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原文題目(出處): Oral candidiasis mimicking an oral squamous cell carcinoma:report of case. Gerodontology 2012;29:70-4.

原文作者姓名: He´ lder Antoˆ nio Rebelo Pontes, Helena Borges Paiva, Brunno Santos de Freitas Silva, Felipe Paiva Fonseca, Fernanda Braganc¸a Monteiro da Silva1, Fla´ via Sirotheau Correˆa Pontes,De´ cio dos Santos Pinto Jr

通訊作者學校: Joa˜o de Barros Barreto University Hospital, Federal University of Para´ , Bele´m, Para´ , Brazil; Department of Stomatology (Oral Pathology), Dental School, University of Sa˜o Paulo, Sa˜o Paulo, Brazil

報告者姓名(組別): 嚴崇文Intern B組 報告日期: 101/10/8

內文:

Introduction:

1. Oral candidiasis is the most common opportunistic oral infection in humans and it has received increasing attention, presumably due to its increased prevalence word wide 2. The majority of infectious episodes are caused by Candida

albicans, a dimorphic fungal commensal organism of the

gastrointestinal and lower female reproductive tracts 3. Candida albicans asymptomatically colonises epithelial surfaces presumably in the blastoconidia form that it takes in nature.As a result of this exposure, many healthy individuals have developed detectable Candida-specific immunity,which presumably protects against infection.

4. However, numerous studies have shown that several Candida species posses a multitude of virulence mechanisms leading to successful colonization and infection of the host

5. Oral candidal colonization and candidiasis is increased with (1)Xerostomia

(2)immunodeficiency (3)denture wearing (4)smoking

(5)DM(high carbohydrate diet)

6. OSCC(Oral squamous cell carcinoma) :

(1) One of the most common types of cancer in the world, accountin for more than 95% of all malignant neoplasms in the oral cavity.

(2) Many parts of the world as its high incidence,

unsatisfactory 5-year survival rate and treatmentment can result in severe functional defects.

(3) Presents as an asymptomatic chronic ulcerative lesion with elevated borders and areas of tissue necrosis, mainly affecting elderly patients with smoking habit 7. The aim of this article is to report a case of oral

candidiasis with an atypical presentation resembling an OSCC in a 64-year-old male diabetic patient.

Case Report:

1. General data

(2)

(1) Age:64-year-old (2) Sex:male

(3) Personal habit:

1 Alcohol:(-) ○2 Betel nut:(-)

3 Cigarettes:(+) 60 cigarettes/day

(4) No contributory past medical/dental history 2. Chief complaint:

“hole in his palate”

3. Pressent illness

referd from general dental practitioner , which under clinical evaluation led his dentist suspect an OSCC.

Intraoral evaluation,a large lesion affecting the posterior portion of the hard palate and the anterior portion of the soft palate of the right side, presenting

with erythematous and ulcerated areas, elevated borders and central portions resembling necrosis was observed.The patient underwent blood-fasting glucose dosage to evaluate the presence of DM and results revealed a laboratory value of 543 mg/dl.Use prosthesis more than 20 years.

4. Incisional biopsy & pathological analysis:

revealed an unspecified chronic inflammatory process, ulcerative areas and hyphae of Candida albicans.

(3)

5. Cytological examination using the periodic acid-Schiff(PAS):

6.Treatment plan

(1) Refer to an endocrinologist to control DM (2) Use of nystatin 500’000 IU ,QID x 10 days.

Retaining the drug in the mouth for some minutes before swellowing.

(3) Change his prosthesis,not sleeping wearing his prosthesis and to wash it at least once daily

(4)

Discussion

1. Although non-albicans Candidiasis species are emerging as significant pathogens, C. albicans still occupies the top of the list for causing all forms of candidiasis(40-60%) 2. Factors:

(1) Systemic disease (DM,neutropenia,AIDS)

This fungus may change from commensal to pathogenic microorganism in the mouth in relation to oral and systemic conditions,hence,once the host is afflicted with any immune-compromising condition (DM,neutropenia,AIDS) it will become more liable to candidiasis.

(2) Cigarette

The habit of cigarette smoking is clearly recongnized as a predisposing factor for oral candidiasis.In a recent study, Shin et al., using 180 healthy subjects, found a significant relationship between cigarette smoking and oral candida carriage.However,the exact mechanism by which candida carriage may be affected by cigarette smoking is not yet fully established.It has been suggest that smoking may ○1lead to localized epithelial

alterations,increasing oral epithelial keratinization

and subsequent enhancement of hydrophobicity.○2depress the activity of oral leucocytes and reduces gigiva

exudate with the consequence that the carriage of leucocytes and immunoglobulins.

Increases adrenaline level in blood.->increases blood glucose level

(3) Saliva

1 Increased salivary glucose,may form chemically reversible glycosylation products in tissues during hyperglycaemic episodes.It is possible that

accumulation of such glycosylation products on buccal

(5)

epithelial cells may increase the number of available receptors for Candida.

2 Qualitative & Quantitative

Saliva contains a variety of anti-candidal agents such as transferrin,lactoferrin,secretory immunoglobulin A(sIgA),defensins and histatins(Candida adhesion -inhibiting proteins)

3 Age

Depends on senile hypofunction of the parotid and submandibular glands, on systemic disease and , especially,on the side effect of medication.Geriatric patients present with oral candidiasis prevalence ranging from 34-51%

(4) Acrylic resin denture

1 A large body of evidence indicating that Candida is able to adhere to acrylic resin denture.

2 Poor denture hygine by patients is common and by virtue of the lack of local saliva and high pH,Candida can easily proliferate beneath and within the

denture.

3 Ill-fitting prosthesis may cause palatal trauma, altering the mucosal surface and allowing a direct mucosal insult by tobacco smoke, facilitating fungle entry into the adjunct mucosa and consequent candida colonization.

3. D.D.to OSCC

Lesion,smoke(main risk,7 times)

Dentist must be aware of older patients presenting with lesions with atypical features,and that it is extremely important and necessary that an incisional biopsy examination be performed in these cases.

題號 題目

1 Which one of the various types of clinical lesions of candidiasis is wrong

(A)Pseudomembranous-red necrotic

(B)Erythematous-red (C)Atrophic-red

(D)Hyperplastic-white,red raised

答案(A) 出處:Oral & Maxillofacial Lesions Ch.5,6,7,8

題號 題目

2 Which one of predisposing conditions to oral candidiasis is wrong (A)Drug/Madications(Multiple antibiotic rigimes

(B)Endocrinopathies(DM) (C)Immunodeficiency(AIDS) (D)Systemic disease(Hypertension) 答案(D) 出處:

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