Intestinal Cellular Biomarkers of Mucosal Lesion Progression in Pediatric Celiac Disease

Celiac disease (CD) is a chronic intestinal inflammation caused by gluten ingestion in genetically predisposed individuals. Overt-CD and potential-CD are the two main forms of gluten intolerance in pediatric patients with different grades of intestinal mucosa lesion and clinical management. For overt-CD patients the gluten-free diet is mandatory, while for potential-CD the dietary therapy is recommended only for those subjects becoming clinically symptomatic overtime. To date, specific early biomarkers of evolution to villous atrophy in potential-CD are lacking. We recently observed an expansion of TCRγδ+ T cells and a concomitant disappearance of IL4-producing T cells in the intestinal mucosa of overt-CD patients compared to potential-CD children, suggesting the involvement of these two cells subsets in the transition from potential-CD to overt-CD. In this study, we demonstrated that the intestinal densities of IL4+ T cells inversely correlated with TCRγδ+ T cell expansion (p < 0.005) and with the serum levels of anti-tissue transglutaminase antibodies (p < 0.01). The changes of these two cell subsets strongly correlated with mucosal lesions, according to the histological Marsh classification, as the transition from M0 to M3 lesions was associated with a significant reduction of IL4+ T cells (M0 vs. M1 p < 0.04, M0 vs. M3 p < 0.007) and an increase of TCRγδ+ T cells (M0 vs. M1 p < 0.05, M0 vs. M3 p < 0.0006). These findings strongly suggest that the detection of TCRγδ+ and IL4+ T cells could serve as cellular biomarkers of mucosal lesion and targets of novel immunomodulatory therapies for CD.

A Sketch on Oral Mucosal Lesion Presenting in a Rural Tertiary Care Hospital in Bangladesh

Background: Oral mucosal lesion (OML) is defined as any abnormal alteration in color, surface aspect, swelling, or loss of integrity of the oral mucosal surface. Some oral mucosal lesions are benign and require no treatment but some may present with significant pathology. Several oral potential disorders frequently progress into malignancy Objective: The present study was carried out to assess the pattern of various oral cavity lesions of patients attending in a regional tertiary care hospital in northern area of Bangladesh. Materials and Methods: This prospective cross-sectional study was carried out in the Department of Dentistry in collaboration with department of Pathology of Khwaja Yunus Ali Medical College and Hospital, Sirajgonj, Bangladesh during the period of one year from December 2016 to December 2017. An elaborate schedule was prepared before undertaking the study. A total of 73 patients in the Dental OPD of the hospital presenting with oral lesion for more than 3 weeks were randomly selected. An incisional biopsy was taken from all patients and histological examinations were done. The collected data were analyzed using SPSS (V-20) and MS Excel. Results: Most common site of oral lesion is Buccal Mucosa (36.99%), then supraglotic region (26.03%), lower lip 6.85%, gingiva 5.48%, anterior palate and oral flor 4.11% each. Most of the lesion was Squamous cell carcinoma (58%), then lichen planus, leukoplakia, inflammatory lesion, pyogenic granuloma and verrucous carcinoma, each of them was around 5% of lesion. Conclusion: The epidemiological data on the prevalence of oral lesion is an important determinant in planning appropriate levels of services and further studies are required to provide accurate estimates of the treatment need in Bangladeshi population with oral lesion. Update Dent. Coll. j: 2021; 11(2): 4-9

Phlegmonous gastritis: a case series

Background Phlegmonous gastritis is a rare and fatal infectious disease of the stomach, presenting varied and nonspecific endoscopic images, which are therefore difficult to diagnose. This report discusses three cases of phlegmonous gastritis, each with unique endoscopic images, and considers the differential diagnosis of this disease. These cases were initially suspected of scirrhous gastric cancer, gastric syphilis, and acute gastric mucosal lesion. Case presentation Case 1 A 32-year-old Asian man visited our hospital complaining of upper abdominal pain. Endoscopy raised suspicion of scirrhous gastric cancer. However, a histopathological examination showed no malignant cells, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, which was effective. Case 2 A 33-year-old Asian man visited our hospital complaining of epigastralgia. Endoscopy raised suspicion of gastric syphilis. However, the serum test for syphilis was negative, and Streptococcus viridans was detected in the biopsy specimen culture, which led to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in significant improvement in the endoscopic image after 2 weeks. Case 3 A 19-year-old Asian man visited our hospital complaining of epigastric pain. Endoscopy raised suspicion of acute gastric mucosal lesion. A gastric juice culture showed Pseudomonas aeruginosa and Streptococcus viridans, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in the disappearance of the gastric lesions. Conclusion In severe cases of phlegmonous gastritis, immediate surgical treatment is generally required. However, the endoscopic images are varied and nonspecific. These three cases suggest that clinicians need to consider the differential diagnosis of phlegmonous gastritis and make accurate diagnoses at an early stage.

Mind your head: two cases of mucosal metastasis of BRAF-mutated melanoma of the scalp

Mucosal melanomas are rare and only a small portion bear BRAF mutations while cutaneous melanomas have a much higher prevalence and often harbor BRAF mutations. We present two cases in which, after a malignant melanocytic mucosal lesion with a BRAF mutation was found, the primary cutaneous source was identified and clonality confirmed between the lesions. In both cases, primary lesions occurred on the scalp, an often-overlooked site. Both lesions showed signs of regression implying that in due time these lesions could have been fully regressed and might never have been detected. In that case, the metastatic mucosal lesion would erroneously be identified as a BRAF-mutated mucosal melanoma. These cases give warrant; a careful dermatological inspection should be instigated when confronted with a BRAF-mutated mucosal melanoma. We hypothesize that some BRAF-mutated mucosal melanomas might actually represent metastases of regressed cutaneous melanomas.

Oral Cancer: Raising Awareness of the Importance of Suspicion in Early Detection

Oral cancer is a significant cause of morbidity and mortality worldwide. In this article we present two cases of potentially innocuous looking lesions, initially thought to be traumatic in origin, but later diagnosed as cancer. The first patient presented with a persistent laceration thought to be caused by an accidental shaving injury, which was subsequently diagnosed as squamous cell carcinoma. The second patient presented with a hyperplastic mucosal lesion, suspected as forming due to denture-clasp irritation, which was subsequently diagnosed as proliferative verrucous carcinoma. The importance of early detection and palpation of suspicious lesions is emphasised in this article.

Prevalence of oral mucosal lesion in peri-urban area of Lucknow city (Uttar Pradesh)

Introduction: . The oral mucosa performs essential protective functions that affect the general health of the patient. Oral lesions can cause discomfort or pain that interferes with mastication, swallowing, and speech. Aim: The aim of this study is to assess the prevalence of oral mucosal lesions in periurban area in the city of Lucknow aged 15 years and above. Settings and Design: A multistage random sampling was done for identifying the study sample. Materials & Methods: In the first stage. all peri-urban areas of Lucknow city was grouped into four geographical zones. Second stage consisted of random selection of 20 peri-urban areas by lottery method (5 from each zone). In third stage there was selection of individuals using simple random method. A total of 45 individuals was selected. Thus a total 900 individuals was selected (i.e. 225 from each zone). Results: The prevalence of oral mucosal lesion in the present study was found to be 11.8%. The percentage of patients suffering from leukoplakia, oral submucous fibrosis and lichen planus was 51.9%, 20.8% & 11.3% respectively. Conclusion: This survey high-lighted the rampant misuse of variety of harmful substances as well as the high prevalence of oral lesions in the community.