2021, Number 3
Epithelial dysplasias, a diagnostic challenge for the oral pathologist
Full text
Language: English/Spanish [Versión en español]
References: 3
Page: 202-203
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In oral and maxillofacial pathology, biopsy and therefore histopathological study is undoubtedly the gold standard for the diagnosis of the wide range of diseases affecting the oral and maxillofacial region; a very particular case is that of potentially malignant lesions, which histopathologically present different degrees of dysplasia. To establish the diagnosis of epithelial dysplasias, we must focus on two general aspects, the architectural and cytological characteristics. Among the architectural changes, we have irregular stratification of the epithelium, loss of polarity of the basal cells, and loss of cell cohesion, among others. As for cytologic changes, the most frequent are the abnormal variation of the size and shape of the nucleus and cytoplasm, as well as the presence of atypical mitoses. These changes are present to a greater or lesser extent in the epithelium, and there are two options for grading each case since there is still no consensus; the first is binary, i.e. to classify as mild or severe, and the one established by the WHO (World Health Organization), which in turn is the most used in the guild and consists of a more objective approach with three categories, mild, moderate and severe;1-3 this considering the epithelial thickness and the affected level.
When we refer to a diagnostic challenge for the oral pathologist, we are not necessarily talking about the difficulty of establishing the histopathological diagnosis itself, rather we refer to the difficulty in establishing the grading for epithelial dysplasias, although we have no problem in differentiating a mild dysplasia from a severe one, the real challenge is to establish a line between the intermediate or borderline stages, at what point a mild dysplasia can already be in a moderate grade? Or when is a moderate dysplasia already a severe dysplasia, and finally, when is a severe dysplasia already a carcinoma in situ? The establishment of one or the other depends not only on the observed changes but above all on the pathologist's experience and perception, i.e. having to divide the epithelial thickness into thirds, a situation that can vary considerably from specialist to specialist; other factors to take into account are the clinical characteristics observed or referred, is it a homogeneous or mixed lesion, the dimensions of the lesion or if it is adjacent to an ulcer. For this reason, it is of vital importance to have all the clinical information since we are not always faced with defining characteristics of one of the aforementioned degrees, and the establishment of the same is of great importance since derived from it, the treatment and prognosis of each case will be suggested.
REFERENCES
AFFILIATIONS
1 Especialista en Patología Bucal. Universidad Nacional Autónoma de México (UNAM). México.
2 Maestra en Ciencias. Universidad Nacional Autónoma de México (UNAM). México.
CORRESPONDENCE
Diana Ivette Rivera-Reza. E-mail: dianrvr@gmail.com