is known that rapid abnormal proliferation is characterized by hyperchromatosis, numerous mitoses, cellular and nuclear polymorphism. The degree of cell differentiation is revealed by the presence or absence of intercellular bridges and the production of keratin.

Pathological processes in the oral mucosa can be divided into two groups: inflammatory lesions and tumors.

Inflammation- protective vascular-tissue reaction of the body to the action of an irritant. According to morphology, three phases of inflammation are distinguished: alterative, exudative and proliferative. According to the flow, inflammation can be acute, subacute and chronic. At acute course Alterative and exudative changes predominate, and in chronic cases - proliferative ones.

Alternate phase of inflammation characterized by the predominance of dystrophic and necrotic processes in cells, fibrous structures and in the interstitial substance of the mucosa.

Exudative phase of inflammation characterized by a predominance of hyperemia, edema and infiltration. Following a short-term reflex narrowing of the lumen of the capillaries, their persistent expansion occurs. Slowing blood flow leads to stasis and thrombosis of mucosal vessels. The tone of blood vessels decreases and the permeability of their walls is impaired. Blood plasma (exudation) and shaped elements blood (emigration).

Violation of vascular permeability is caused by the release large quantity biologically active substances (acetylcholine, histamine, serotonin, kinins) as a result of cell lysis. In this case, swelling and infiltration of the walls of blood vessels and connective tissue of the oral mucosa are observed. The infiltrate can be leukocyte, lymphoid, plasma cells and with a predominance of erythrocytes.

Proliferative phase of inflammation characterized by the processes of cell reproduction and transformation. The proliferation of connective tissue cells underlies the formation of granulation tissue. During the process of fibroblastic proliferation, neoplasm occurs connective fibers. This is the outcome of an acute process.

Chronic inflammation The mucous membrane is characterized by the proliferation of connective tissue cells (lymphocytes, plasma cells, fibroblasts, etc.). Young, cell-rich granulation tissue is then formed. The outcome of productive inflammation is the formation of mature connective tissue, i.e. development of sclerosis and fibrosis.

As a result of neurovascular disorders, focal necrosis often appears in the connective tissue structures of the mucosa. Surface defects - erosion - are formed when the integrity of only surface layers epithelium. If the connective tissue layer is damaged, a scar is formed as a result of healing.

With an exacerbation of the chronic process, it joins acute disorder vascular permeability with the release of polymorphonuclear leukocytes and erythrocytes into the connective tissue layer of the mucous membrane.

Pathological processes lead to changes in the oral mucosa, in particular to disturbances in the processes of keratinization in the epithelium.

Acanthosis- thickening of the epithelial layer of the mucous membrane due to the proliferation of basal and spinous cells. The result of acanthosis is the appearance of a nodule, nodule, and lichenification.

lichen planus;
leukoplakia;
soft leukoplakia;
hypo- and vitamin deficiencies;
lupus erythematosus;
precancerous cheilitis Manganotti;
atopic cheilitis;
actinomycosis;
changes in the mucosa due to endocrine disorders.

Parakeratosis- incomplete keratinization of the superficial cells of the spinous layer while maintaining flattened elongated nuclei in them. In this process, the formation phase of keratohyalin and eleidin is eliminated, so the granular and lucid layers are absent. The adhesive substance, keratin, disappears from the cells of the stratum corneum, resulting in pronounced peeling of the epidermis. The resulting scales are easily torn off.

Diseases that accompany this pathological process:

leukoplakia;
hypo- and avitaminosis A, C, B;
lichen planus;
dry form of exfoliative cheilitis;
atopic cheilitis;
lupus erythematosus.

The result of parakeratosis is the appearance of a spot, lichenification, vegetation, node, nodule. Areas of parakeratosis are whitish in color and cannot be scraped off.

Dyskeratosis- a form of irregular keratinization, characterized by pathological keratinization of individual epithelial cells.

The cells become larger, rounder, with granularity in the cytoplasm - “Darier bodies”, then turn into homogeneous acidophilic formations with small pictonic nuclei, called grains and located in stratum corneum. Dyskeratosis occurs with aging. Malignant dyskeratosis is characteristic of Bowen's disease, squamous cell carcinoma.

Hyperkeratosis- excessive thickening of the stratum corneum of the epithelium. It can develop as a result of excessive keratin formation or due to delayed desquamation of the epithelium. Hyperkeratosis is based on intensive synthesis of keratin as a result of increased functional activity of epithelial cells (chronic irritation or metabolic disorders).

This process accompanies the following diseases:

dry form of exfoliative cheilitis;
leukoplakia;
lichen planus;
intoxication with mercury, lead, bismuth, aluminum, zinc, etc.;
lupus erythematosus;
actinomycosis.

Papillomatosis- proliferation of the papillary layer of the lamina propria of the mucous membrane and its ingrowth into the epithelium. This process is observed in chronic trauma to the mucous membrane of the palate with a plate prosthesis and other chronic injuries.

Vacuolar dystrophy- intracellular swelling of epithelial cells with the appearance of vacuoles in the cytoplasm that destroy cells. Sometimes the vacuole occupies almost the entire cell, pushing the nucleus to the periphery. In this case, the core takes on a saddle shape.

pemphigus vulgaris;
herpes simplex;
lupus erythematosus;
changes in the mucosa due to endocrine diseases (gingivitis in pregnant women, Itsenko-Cushing syndrome, etc.).

Spongiosis- accumulation of fluid between the cells of the spinous layer. The intercellular spaces are expanded, filled with fluid, and the cytoplasmic protrusions are elongated. The process begins with the expansion of intercellular tubules, which are filled with exudate coming from the connective tissue. This exudate stretches and then breaks intercellular connections, forming a cavity. In the resulting cavity, serous contents and epithelial cells that have lost contact with the epithelium are found. The result of this process can be a blister, blister, or bubble.

Spongiosis accompanies the following diseases:

herpes simplex;
pemphigus vulgaris;
lichen planus (bullous form);
exudative erythema multiforme;
chronic recurrent aphthous stomatitis; eczema.

Ballooning dystrophy- disruption of connections between the cells of the spinous layer, which leads to the free arrangement of individual cells or their groups in the exudate of the resulting vesicles in the form of balloons. This is preceded by some thickening of the epithelium, the appearance of giant epithelial cells formed as a result of amitotic nuclear division, but the cell itself does not divide. The cell increases in size (ball, balloon) and floats in the liquid. This pathological process manifests itself in herpes simplex, eczema, erythema multiforme exudative, and lichen planus.

Acantholysis- melting of intercellular bridges in the spinous layer, which leads to loss of connections between epithelial cells. Clefts and intraepithelial blisters and vesicles form in the epithelium. This process is based on immune mechanisms. In this case, the spiny cells become rounded, slightly decrease in size, and the nucleus becomes larger. These cells are called Tzanka cells. The cells float freely in the contents of the bladder and also line its bottom. This process occurs in pemphigus vulgaris and herpes simplex.

Tumors (blastomas)- pathological tissue proliferation as a result of potentially unlimited cell division. Blastomas are divided into benign (mature) and malignant (immature). Based on their origin, they are classified as follows: tumors from epithelial, connective, vascular, glandular, muscle and nervous tissue, as well as mixed tumors.

Benign tumors of the oral mucosa consist of differentiated cells similar in structure to the original tissue. Tissue atypia is observed. These tumors grow slowly, are clearly limited, never grow into surrounding tissues, and do not metastasize.

Malignant tumors- built from poorly and undifferentiated cells and bear little resemblance to maternal tissue. Not only tissue but also cellular atypia is characteristic: changes in cell shape, enlargement of the nucleus, polymorphism, the appearance of giant cells. Malignant tumors grow rapidly and are prone to metastasis and relapse. The criterion for malignancy is the classic triad: atypia, polymorphism, invasive growth.

Elements of defeat

Distinguish primary elements of the lesion and secondary, developing from the primary ones.

TO primary include spot, nodule (papule), node, tubercle, vesicle, bubble, abscess, cyst, blister, abscess.

Secondary elements are erosion, aphthae, ulcer, crack, scar, plaque, scale, crust.

Spot- change in color of the mucous membrane in a limited area. There are inflammatory and non-inflammatory spots. Roseola- limited hyperemia up to 1.5 cm in diameter. Erythema- diffuse redness of the mucous membrane. Non-inflammatory spots include hemorrhagic spots: petechiae(point hemorrhages) and ecchymoses(extensive round hemorrhages). Pigment spots are formations resulting from the deposition of exogenous and endogenous origin(melanin deposits, taking medications containing bismuth or lead).

Nodule (papule)- a cavityless formation of inflammatory origin up to 5 mm in size, protruding above the level of the mucous membrane and involving the epithelium and the surface layer of the mucous membrane itself. Morphologically, small cell infiltration, hyperkeratosis and acanthosis are determined. Lichen planus is a typical example of the manifestation of papules on the oral mucosa. At reverse development no trace of papules remains. Plaque- merged papules.

Knot- dense, slightly painful, rounded infiltrate originating in the submucosa. Much larger than a nodule. With actinomycosis, it may suppurate with the formation of a fistula. With syphilitic gumma, the node may ulcerate. The node is formed as a result of the inflammatory process, tumor growth, etc.

Tubercle- infiltrative cavity-free formation 5-7 mm, covers all layers of the oral mucosa and rises above its surface. The tubercles are formed during tuberculosis, tertiary syphilis, and leprosy. They quickly decay with the formation of ulcers. After they heal, a scar forms.

Bubble- this is a cavity element up to 5 mm in diameter, resulting from a limited accumulation of fluid (exudate, blood). It is located in the spinous layer (intraepithelial) and quickly opens, forming erosion. Bubbles occur due to viral infections.

Bubble- a formation that differs from a vesicle in its larger size (more than 5 mm), with serous or hemorrhagic exudate. It can be located intraepithelially (with acantholytic pemphigus as a result of acantholysis) and subepithelially (with exudative erythema multiforme, allergies, etc.).

Pustule- cavity formation with purulent exudate; found on the skin and red border of the lips.

Cyst- a cavity formation having a connective tissue capsule with an epithelial lining.

Blister- acavitary formation up to 2 cm due to acute limited swelling of the papillary layer. An example is Quincke's edema.

Abscess- limited cavity formation filled with pus; occurs due to the decomposition of pathologically altered tissue or the fusion of pustules.

Erosion- a violation of the integrity of the epithelium that occurs at the site of the papule, after the opening of the vesicle, as a result of injury. Heals without a scar. Excoriation- erosion of traumatic origin.

Aphtha- a superficial defect of the epithelium of a round shape of 3-5 mm, located on a hyperemic area of the mucous membrane, covered with fibrous plaque and surrounded by a bright red rim. Heals without a scar. An example is chronic recurrent aphthous stomatitis.

Ulcer- a defect that involves all layers of the mucous membrane. In an ulcer, the bottom and edges are distinguished. Healing occurs with the formation of a scar. Ulcers occur due to injury, tuberculosis, syphilis, or tumor decay.

Crack is a linear defect resulting from loss of tissue elasticity. Superficial cracks are localized within the epithelium, deep cracks penetrate into the lamina propria and heal without a scar.

Scar- replacement of the defect with connective tissue with a high content of fibrous structures. Hypertrophic (keloid) scars occur after injury, surgical interventions. Atrophic scars form after healing of elements of tuberculosis, syphilis, and lupus erythematosus. They are characterized by irregular shape and great depth.

Raid- a formation consisting of microorganisms, fibrinous film or layers of rejected epithelium.

Flake- a falling thin plate of keratinized epithelial cells, resulting from pathological keratinization, in particular, with some cheilitis.

Crust- dried exudate at the site of a bubble, crack, erosion. The color of the crust depends on the nature of the exudate (serous, purulent, hemorrhagic).

Aphthae – a superficial defect of the epithelial layer with a diameter of 0.3-0.5 cm, filled with a fibrin film. At the end of inflammation, the defect is epithelialized without the formation of a scar in the lamina propria.

Erosion (erosio) – a superficial defect of the epithelial layer, the lamina propria of which is the bottom of a crater-shaped defect filled with fibrin and necrotic epithelial cells. Erosion is formed when the cavity primary elements are opened (see above).

Ulcer (ulcus) – defect of the epithelial layer and the lamina propria of the mucous membrane. The bottom of the ulcer is covered with fibrinous-purulent exudate. As the ulcer heals, a scar forms.

Crack (rhagades) – deep linear defect of the mucous membrane, a type of ulcer.

Tripe (cicatrix) – incomplete regeneration of the connective tissue of the lamina propria and the submucosal layer of the epithelial layer of the oral mucosa.

Peeling (squama) – rejection of keratinized cells of the epithelial layer in places of hyperkeratosis that has arisen above the primary non-cavitary elements.

crust (crusta) – dried (coagulated) exudate (serous, purulent, hemorrhagic), located in the superficial layers of the epithelial layer and rejected along with the damaged epithelium.

Raid – superficial application of fibrinous exudate containing leukocytes, bacteria, fungi and damaged epithelium. Candidiasis of the mucous membrane of the tongue can be manifested by the formation of a whitish coating, which is called thrush (soor).

End of work -

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Rules for sending material for biopsy research

1. Biopsies and surgical material are delivered to the pathology department immediately after they are taken.
2. If it is impossible to deliver the material on time, it should be placed in a

Clinical and anatomical analysis of the results of the study of surgical biopsy material
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For a correct assessment of the results Solving problems on clinical-anatomical analysis of biopsy examination Solve the proposed problems sequentially, and check your answers with the standards.

1. Erosion Problem No. 1 (V.V. Serov et al, 1987, p. 270) A 22-year-old patient was admitted to the hospital

2. Aphtha Choose one correct answer.

3. 001. Biopsy is the removal of material for intravital histological examination

4. for the purpose of... 1) treatment, 2) diagnosis,(erosia). Violation of the integrity of the surface layer of the epithelium. It occurs as a result of injury or, more often, due to unfavorable development of the primary element. Heals without a scar (Fig. 8).

5. Flake(squama). Separating keratinized epithelial cells. In some diseases of the red border of the lips (exfoliative cheilitis), parakeratotic scales have the appearance of mica translucent plates fixed in the center (Fig. 11).

6. Crust(crusta). Dried exudate of the contents of a vesicle, erosion, ulcer. The color depends on the nature of the fluid (serous fluid, pus, blood). The crusts are usually located on and near the lips.

7. Crack(rhagade). A linear defect that occurs when tissue loses elasticity. Observed as a result mechanical impact(different extensibility of normal and inflamed tissues). Localized in the corners of the mouth, in the middle or near the middle of the red border of the lips. Cracks often appear with verrucous leukoplakia (Fig. 12).

8. Abscess(abscessus). A purulent focus that appears as a result of the decomposition of pathologically altered tissue. Cavity filled with pus. Its wall is pathologically altered tissue. The abscess can open to form a fistula, from which pus is released.

9.Atrophy(atrophia). Thinning of the mucous membrane, it is smooth, shiny, easily folded. The vessels located in the depths are contoured more clearly than in normal mucosa. Atrophy occurs with lichen planus (atypical form), lupus erythematosus, after suffering radiation therapy and others (Figure 13).

10. Pigmentation(pigmentatio). A change in tissue color that occurs on the basis of previous inflammatory changes in which hemorrhage occurred in the tissue.

It should be remembered that by identifying morphological elements it is impossible to definitively diagnose the disease, since the primary elements in most cases are not pathognomonic. At the same time, in a complex of studies of a sick person, the establishment of elements of the lesion serves as an important additional factor in clarifying the diagnosis.

Control questions

1. The position of the patient in the chair, the position of the doctor.
2. Patient interview scheme. Features of the survey for diseases of the teeth and oral mucosa.
3. The importance of pain symptoms in the diagnosis of diseases of the maxillofacial region. Characteristics of pain.
4. External examination of the patient. The nature of changes depending on general diseases and changes in the oral cavity.
5. Degenerative changes in the mucous membrane: spongiosis, ballooning degeneration, acantholysis, acanthosis, hyperkeratosis, parakeratosis, papillomatosis.
6. Elements of damage to the oral mucosa (primary, secondary).

Primary morphological elements of damage to the oral mucosa:

Spot-change in color of the mucous membrane in a limited area. There are inflammatory and non-inflammatory spots. Roseola - limited hyperemia up to 1.5 cm in diameter. Erythema is diffuse redness of the mucous membrane. Non-inflammatory spots include hemorrhagic spots: petechiae (point hemorrhages) and ecchymoses (extensive round hemorrhages).
Pigment spots are formations resulting from the deposition of coloring substances of exogenous and endogenous origin (melanin deposits, taking medications containing bismuth or lead).

Nodule(papule) - a cavityless formation of inflammatory origin up to 5 mm in size, protruding above the level of the mucous membrane and involving the epithelium and the surface layer of the mucous membrane itself. Morphologically, small cell infiltration, hyperkeratosis and acanthosis are determined.

Knot- dense, slightly painful round infiltrate originating in the submucosa. Much larger than a nodule. With syphilitic gumma, the node may ulcerate. The node is formed as a result of the inflammatory process, tumor growth, etc.

Tubercle- infiltrative cavity-free formation 5-7 mm, covers all layers of the oral mucosa and rises above its surface. The tubercles are formed during tuberculosis, tertiary syphilis, and leprosy.
They quickly decay with the formation of ulcers. After they heal, a scar forms.

Pustule- cavity formation with purulent exudate; found on the skin and red border of the lips.

Cyst- a cavity formation having a connective tissue capsule with an epithelial lining.

Blister- acavitary formation up to 2 cm due to acute limited swelling of the papillary layer.
An example is Quincke's edema.

Abscess- limited cavity formation filled with pus; occurs due to the decomposition of pathologically altered tissue or the fusion of pustules.

Erosion- a violation of the integrity of the epithelium that occurs at the site of the papule, after the opening of the vesicle, as a result of injury. Heals without a scar. Excoriation is erosion of traumatic origin.

Crack is a linear defect resulting from loss of tissue elasticity. Superficial cracks are localized within the epithelium, deep cracks penetrate into the lamina propria and heal without a scar.

Scar- replacement of the defect with connective tissue with a high content of fibrous structures.
Hypertrophic (keloid) scars occur after injury or surgery.
Atrophic scars form after healing of elements of tuberculosis, syphilis, and lupus erythematosus. They are characterized by irregular shape and great depth.

Chant- a formation consisting of microorganisms, fibrinous film or layers of rejected epithelium.

Flake- a falling thin plate of keratinized epithelial cells, resulting from pathological keratinization, in particular, with some cheilitis.

Crust- dried exudate at the site of a bubble, crack, erosion. The color of the crust depends on the nature of the exudate (serous, purulent, hemorrhagic).