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Almazyad A, Alabdulaaly L, Noonan V, Woo SB. Oral hairy leukoplakia: a series of 45 cases in immunocompetent patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:210-216. [PMID: 34030995 DOI: 10.1016/j.oooo.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/07/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Oral hairy leukoplakia (OHL) is a benign Epstein-Barr virus infection typically presenting as a white lesion on the lateral border of the tongue. Historically, OHL was described in patients who are severely immunocompromised, such as those with HIV/AIDS and organ transplant patients. OHL is increasingly seen in patients who are not severely immunocompromised. This study reviews 45 cases of OHL in a single institution and characterizes the clinical features of these relatively immunocompetent patients. STUDY DESIGN Retrospective study. RESULTS There were 45 cases with 23 male patients (51.1%) and a median age of 64 (range, 24-100 years). The lateral/ventral tongue was the affected site in 41 cases (91.1%), and 5 cases presented bilaterally. A review of the medical history and medications showed the most common conditions were hypertension (53.3%), hyperlipidemia (42.2%), and chronic respiratory conditions (33.3%); 8 patients (17.8%) had diabetes mellitus, and 1 had rheumatoid arthritis. Eleven cases (24.4%) reported no underlying medical conditions or history of medications. The most frequently reported medications included antihypertensive drugs (21.0%), steroid inhalers (14.6%), and cholesterol-lowering drugs (11.0%). CONCLUSIONS OHL is not exclusively seen in profoundly immunocompromised patients. Localized immunosuppression (from steroid inhalers) and immunosenescence (aging) are possible contributing factors.
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Affiliation(s)
- Asma Almazyad
- Maxillofacial Surgery and Diagnostic Sciences Department, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
| | - Lama Alabdulaaly
- Maxillofacial Surgery and Diagnostic Sciences Department, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Vikki Noonan
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Center of Oral Pathology, StrataDx, Lexington, MA, USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Center of Oral Pathology, StrataDx, Lexington, MA, USA; Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
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Vučićević Boras V, Vidović Juras D, Aurer I, Bašić-Kinda S, Mikulić M. GINGIVAL ULCERATIONS IN A PATIENT WITH ACUTE MYELOID LEUKEMIA: A case report and literature review. Acta Clin Croat 2019; 58:556-560. [PMID: 31969772 PMCID: PMC6971802 DOI: 10.20471/acc.2019.58.03.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 40-year-old female patient was admitted to the Department of Oral Medicine due to oral ulcerations. Oral ulcerations were present on vestibular mucosa above teeth 21, 22, 25 and 26 and were 1 cm in diameter, and also around teeth 45 and 46. The patient had prolonged neutropenia due to therapy-related myelodysplastic syndrome that progressed to therapy-related acute myeloid leukemia. Initially, the patient was successfully treated with polychemotherapy for non-Hodgkin lymphoma. Unfortunately, many toxic complications ensued, such as peripheral neuropathy, dilated cardiomyopathy and therapy-related myelodysplastic syndrome/therapy-related acute myeloid leukemia. The onset of therapy-related myelodysplastic syndrome was less than six months after initiation of chemotherapy treatment, which was rather early, but cytogenetic changes (monosomy 5 and 7) were consistent with the diagnosis. Upon admission to our Department, microbiological swabs were obtained and were all negative, while x-ray finding showed that ulcerations did not have dental cause. Biopsy was not obtained as the patient had severe neutropenia and thrombocytopenia. While viral and fungal swabs were negative, Stenotrophomonas maltophilia was cultured from the oral cavity. Thus, differential diagnoses are listed in this report. Neutropenic ulcerations did not heal albeit extensive medicamentous oral and systemic treatments were applied and the patient died.
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Affiliation(s)
| | - Danica Vidović Juras
- 1Department of Oral Medicine, School of Dental Medicine, University of Zagreb; 2Department of Oral Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Hematology, School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia; 4Croatian Bone Marrow Donor Registry, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Igor Aurer
- 1Department of Oral Medicine, School of Dental Medicine, University of Zagreb; 2Department of Oral Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Hematology, School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia; 4Croatian Bone Marrow Donor Registry, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Sandra Bašić-Kinda
- 1Department of Oral Medicine, School of Dental Medicine, University of Zagreb; 2Department of Oral Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Hematology, School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia; 4Croatian Bone Marrow Donor Registry, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Mirta Mikulić
- 1Department of Oral Medicine, School of Dental Medicine, University of Zagreb; 2Department of Oral Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Hematology, School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia; 4Croatian Bone Marrow Donor Registry, Zagreb University Hospital Centre, Zagreb, Croatia
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Flores-Hidalgo A, Lim SO, Curran AE, Padilla RJ, Murrah V. Considerations in the diagnosis of oral hairy leukoplakia-an institutional experience. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:232-235. [PMID: 29325854 DOI: 10.1016/j.oooo.2017.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We report here the 10-year experience with oral hairy leukoplakia (OHL) at the Division of Oral and Maxillofacial Pathology at the University of North Carolina at Chapel Hill, NC, USA. STUDY DESIGN All the associated hematoxylin and eosin and Epstein-Barr virus encoding region in situ hybridization slides of OHL cases between January 1, 2008, and February 1, 2017, were retrieved and reviewed. Collected demographic characteristics, clinical presentation, medical and social histories were reviewed and reported. RESULTS Six OHL cases with confirmed in situ hybridization showed predilection for the lateral tongue. The study included 3 females and 3 males (mean age 50.5 years; age range 29-70 years). One patient had known HIV-positive status before biopsy was performed. Three patients had reported a history of heavy smoking. Other medical conditions reported were history of breast cancer, a long history of corticosteroid inhaler use for asthma treatment, high cholesterol, diabetes, and hypertension. CONCLUSIONS The findings of this study indicate the need to include OHL as a potential entity in the differential diagnosis of leukoplakic tongue lesions, regardless of the patient's HIV status. In addition, the presence of OHL in the patient requires investigation of various explanations for EBV infection, including immunosuppression caused by HIV infection or chronic steroid use.
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Affiliation(s)
- Andres Flores-Hidalgo
- Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Si On Lim
- Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alice E Curran
- Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ricardo J Padilla
- Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie Murrah
- Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Davis G, Perks A, Liyanage P, Staines K. Oral hairy leukoplakia arising in a patient with hairy cell leukaemia: the first reported case. BMJ Case Rep 2017; 2017:bcr-2016-218663. [PMID: 28385698 DOI: 10.1136/bcr-2016-218663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oral hairy leukoplakia (OHL) is an oral mucosal lesion that is associated with Epstein-Barr virus infection. It commonly presents as an asymptomatic, non-removable white patch on the lateral borders of the tongue in individuals who are immunocompromised. Historically, OHL was thought to be pathognomonic of HIV infection; however, it is now an established phenomenon in a range of conditions affecting immune competence. Hairy cell leukaemia (HCL) is a rare chronic B cell lymphoproliferative disease named after the distinctive cytology of the atypical cells. We report the first case of OHL arising in an individual with HCL that resolved following remission of the haematological malignancy.
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Affiliation(s)
- Gemma Davis
- Oral Medicine, University of Bristol Dental Hospital, Bristol, UK
| | - Alexandra Perks
- Oral Medicine, University of Bristol Dental Hospital, Bristol, UK
| | - Pemith Liyanage
- Oral and Maxillofacial Pathology, University of Bristol Dental Hospital, Bristol, UK
| | - Konrad Staines
- Oral Medicine, University of Bristol Dental Hospital, Bristol, UK
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Guan H, Miao H, Ma N, Lu W, Luo B. Correlations between Epstein-Barr virus and acute leukemia. J Med Virol 2017; 89:1453-1460. [DOI: 10.1002/jmv.24797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/09/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Hongzai Guan
- Department of Hematology; Qingdao University Medical College; Qingdao China
| | - Hongxia Miao
- Department of Hematology; Qingdao University Medical College; Qingdao China
| | - Na Ma
- Department of Hematology; Ji Ning Medical College; Ji Ning China
| | - Wei Lu
- Department of Hematology; Qingdao University Medical College; Qingdao China
| | - Bing Luo
- Departmentof Microbiology; Qingdao University Medical College; Qingdao China
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Vigarios E, Fricain JC, Projetti F, Boulanger M, Sibaud V. [Oral hairy leukoplakia induced by topical steroids]. Ann Dermatol Venereol 2015; 142:572-6. [PMID: 26362131 DOI: 10.1016/j.annder.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/02/2015] [Accepted: 08/05/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral hairy leukoplakia (OHL) is an EBV-associated condition of the oral mucosa, which is often painless. It is found predominantly in HIV-positive patients and is considered a clinical indicator of immunosuppression. OHL has rarely been described in HIV-negative patients, being found most often in association with iatrogenic immunosuppression. OHL induced by topical steroids remains extremely rare. PATIENTS AND METHODS An 81-year-old HIV-negative woman, treated for 3 months with topical steroids for oral lichen planus, developed an asymptomatic white, corrugated, non-removable plaque with vertical folds on the lateral edge of the tongue. Associated oral candidiasis was noted. Based upon histological findings and in situ hybridisation showing numerous EBV-infected epithelial cells, a diagnosis of oral hairy leucoplakia was made. DISCUSSION AND CONCLUSION To our knowledge, we report herein only the second recorded case of OHL induced strictly by topical steroids. Self-medication and poor adherence to dosage recommendations were noted in the patient's medical history. Physicians must be aware of the rare but nevertheless possible adverse events associated with topical steroid use, particularly when such medication is prescribed over a long period for inflammatory diseases of the oral mucosa.
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Affiliation(s)
- E Vigarios
- Médecine bucco-dentaire, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France.
| | - J-C Fricain
- Chirurgie orale, consultation pluridisciplinaire de pathologies de la muqueuse buccale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; UFR d'odontologie, 16-20, cours de la Marne, 33082 Bordeaux cedex, France
| | - F Projetti
- Anatomie et cytologie pathologiques, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - M Boulanger
- UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France; Chirurgie orale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - V Sibaud
- Dermatologie, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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Chambers AE, Conn B, Pemberton M, Robinson M, Banks R, Sloan P. Twenty-first-century oral hairy leukoplakia--a non-HIV-associated entity. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:326-32. [PMID: 25600979 DOI: 10.1016/j.oooo.2014.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/10/2014] [Accepted: 11/19/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study presents the clinicopathologic features of a series (N = 35) of patients with non-human immunodeficiency virus (HIV)-associated oral hairy leukoplakia (OHL). METHODS Patients with non-HIV-associated OHL were identified from three centers. Epstein-Barr virus infection was demonstrated by using EBV early ribonucleic acid in situ hybridization. The presence of Candida co-infection was evaluated by diastase periodic acid-Schiff staining. The clinical features were determined by review of the medical records. RESULTS Twenty-eight patients had intercurrent respiratory problems requiring long-term steroid inhaler use, four suffered from autoimmune diseases requiring immunosuppressant therapy, and four had diabetes. The majority of lesions were located on the tongue, and 24 showed evidence of Candida co-infection. CONCLUSIONS In the twenty-first century, the presence of OHL should not be regarded as pathognomic for HIV infection or significant systemic immunosuppression. Local and systemic immunosuppression, in the form of steroid inhaler use, is a risk factor for the development of OHL.
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Affiliation(s)
- Anne Elizabeth Chambers
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of Cellular Pathology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK.
| | - Brenden Conn
- Royal Infirmary of Edinburgh, Department of Pathology, Royal Infirmary Edinburgh, Scotland
| | - Michael Pemberton
- University Dental Hospital of Manchester, Department of Oral Medicine, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, UK
| | - Max Robinson
- Newcastle University, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Rob Banks
- Sunderland Royal Hospital, Department of Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland, Tyne and Wear, UK
| | - Philip Sloan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of Cellular Pathology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK
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Epstein-Barr virus: dermatologic associations and implications: part I. Mucocutaneous manifestations of Epstein-Barr virus and nonmalignant disorders. J Am Acad Dermatol 2015; 72:1-19; quiz 19-20. [PMID: 25497917 DOI: 10.1016/j.jaad.2014.07.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/23/2014] [Accepted: 07/16/2014] [Indexed: 12/22/2022]
Abstract
Epstein-Barr virus (EBV) is a ubiquitous virus that has been implicated in a wide range of human diseases, many of which have mucocutaneous manifestations. As a member of the herpesviridae family, EBV causes lifelong infection by establishing latency in B lymphocytes. An intact immune response is critical in preventing progression of EBV disease, and the clinical manifestations of infection are dependent on the intricate relationship between virus and host immune system. This review provides a comprehensive overview of the epidemiology, pathophysiology, and diagnostic testing in EBV infection. In part I of this continuing medical education article, the mucocutaneous manifestations of EBV infection are reviewed with an emphasis on pathophysiology and management.
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Abstract
Epstein-Barr virus (EBV) is a human B-lymphotropic herpes virus and one of the most common viruses in humans. Specific skin signs related to EBV infection are the exanthem of mononucleosis, which is observed more frequently after ingestion of amoxicillin, and oral hairy leukoplakia, a disease occurring mostly in immunocompromised subjects with HIV infection. Other more uncommon cutaneous disorders that have been associated with EBV infection include virus-related exanthems or diseases such as Gianotti-Crosti syndrome, erythema multiforme, and acute genital ulcers. Other skin manifestations, not correlated to virus infection, such as hydroa vacciniforme and drug-induced hypersensitivity syndrome have also been linked to EBV. The putative involvement of EBV in skin diseases is growing similarly to other areas of medicine, where the role of EBV infection is being investigated in potentially debilitating inflammatory diseases. The prognosis of EBV infection in healthy, immunocompetent individuals is excellent. However, lifelong infection, which is kept in check by the host immune system, determines an unpredictable risk of pathologic unpredictable scenarios. In this review, we describe the spectrum of non-tumoral dermatological manifestations that can follow EBV primary infection or reactivation of EBV in childhood.
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Affiliation(s)
- Vito Di Lernia
- Unit of Dermatology, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
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Prasad JL, Bilodeau EA. Oral hairy leukoplakia in patients without HIV: presentation of 2 new cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e151-60. [PMID: 25096885 DOI: 10.1016/j.oooo.2014.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/10/2014] [Accepted: 05/04/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We report 2 cases of oral hairy leukoplakia (OHL) in patients without HIV and present a comprehensive review of OHL in HIV-negative individuals. STUDY DESIGN Two cases of non-HIV-associated OHL are described. A PubMed search identified previously reported cases. The attributes of those cases were ascertained. RESULTS OHL was confirmed in both of our cases. Both patients used inhaled steroids for pulmonary disorders, and were found to have depressed levels of immunoglobulin M. Additionally, 76 cases were identified in the literature. The condition occurred in association with various medical conditions, with the majority of patients on immunosuppressant medications (67 of 76). Systemic drugs were implicated most frequently. The condition has also been reported in healthy individuals (6 of 76). CONCLUSIONS Although thought of as an HIV/AIDS-associated condition, OHL can develop in patients without HIV, including healthy individuals. There is a strong correlation between the use of immunosuppressants and development of OHL in these patients.
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Affiliation(s)
- Joanne Leger Prasad
- Clinical Assistant Professor, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.
| | - Elizabeth Ann Bilodeau
- Assistant Professor, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
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Oral complications and management strategies for patients undergoing cancer therapy. ScientificWorldJournal 2014; 2014:581795. [PMID: 24511293 PMCID: PMC3910370 DOI: 10.1155/2014/581795] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/19/2013] [Indexed: 12/22/2022] Open
Abstract
With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given.
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Ahmed HG, Osman SI, Ashankyty IM. Incidence of Epstein-Barr virus in pediatric leukemia in the Sudan. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 12:127-31. [PMID: 22264774 DOI: 10.1016/j.clml.2011.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/02/2011] [Accepted: 11/14/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Results of several studies have suggested a probable etiologic association between Epstein-Barr virus (EBV) and leukemias; therefore, the aim of this study was to investigate the association of EBV in childhood leukemia. METHODS A direct isothermal amplification method was developed for detection of the latent membrane protein 1 (LMP1) of EBV in the peripheral blood of 80 patients with leukemia (54 had lymphoid leukemia and 26 had myeloid leukemia) and of 20 hematologically healthy control subjects. RESULTS EBV LMP1 gene transcripts were found in 29 (36.3%) of the 80 patients with leukemia but in none of the healthy controls (P < .0001). Of the 29 EBV(+) cases, 23 (79.3%), 5 (17.3%), and 1 (3.4%) were acute lymphoblastic leukemia, acute myeloid leukemia, and chronic myeloid leukemia, respectively. CONCLUSION EBV LMP1 gene transcriptional activity was observed in a significant proportion of patients with acute lymphoblastic leukemia. EBV infection in patients with lymphoid leukemia may be a factor involved in the high incidence of pediatric leukemia in the Sudan.
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Mosel DD, Bauer RL, Lynch DP, Hwang ST. Oral complications in the treatment of cancer patients. Oral Dis 2011; 17:550-9. [DOI: 10.1111/j.1601-0825.2011.01788.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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