Identification of inflammatory cell phenotypes in human oral carcinomas by means of monoclonal antibodies

Pathophysiology of Langerhans cells

Langerhans cells (LCs) were first described by Paul Langerhans, in 1868, as dendritically shaped cells, which were located in the squamous epithelia of epidermis. Later on, these cells were identified in all stratified squamous epithelium of mammals. Dendritic cells (DCs) play an important role in local defense mechanisms in the epithelium. LCs are situated usually in the suprabasal layer of stratified squamous epithelia of oral mucosa and epidermis of skin. They constitute 3% of the cell population in epidermis. LCs are thought to act as antigen presenting cells (APCs) during initiation of immune responses. With the help of APCs, the lymphocytes are able to recognize and respond to specific microbes. In this paper we have reviewed the origin, distribution, demonstration and mechanism of action of LCs and their role in different pathological conditions.

Cell-mediated immunity and head and neck cancer: with special emphasis on betel quid chewing habit

Betel quid (BQ) chewing is popular in Taiwan, India, and many southeast-Asian countries. BQ chewing has strong association with the risk of oral leukoplakia (OL), oral submucous fibrosis (OSF), and oral cancer (OC). BQ components exhibit genotoxicity and may alter the structure of DNA, proteins and lipids, resulting in production of antigenicity. BQ ingredients are also shown to induce keratinocyte inflammation by stimulating the production of prostaglandins, TNF-alpha, IL-6, IL-8, and granulocyte-macrophage colony-stimulating factor (GM-CSF) in keratinocytes. These events may provoke tissue inflammation, early cell-mediated immunity (CMI), and immune surveillance in BQ chewers. However, BQ components also directly affect the functional activities of immunocompotent cells, and moreover tumor cells may hypo-respond to the CMI via diverse mechanisms such as induction of apoptosis of lymphocytes, induction of production of suppressor T cells, downregulation of MHC molecules in tumor cells, etc. Clinically, an alteration in lymphocyte subsets, a decrease in total number of lymphocytes, and a reduction in functional activities of CMI have been observed in isolated peripheral blood mononuclear cells (PBMC) and tumor infiltrated lymphocytes (TIL) in patients with OSF, OL or OC. Adaptation of tumor cells to immune system may promote clonal selection of resistant tumor cells, leading to immune tolerance. Future studies on effects of BQ components on CMI and humoral immunity in vitro and in vivo can be helpful for chemoprevention of BQ-related oral mucosal diseases. To elucidate how virus infection, tobacco, alcohol and BQ consumption, and other environmental exposure affect the immune status of patients with oral premalignant lesions or OC will help us to understand the immunopathogenesis of OC and to develop immunotherapeutic strategies for OC.

Comparison between submucosal (extra-nodal) and nodal non-Hodgkin's lymphoma (NHL) in the oral and maxillofacial region

Fifty-two cases of non-Hodgkin's lymphoma (NHL) in the oral and maxillofacial region, comprising 31 submucosal (extra-nodal) and 21 cervical node NHLs, were investigated. The patients' ages ranged from 5 to 86 years, with a bimodal age distribution among young people below 12 years of age (average 8 years) and in those aged 30 years or older (average 60.3 years). The male-to-female gender difference ratio was 1.3:1. Patients presented with swelling as the major symptom. Histologically, diffuse, large cell malignant lymphoma was the most frequent type and 67.9% of lymphomas were of intermediate malignancy as defined by the Working Formulation for Clinical Usage. All submucosal lymphomas showed diffuse proliferation patterns, although follicular proliferation was identified in 5 of the 21 nodal lymphomas. Immunohistochemistry showed that the B-cell type was predominant, especially in nodal lymphomas.

Oral mucosal Langerhans' cells

Langerhans' cells (LC) are dendritic, antigen-presenting cells present within the epithelium of skin and mucosa, including that of the oral cavity. This article reviews the literature on the phenotypic and functional features of oral mucosal Langerhans' cells, and speculates on other aspects by extrapolating from data on their epidermal counterparts.

The distribution of lymphocyte subpopulations in normal and acanthotic ovine skin

The prevalence and distribution of lymphocyte subpopulations in normal and acanthotic ovine skin were investigated using monoclonal antibody immunocytochemistry. CD8+ cells were predominant in the epidermis of both normal and acanthotic skin, but were CD8+ cells, CD4+ cells and T19+ cells infrequent in normal epidermis. Within the dermis of normal skin, there were significantly greater numbers of CD4+ and T19+ cells situated around the superficial dermal vessels than in any other region examined. The majority of the CD8+ cells adjoined vessels, but the proportion that did not was greater for CD8+ than for CD4+ or T19+ cells. The CD4+ and CD8+ subsets were represented equally in adnexa. T cells were of memory phenotype. B cells and naive T cells, both of which express the CD45RA antigen, were rarely seen and tended to be associated with vessels in both normal and acanthotic skin. None of the T19+ cells (which are gamma delta+) resembled the dendritic gamma delta cells seen in murine epidermis. Acanthotic skin was strikingly different to normal skin. There was a greater abundance of T cells, particularly CD4+ cells, in acanthotic epidermis and the numbers of CD8+ and T19+ cells, and to a greater extent CD4+ cells, were greater at the dermal-epidermal junction. There were more CD4+ and CD8+ cells in the superficial dermal stroma of acanthotic skin. Within the dermis of acanthotic skin, T cells were concentrated near vessels but the apportioning of T cells between stromal/adnexal and vessel-associated sites differed from normal. Such observations suggest that migration away from perivascular sites and into the stroma may be controlled separately for subregions of skin and for each T cell subset. The role of this altered nonrandom migration of T cells in skin chronically exposed to ultra violet radiation is uncertain.

Langerhans cell density in normal human oral mucosa and skin: relationship to age, smoking and alcohol consumption

The immune function of skin has been studied extensively and it has been suggested that epidermal Langerhans cell (LC) density and function decreases with increasing age. Little is known, however, about the effect of age on oral mucosal LC. Cryostat sections from biopsies of buccal mucosa, lip, hard palate, lateral border of tongue, floor of mouth and abdominal skin, obtained from 91 subjects (aged 16-96 yr), were reacted immunocytochemically with a monoclonal antibody against CD1a and then LC density was expressed as LC/mm epithelial surface length. No significant effect of age on mucosal or skin LC density was found, whilst a history of smoking was associated with an increase in LC density in lateral border of tongue and in biopsies of labial mucosa taken from men (P < 0.05). There was no significant difference between LC density in men and women in oral mucosa. Oral mucosal LC may therefore form a relatively stable population in the adult and thus the increased incidence of mucosal disease in the elderly may be the result of subtle changes in cell mediated immune function rather than changes in LC density.

Langerhans cells: structure, function and role in oral pathological conditions

Langerhans cells (LCs) are dendritic bone marrow derived cells situated suprabasally in most stratified squamous epithelia, such as the epidermis and the epithelium of oral mucosa, including the gingiva. Langerhans cells are thought to act as antigen-presenting cells (APC) during induction of immune responses. The exact role of Langerhans cells in the oral mucosa is not fully understood although several investigations suggest that these cells are involved in reactions to antigen challenge under both normal and pathological situations. In this paper the structure, phenotypic markers and derivation of Langerhans cells are reviewed. In view of recent findings, the immunological characteristics and the implications of Langerhans cells in pathologic oral reactions are discussed.

T-lymphocyte subsets in oral mucosa of patients with recurrent aphthous ulceration

In the present study, the proportion of mononuclear cells and percentages of CD4+ (OKT4+) and CD8+ (OKT8+) were determined in clinically healthy buccal mucosa in patients with recurrent minor aphthous ulceration (RAU) (n = 43) during active and inactive disease as compared with RAU-free controls (n = 15). In lamina propria, the total number of mononuclear cells and subset percentages were determined histologically and immunohistochemically. Mononuclear cell counts in patient specimens were significantly lower than in the control group. CD4+ percentages were not significantly different between controls and patients. CD8+ percentages of the patients were significantly increased during active RAU, but not during inactive RAU as compared with controls. In proportion to the total number of mononuclear cells, CD4+ and CD8+ cell counts per 0.25 mm2 were significantly lower in the patients during both active and inactive disease as compared with controls. Thus, RAU seems characterized by reduced numbers of mononuclear cells, including T-lymphocytopenia in the oral mucosa as such, features that appear more pronounced during active disease than during quiescence.

Coexpression of cytokeratins, involucrin, and blood group antigens in oral squamous cell carcinomas

The well and poorly differentiated oral squamous carcinomas preferentially express proteins, blood group antigens, and contain associated dendritic Langerhans' cells. Keratin pearls in well-differentiated carcinomas simulate the differentiation pathway of the normal oral squamous epithelium, whereas poorly differentiated carcinomas do not and appear more heterogeneous. Terminally keratinized cells correlate with involucrin and expression of blood group antigens in keratin pearls, a feature that differs from the nonkeratinizing normal epithelium in which such carcinomas arise. Dendritic Langerhans' cells are reduced in number in squamous carcinomas.

Langerhans cells in oral epithelium of chronically inflamed human gingivae

This study describes the histopathological features and the distribution of oral epithelial Langerhans cells in 19 gingival biopsies originating from an adult Tanzanian population characterized by very poor oral hygiene and severe gingival inflammation. Light-microscopically, all biopsies contained often large inflammatory connective tissue infiltrates, 6 of which predominantly contained plasma cells while the rest were dominated by lymphocytes. Seven specimens contained peculiar accumulations of round lymphoid and dendritic cells in the lower cell layers of the oral epithelium. These phenomena have not previously been demonstrated in human gingiva and deserve further attention in studies on the pathogenesis of periodontal diseases. Immuno-histochemical staining with OKT6, OKT4 and OKT8 antibodies showed markedly increased numbers of OKT6-positive cells in 7 specimens and clusters of OKT4- and OKT8-positive cells in the oral epithelium of 4 specimens. High numbers of OKT6-positive cells were not related to the presence of intra-epithelial, non-keratinocyte infiltrates or large connective tissue infiltrates. The variable numbers of oral epithelial Langerhans cells may therefore result from different bacterial antigens elucidating different responses or, alternatively, reflect different responses to similar plaque antigens penetrating the surface of the oral epithelium.

Epithelial dendritic cells in pathological human oral tissues

Epithelial dendritic cells (EDC) were examined in human oral tissues with non-specific keratosis, lichen planus and squamous cell carcinoma. Acetone-fixed frozen sections were stained using an indirect immunoperoxidase technique and monoclonal antibodies to the human CD1 thymocyte (OKT6) and HLA-DR antigens. Significantly more T6+ and DR+ EDC were present in lichen planus tissues than normal controls, tissues with non-specific keratosis and the epithelial overlying/adjacent to squamous cell carcinomas, the latter tissues having comparable numbers of both T6+ and DR+ EDC. By contrast, significantly fewer T6+ EDC and significantly more DR+ cells were present in the invasive epithelium of squamous cell carcinomas than the overlying/adjacent epithelium of carcinomas, the non-specific keratosis group and the normal tissues. 23-60% of pathological tissues had either focal or general DR+ reactivity in keratinocytes, but there was no correlation between the density of T6+ or DR+ EDC and the keratinocyte DR status of the tissues. The results suggest that immunological enhancement occurs in lichen planus and possibly immunological impairment may characterize invasive squamous cell carcinoma.

Ia+ epithelial dendritic cells during oral carcinogenesis in the rat

Epithelial dendritic cells (EDC) were examined during the induction and growth of oral squamous cell carcinomas in rats treated with the carcinogen 4-Nitroquinoline N-oxide (4NQO). Acetone-fixed frozen sections of the palate and tongue were stained using an indirect immunoperoxidase technique and a monoclonal antibody to rat Ia (MRC OX-6). After 6 months there was a significant increase in Ia+ EDC/mm2 in non-invasive palatal and lingual epithelium compared with untreated and solvent painted controls. Furthermore, after 9 months there were significantly more Ia+ EDC/mm2 in non-invasive lingual epithelium compared with invasive epithelium or the epithelium overlying/adjacent to squamous cell carcinomas of the tongue. Although there were no significant differences of Ia+ EDC/mm2 between infiltrating epithelium of lingual carcinomas and non-invasive epithelium overlying/adjacent to the tumour, these tissues did contain significantly more Ia+ EDC than lingual epithelium from either solvent-only or untreated controls. The results indicate that treatment with 4NQO stimulates an increase in Ia+ EDC numbers which, although remaining higher than in controls, is not maintained within, or adjacent to, sites of neoplastic change.

Immunohistochemistry (S 100, KL 1) and human papillomavirus DNA hybridization on morbus Bowen and bowenoid papulosis

In this study 55 paraffin embedded samples defined as Bowen's disease or bowenoid papulosis were investigated with antibodies against S 100 protein and keratins (KL 1). S 100-positive cells were quantified and related to defined section area of the epidermal compartment by computer-assisted image analysis. The density of S 100-positive cells was compared with normal skin and was particularly related to growth patterns and keratinization of the different lesions under study. S 100-positive dendritic cells were found to be reduced overall in bowenoid lesions when compared with normal skin. Lesions with high counts of S 100-positive dendritic cells most frequently showed a solitary growth pattern with highly conserved architecture and differentiation and no tendency to stromal invasion. In contrast, cases with low counts of S 100-positive cells very often showed multifocal development, a high degree of architectural disturbance and dedifferentiation. In this group, stromal invasion (cases of invasive carcinoma associated with Bowen's disease) was seen more often. Interestingly, this latter group of cases also revealed a peculiar keratin pattern. Frequently, the basal cell layer was decorated with KL 1 antibody, which usually recognizes only suprabasaly located keratinocytes. No differences between Bowen's disease and bowenoid papulosis were found in terms of densities of S 100-positive dendritic cells and keratin pattern. In our experience, extragenital Bowen's disease and genital Bowen's disease can not be distinguished on purely morphological grounds or with the immunocytochemical approach presented here. Interestingly, when employing in situ hybridization with HPV 16 probes three of seven samples of genital Bowen's disease harboured HPV 16 DNA, whereas six cases of extragenital disease were negative.

Extent and diversity of inflammatory cell infiltrates in squamous cell carcinomas and basal cell epitheliomas of the head and neck

Using monoclonal antibodies reactive with Langerhans' cells (LCs), macrophages, and T cell subpopulations, the density and proportions of cells of the immune system of the normal oral mucosa were determined immunohistochemically, and compared with findings in oral squamous cell carcinomas (SCC) and basal cell epitheliomas (BCE). In normal oral epithelia, the dominant cell type was the LC, positive for CD 1, and expressing HLA-DR antigens (DR+). Many intraepithelial cells were lymphocytes of the suppressor/cytotoxic phenotype (CD 8+), which was also the most prominent cell type in the normal mucosal stroma. Significant differences were observed for the content of CD 8-, OKM 1-, and CD 4-positive cells in the epithelium of normal oral mucosa, SCC, and BCE, and for the amount of CD 1-positive Langerhans cells in the connective tissue of the different groups of tissues. When CD 4/CD 8 ratios were calculated, differences between SCC and BCE became most evident. A CD 4/CD 8 ratio greater 0.5 was seen to be characteristic for BCE. Thus, in contrast to the striking preponderance of suppressor/cytotoxic lymphocytes (CD 8+) in SCC, BCE showed typically almost balanced numbers of suppressor/cytotoxic (CD 8+) and helper/inducer (CD 4+) lymphocytes. This finding further underlines the biological differences recognized between these most common neoplasias of the head and neck.

Dual expression of the cell-surface antigens HLA-DR and CD1 (T6) by Langerhans cells in human buccal mucosa and skin

The expression of HLA-DR and CD1 (T6) by Langerhans cells (LC) in human buccal mucosa and skin was investigated with the monoclonal antibodies YE2/36HLK (HLA-DR) and HTA1-C1 (CD1). A five-stage sequential double immunofluorescent-labelling technique, with rhodamine and fluorescein as the fluorochromes, was used to visualize the two surface antigens in the same microscope field. The majority of LC in cryostat sections of buccal mucosa and skin expressed both HLA-DR and CD1.

Langerhans cells in human warts

Seventy-six warts (15 plantar, 38 hand, 16 miscellaneous and seven anogenital lesions) taken from 55 patients, were studied by indirect immunofluorescence with monoclonal antibodies specific for T-cell subsets, Langerhans cells (LC) and HLA-DR antigen. The results were related to the presence of viral antigen. Approximately 80% of the lesions showed an infiltrate. Only 19 lesions contained helper/inducer or suppressor/cytotoxic T cells. The distribution of LC was abnormal in 65% of biopsies which contained LC in the dermis, and 29% were devoid of LC in the epidermis. Many lesions had reduced numbers of LC in the epidermis. The disappearance of LC from the epidermis was related to the presence of viral antigen, but not to the presence of particular T-cell subsets. Infiltrating cells were sometimes HLA-DR-positive, whereas basal cells did not express HLA-DR antigen, irrespective of the density of the infiltrate.

Laryngeal papillomas: local cellular immune response, keratinization and viral antigen

Various parameters of the local cellular response have been studied in 16 laryngeal papillomas from ten patients with recurrent papillomas as well as normal control laryngeal and tracheal tissue by indirect immunofluorescence on frozen sections using monoclonal antibodies specific for T-cell subsets, Langerhans cells (LC) and HLA-DR antigens. Keratinization was investigated with a monoclonal antibody KL1 recognizing an acidic 56.5 Kd keratin, which is a marker of suprabasal cells in stratified squamous epithelium and is absent from the basal layer. The presence of viral antigen was detected with a rabbit antiserum raised against SDS-dissociated purified virus. A mild inflammatory response was observed in most biopsies. Cytotoxic/suppressor T-cells were the predominant cells found in the lesions. Compared with normal epithelium, the number of LC was dramatically reduced in the papillomatous epithelium. High densities of HLA-DR-positive cells were found mainly in the corium. The keratinization process was disturbed in most specimens in that both basal and suprabasal compartments reacted positively with the KL1 monoclonal antibody. Viral antigen was present in the nucleus of very occasional epithelial cells in some samples.

Lymphocyte subpopulations infiltrating squamous carcinomas of the head and neck: correlations with extent of tumor and prognosis

Because little is known about the mechanisms involved in local tumor-host immune reactions in squamous carcinoma of the head and neck, a study was undertaken to better characterize the types of immune cells present at the local tumor site and determine their relationship to tumor extent, systemic cellular immune parameters, and clinical outcome. In 40 untreated patients, lymphocyte subsets (LS) at the tumor-host interface were quantitated immunohistologically from serial sections of frozen tumor specimens and correlated with concurrently measured peripheral LS levels and in vitro lymphocyte reactivity to phytohemagglutinin (PHA). The majority of infiltrating lymphocytes were T cells with rare B or Leu 7 cells. Proportions of T4 and T8 were similar in peritumor stroma; however, T8 cells predominated tumor parenchyma. Stromal and parenchymal infiltration by LS were not related to peripheral blood LS levels, lymphocyte reactivity, or tumor site. However, parenchymal T11 and T4 cell infiltration was less in advanced primary tumors (T3, T4) than in early tumors (T1, T2) (P = 0.01, P = 0.067, respectively), as was peripheral lymphocyte reactivity to PHA (P = 0.013). Short-term disease-free interval and actuarial survival differed significantly--according to parenchymal T11 and T4 cell infiltration--and were not related to T8, Leu 7, and B-cell infiltration. The findings extend prior studies of lymphocytic infiltration in head and neck cancer and demonstrate the potential importance of differences in tumor stromal and parenchymal infiltration. Together with recent evidence that T4 cells are critical for lymphokine production and for the proliferation of cytotoxic effector cells, the current results suggest that T4 cells play a critical role in the local immune response in squamous carcinoma of the head and neck.

Inflammatory infiltrates of experimental mammary cancers

The purpose of this review was to summarize observations on the type and function of inflammatory infiltrates of mouse mammary tumors and to speculate on the underlying mechanisms and the significance of infiltrates to mammary tumor biology. Although the major conclusion is that much more work is needed, certain themes seem to be emerging. The number of infiltrating cells can be very high but is unrelated to biological behavior of the tumors. What seems to be important is the relative contributions of inflammatory cell subsets. In the case of T-cell subsets and NK cells, the infiltrates from tumors of long-term cell lines so far seem uninformative. The general characteristics are similar to those of infiltrates from rapidly proliferating, normal mammary tissues. These characteristics do not correlate with diverse biological behavior or malignant potential. A more informative model appears to be one in which the development of tumors from preneoplastic tissue can be observed. Here our attention is currently focused on NK cells. By contrast, the correlation between activated TAM and metastatic behavior suggests that our transplantable MMT lines may be biologically relevant in the study of infiltrating macrophages. We are especially interested in the role of TAM in the generation of tumor cell variability. Overall, our data indicate that the host infiltrate is another manifestation of both inter- and intra-tumor heterogeneity and, as such, is not simply a response to, but, rather, a part of the tumor ecosystem. Unraveling the cellular and molecular mechanisms that govern the inflammatory cell component of tumors should provide insight into the types of cellular interactions that result in tumor development and progression.

In situ characterization of the inflammatory cell infiltrates of hyperplastic denture stomatitis

Cryostat sections from 14 surgical specimens were examined to determine whether selected factors of the immune response related to histopathological reactions are present in the palatal mucosa affected by hyperplastic denture stomatitis. By means of various immunological techniques the presence of IgG, IgA, IgM, complement factor C3c, receptors for the Fc region of IgG (FcR) and for complement factor C3b (C3bR), T lymphocytes, and macrophages were studied. The inflammatory infiltrate was mainly located in the papillary part of the lamina propria. IgG, IgA, and IgM appeared both in plasma cells and intercellularly. FcR, C3bR, and T lymphocytes were present in the areas with inflammatory cell infiltrate. Macrophages were found in the papillary part of the lamina propria and within the epithelium. The immunological response in the mucosa affected by denture stomatitis was in many respects similar to that of marginal and apical periodontitis. We conclude that hyperplastic denture stomatitis is a complex inflammatory lesion showing elements of both humoral and cellular immune responses.

Pattern of distribution of T lymphocytes, Langerhans cells and HLA-DR bearing cells in normal human oral mucosa

The tissue distribution of helper/inducer and suppressor/cytotoxic T cells, Langerhans cells (LC) and HLA-DR bearing cells was determined in normal oral mucosa by use of monoclonal antibodies OKT4, OKT8, OKT6 and OKIa1, respectively. OKT4+ and OKT8+ cells were invariably present in normal oral epithelium and in the lamina propria. OKT8+ cells were consistently seen inside the basal cell layer of the epithelium. The distribution of LC in oral epithelium showed regional variation. In palatal epithelium LC were evenly distributed in the basal half of the epithelium, whereas in buccal mucosa the highest concentration of LC was seen in the epithelium overlying the tips of connective tissue papillae. OKIa1 stained dendritic cells in the epithelium and plump cells with small dendritic processes in the connective tissue. Some of the latter were located close to the basal cells of the epithelium. The consistent relationship between immunocompetent cells and the epithelium of the oral mucosa suggests the presence of a local immunologic defence barrier in the oral mucosa.

Osteosarcomas and Ewing's sarcomas. Comparative immunocytochemical investigation of filamentous proteins and cell membrane determinants

Primary malignant bone tumors, osteosarcomas (9 cases), and Ewing's sarcomas (10 cases) were examined for their reactivities with monoclonal and polyclonal antibodies against filamentous proteins and cell membrane determinants of the lymphoid and macrophage marker series. The reactivity of antibodies was studied on snap-frozen tissue probes by using a triple layer immunoperoxidase method. Osteosarcomas were positive for vimentin and, in part, for HLA-DR. Other types of intermediate-sized filaments were not detected in tumour cells. In a small number of cases (2/9) tumour cells were reactive with antibodies of the macrophage series (Leu M2). In Ewing's sarcomas, vimentin and HLA-DR was also demonstrated. It was particularly interesting that Leu M2 staining was found in the majority of cases (8/10). The staining pattern supports the assumption that this peculiar tumour is of mesenchymal (monocyte/macrophage) histogenesis. It was evident from the present study that, in primary osteogenic tumors, none of the examined tumour "markers" were as distinctive as they are for bone metastases. Nevertheless, the reactivity of Ewing's sarcoma cells with monoclonal antibodies of the Leu M2 type throws some highlights on the, as yet, obscure histogenesis of the neoplasm and may be of diagnostic value in conjunction with the known light and electron microscope features of the tumour.

Quantitative analysis of immunocompetent cells in human normal oral and uterine cervical mucosa, oral papillomas and leukoplakias

Using monoclonal antibodies reacting with T-cell subpopulations, Langerhans cells and macrophages, the number and distribution of cells of the immune system in normal oral and cervical mucosa was determined and statistically compared with that in oral papillomas and oral leukoplakias. Increased numbers of labelled cells were found in oral leukoplakias and particularly in oral papillomas. In the epithelium of all specimens, Langerhans cells and T-lymphocytes of the suppressor/cytotoxic phenotype as well as of the helper phenotype were seen. Suppressor/cytotoxic and helper T-lymphocytes were in equal numbers in the epithelium of oral papillomas, but were about 2:1 in all other lesions. In normal oral epithelium, macrophages were rare but were in greater numbers in leukoplakias and papillomas. In the connective tissue of all lesions, more labelled cells were present than in epithelium with T-lymphocytes predominant. Although Langerhans cells were rare in connective tissue, many were seen in oral papillomas.