Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, 02115, USA.
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Head Neck Pathol. 2021 Dec;15(4):1172-1184. doi: 10.1007/s12105-021-01330-8. Epub 2021 Apr 26.
Irritant contact stomatitis (ICS) and contact hypersensitivity stomatitis (CHS) are often caused by alcohol, flavoring agents and additives in dentifrices and foods, and contactants with high or low pH. A well-recognized contactant for ICS is Listerine™ mouthwash, while that for CHS is cinnamic aldehyde. However, many other flavoring agents and even smokeless tobacco are contactants that cause mucosal lesions that are entirely reversible. The objective of this study is to 1) present cases of ICS and CHS with a clear history of a contactant at the site and the histopathologic features of the resulting lesion and 2) define the histopathologic features that characterize such lesions.
12 cases of ICS and CHS with known contactants that exhibited distinct histopathologic patterns were identified.
ICS are characterized by three patterns in increasing order of severity namely: 1) superficial desquamation, 2) superficial keratinocyte edema, and 3) keratinocyte coagulative necrosis with/out spongiosis and microabscesses. CHS is characterized by two patterns namely plasma cell stomatitis with an intense plasma cell infiltrate and a lymphohistiocytic infiltrate with or without non-necrotizing granulomatous inflammation. Three patterns of the latter are recognized: (1) lymphohistiocytic infiltrate at the interface with well-formed or loosely aggregated non-necrotizing granulomas; (2) lymphohistiocytic infiltrate at the interface with peri- and para-vascular lymphohistiocytic nodules; and (3) lymphohistiocytic infiltrate at the interface with peri- and para-vascular lymphohistiocytic nodules containing non-necrotizing granulomas. The same contactant may elicit ICS and CHS, while one histopathologic pattern may be brought on by various contactants.
ICS and CHS have distinct histologic patterns. Recognizing that these patterns are caused by contactants would help clinicians manage such mucosal lesions.
激惹性接触性口炎（ICS）和接触性超敏性口炎（CHS）通常由牙膏和食物中的酒精、调味剂和添加剂以及 pH 值高或低的接触物引起。ICS 的一种公认接触物是李施德林®漱口水，而 CHS 的接触物是肉桂醛。然而，许多其他调味剂甚至无烟烟草也是引起粘膜病变的接触物，这些病变完全是可逆的。本研究的目的是 1）展示具有明确接触物部位病史的 ICS 和 CHS 病例以及由此产生的病变的组织病理学特征，2）定义表征此类病变的组织病理学特征。
确定了 12 例具有已知接触物且表现出明显组织病理学模式的 ICS 和 CHS 病例。
ICS 以三种严重程度递增的模式为特征，即：1）浅表脱屑，2）浅表角质形成细胞水肿，3）角质形成细胞凝固性坏死伴/不伴海绵形成和微脓肿。CHS 以两种模式为特征，即伴有强烈浆细胞浸润的浆细胞性口炎和伴有或不伴有非坏死性肉芽肿性炎症的淋巴样组织细胞浸润。后一种情况有三种模式：1）界面处的淋巴样组织细胞浸润，形成形态良好或松散聚集的非坏死性肉芽肿；2）界面处的淋巴样组织细胞浸润，伴血管周围和血管旁淋巴样组织细胞小结；3）界面处的淋巴样组织细胞浸润，伴血管周围和血管旁淋巴样组织细胞小结，其中含有非坏死性肉芽肿。同一接触物可能引发 ICS 和 CHS，而一种组织病理学模式可能由各种接触物引起。
ICS 和 CHS 具有不同的组织学模式。认识到这些模式是由接触物引起的，将有助于临床医生管理此类粘膜病变。
