Zhang X, Schmitz W, Gelderblom H R, Reichart P A
Department of Oral Biology, Beijing Medical University, Institute of Stomatology, Haidian Weigongcun, Beijing 100081, People's Republic of China.
Oral Oncol. 2001 Oct;37(7):609-12. doi: 10.1016/s1368-8375(00)00123-8.
A Shammah-induced oral leukoplakia-like lesion is described in a 44-year-old Algerian patient, who used this specific chewing tobacco since 33 years. The extended white lesion was located to the right mandibular vestibule and had a homogeneous appearance. Shammah is a chewing tobacco consisting of powdered tobacco leaves with carbonate of lime and other substances. It has been associated with oral cancer in Saudi Arabia. Histologically, acanthosis, hyperortho- and parakeratosis were seen. The spinous cell layer showed large pale staining epithelial cells with pycnotic nuclei. Atypia was not observed, however, an increase in mitotic activity was apparent. The subepithelial infiltrate was mild. Electron microscopy showed changes in the basal membrane with interruptions, duplications and triplications. Follow-up of the patient for 2 years revealed that, whenever, the patient changed the location of application, the white lesion regressed or disappeared within 4-6 weeks. Due to the composition of Shammah, the lesion induced has features of a mucosal burn. In contrast to other smokeless tobacco variants, Shammah seems to cause changes which, according to the small number of reports, may transform into oral cancer. As such, Shammah-induced oral leukoplakia-like lesions may be considered precancerous.
在一名44岁的阿尔及利亚患者中描述了一种由沙马（Shammah）引起的口腔白斑样病变，该患者自33岁起就使用这种特定的咀嚼烟草。扩大的白色病变位于右下颌前庭，外观均匀。沙马是一种咀嚼烟草，由烟草叶粉末与石灰碳酸盐和其他物质组成。在沙特阿拉伯，它与口腔癌有关。组织学上，可见棘层肥厚、正角化和不全角化。棘细胞层可见大的淡染上皮细胞，细胞核固缩。未观察到异型性，但有丝分裂活性明显增加。上皮下浸润轻微。电子显微镜显示基底膜有中断、重复和三重化的变化。对该患者进行2年的随访发现，每当患者改变使用部位时，白色病变在4 - 6周内消退或消失。由于沙马的成分，所诱发的病变具有黏膜烧伤的特征。与其他无烟烟草变体相比，根据少数报告，沙马似乎会引起可能转变为口腔癌的变化。因此，沙马诱发的口腔白斑样病变可被视为癌前病变。
