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The different grading schemes for oral epithelial dysplasia

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The different grading schemes for oral epithelial dysplasia

  1. 1. grading schemes for oral epithelial dysplasia.
  2. 2. Hyperplasia Hyperplasia describes increased cell numbers. This may be in the spinous layer leading to hyperplasia of acanthosis in the basal⁄parabasal cell layers, termed basal cell hyperplasia. The architecture shows regular stratification and there is no cellular atypia.
  3. 3. Dysplasia • the term dysplasia applies when ; When architectural disturbance is accompanied by cytological atypia (variations in the size and shape of the keratinocytes)
  4. 4. The oral intraepithelial neoplasia (OIN) system uses terminology to emphasize that all levels of dysplasia are actually different levels of true neoplasia, prior to invasion. It does not consider simple epithelial hyperplasia to be part of the dysplasia process, since it can be seen in so many other disorders of the mucosa.
  5. 5. These features could be broadly categorized a: 1- changes to the architecture of the epithelium 2-those that manifest as cellular atypia. Conventionally dysplasia is divided into grades of: mild, moderate and severe.
  6. 6. Grades of dysplasia Mild dysplasia In general, architectural disturbance limited to the lower third of the epithelium, accompanied by minimal cytological atypia. defines the minimum criteria of dysplasia.
  7. 7. Mild
  8. 8. Moderate Architectural disturbance extending into the middle third of the epithelium is the initial criterion for recognizing this category. Consideration is then given to the degree of cytological atypia. The presence of marked atypia may indicate that a lesion should be categorized as severe dysplasia despite not extending into the upper third of the epithelium. Alternatively, lesions with mildly atypical features extending into the middle third of the epithelium may merit being graded as mild dysplasia.
  9. 9. Moderate
  10. 10. Severe Recognition of severe dysplasia starts with greater than two-thirds of the epithelium showing architectural disturbance with associated cytological atypia. However, Architectural disturbance extending into the middle third of the epithelium with sufficient cytological atypia is upgraded from moderate to severe dysplasia.
  11. 11. Severe
  12. 12. To sum up
  13. 13. References • Bouquot, J. E., Speight, P. M. and Farthing, P. M. (2006) ‘Epithelial dysplasia of the oral mucosa - Diagnostic problems and prognostic features’, Current Diagnostic Pathology, 12(1), pp. 11–21. doi: 10.1016/j.cdip.2005.10.008. • Fleskens, S. and Slootweg, P. (2009) ‘Grading systems in head and neck dysplasia: their prognostic value, weaknesses and utility.’, Head & neck oncology, 1, p. 11. doi: 10.1186/1758-3284-1-11. • Kujan, O. et al. (2006) ‘Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation’, Oral Oncology, 42(10), pp. 987–993. doi: 10.1016/j.oraloncology.2005.12.014. • Pitiyage, G. et al. (2009) ‘Molecular markers in oral epithelial dysplasia: Review’, Journal of Oral Pathology and Medicine, 38(10), pp. 737–752. doi: 10.1111/j.1600-0714.2009.00804.x. • Warnakulasuriya, S. (2001) ‘Histological grading of oral epithelial dysplasia: revisited’, The Journal of Pathology, 194(3), pp. 294–297. doi: 10.1002/1096-9896(200107)194:3<294::AID- PATH911>3.0.CO;2-Q. • Warnakulasuriya, S. et al. (2008) ‘Oral epithelial dysplasia classification systems: Predictive value, utility, weaknesses and scope for improvement’, Journal of Oral Pathology and Medicine, 37(3), pp. 127–133. doi: 10.1111/j.1600-0714.2007.00584.x.