Myoken Y, Sugata T, Kyo T I, Fujihara M
Hiroshima Red Corss-Atomic Bomb Survivors Hospital, Japan.
J Oral Maxillofac Surg. 1996 Mar;54(3):263-70. doi: 10.1016/s0278-2391(96)90737-5.
Little is known about the characteristic macroscopic and microscopic changes that take place during the progression of oral invasive aspergillosis in immunocompromised patients. The aim of this study was to determine the relationship between the oral and histopathologic findings in these patients. Such a study would aid in understanding the early development of subsequent progression of the disease.
Twelve patients with hematologic malignancies who developed invasive oral aspergillosis were studied. The condition was divided into three stages according to the oral findings at the time biopsy procedures were performed. Tissue sections from biopsy specimens were stained with hematoxylin and eosin for histopathologic study and the findings were evaluated in relation to the oral findings. Fungal cultures of biopsy specimens were also performed to confirm the causative organisms.
The diagnosis of oral aspergillosis was established in terms of both histologic and microbiologic evidence in all 12 patients. In the early stage (three patients), isolated areas of violaceous marginal gingiva consisted of degenerated epithelium and connective tissue infiltrated by fungal hyphae. In the advanced stage (four patients), the violaceous marginal gingiva had become transformed into gray necrotic lesions that extended to the attached gingiva. The necrotic lesions showed ulceration and were covered by a pseudomembrane containing fungal hyphae. At the base of the ulcers, connective tissue was occupied by proliferating fungal hyphae, with vascular invasion being observed. In the late stage (five patients), the ulcerated lesions had progressed, showing destruction of the alveolar bone and surrounding facial muscles, with infiltration of fungal hyphae unto the tissues. No inflammatory cellular reaction was observed until the hematologic status of the patients improved.
These findings indicate that invasive oral aspergillosis has three distinctive clinicopathological stages. Recognition of the different stages of invasive Aspergillus infections is helpful for correct diagnosis of the disease.
关于免疫功能低下患者口腔侵袭性曲霉病进展过程中发生的特征性宏观和微观变化，人们了解甚少。本研究的目的是确定这些患者口腔表现与组织病理学结果之间的关系。这样的研究将有助于理解该疾病后续进展的早期发展情况。
对12例发生侵袭性口腔曲霉病的血液系统恶性肿瘤患者进行了研究。根据活检时的口腔表现，将病情分为三个阶段。活检标本的组织切片用苏木精和伊红染色进行组织病理学研究，并根据口腔表现对结果进行评估。还对活检标本进行真菌培养以确认病原体。
所有12例患者均根据组织学和微生物学证据确诊为口腔曲霉病。早期（3例患者），孤立的紫蓝色边缘龈区域由退变的上皮和被真菌菌丝浸润的结缔组织组成。晚期（4例患者），紫蓝色边缘龈已转变为灰白色坏死性病变，并扩展至附着龈。坏死性病变出现溃疡，表面覆盖有含真菌菌丝的假膜。在溃疡底部，结缔组织被增生的真菌菌丝占据，可见血管侵袭。后期（5例患者），溃疡病变进展，表现为牙槽骨和周围面部肌肉破坏，真菌菌丝浸润至组织中。在患者血液学状态改善之前，未观察到炎症细胞反应。
这些发现表明侵袭性口腔曲霉病有三个不同的临床病理阶段。认识侵袭性曲霉感染的不同阶段有助于对该疾病进行正确诊断。
