Análise clínico-histológica da queilite actínica: uma abordagem interexaminadores e correlação de áreas atróficas e não atróficas
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Data
2004-07-20
Autores
Bertini, Fernanda [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Uma desordem inflamatória crônica do lábio, decorrente da ação dos raios solares, é a entidade clínica conhecida internacionalmente por queilite actínica. Esta afecção acomete quase que exclusivamente pessoas brancas que têm atividades em ambientes externos ou que despendem muito tempo no sol. Devido à sua progressão lenta, o paciente relaciona o processo como uma decorrência do envelhecimento, ignorando sua natureza evolutiva e cancerizável, e, portanto, possibilitando sua transformação maligna. A QA é mais comum na forma crônica. No entanto, episódios agudos e subagudos podem acometer o indivíduo desencadeando uma reação inflamatória, caracterizada por edema, ulceração, sangramento e dor. O objetivo deste trabalho foi avaliar o perfil clínico do paciente portador de QA, assim como avaliar os fatores etiológicos envolvidos e comparar histologicamente áreas atróficas e não atróficas quanto à espessura de queratina, considerando: alterações do epitélio de revestimento (atrofia, hiperplasia e acantose), graus de atipias e o comportamento do tecido conjuntivo. Também foi avaliado o grau de acordo interexaminadores. Foram investigados 48 casos de QA. Dentre os aspectos clínicos presentes a alteração da linha de transição da semimucosa dos lábios com a pele se destacou por estar presente em 44 pacientes (91,67%). No nível do tecido conjuntivo, a presença de elastose solar foi notada em 100% dos casos associada a intensidades variadas de infiltrado inflamatório e vasodilatação. A presença de displasia epitelial também foi vista em quase todos os casos, a exceção de um. O grau de acordo interexaminadores através do teste Kappa variou de substancial a perfeito. Concluímos que clinicamente todas as lesões de QA tinham aspecto multifocal; a radiação actínica tem importante papel na etiologia da QA e hábitos como consumo de fumo e álcool...
A chronic inflammatory disorder of the lip, due to long-lasting solar ultra violet exposure, is worldly known as actinic cheilits (AC). This affection is present preponderantly in fairskinned people who have outdoor occupations or activities under prolonged exposure to sunlight. Due to its slow progression, the patient attributes his condition to the ageing process, ignoring its evolutive nature, permitting its malignant transformation. Actinic cheilitis is commonly seen in its chronic form. Nevertheless, acute and sub acute episodes may appear, triggering an inflammatory reaction, characterized by edema, ulceration, bleeding and pain. The scope of this study was to evaluate the patient clinical profile and the aetiologic factors involved, to compare histologically atrophic and nonatrophic areas, keratin covering thickness, epithelial changes (atrophy, hyperplasia and acanthosis), degrees of atipia, connective tissue behavior, and inter-observers agreement, as well. Forty eigth cases were studied. Among the clinical features presented, the loss of vermilion-skin demarcation was highlighted in 44 patients (91,67%). In the connective tissue, elastose was found in 100% of the patients with varied degrees of inflammatory infiltrate and vessel dilatation. The presence of dysplasia was also seen in the whole sample, but one. The interobservers agreement degree by Kappa varied from substantial to perfect. We conclude that all AC lesions had multicentric aspect; the actinic radiation had important role in the aetiology of (AC) and habits like using tobacco and alcohol, although without scientific comprovation, seem to participate in the development of this condition; non-atrophic areas showed high index of significance (p > 0.01) regarding to the loss of polarity the basal cells when compared to atrophic ones; and solar elastose, inflammatory infiltrate and vessel dilatation frequently observed, although with varied intensity and aspects.
A chronic inflammatory disorder of the lip, due to long-lasting solar ultra violet exposure, is worldly known as actinic cheilits (AC). This affection is present preponderantly in fairskinned people who have outdoor occupations or activities under prolonged exposure to sunlight. Due to its slow progression, the patient attributes his condition to the ageing process, ignoring its evolutive nature, permitting its malignant transformation. Actinic cheilitis is commonly seen in its chronic form. Nevertheless, acute and sub acute episodes may appear, triggering an inflammatory reaction, characterized by edema, ulceration, bleeding and pain. The scope of this study was to evaluate the patient clinical profile and the aetiologic factors involved, to compare histologically atrophic and nonatrophic areas, keratin covering thickness, epithelial changes (atrophy, hyperplasia and acanthosis), degrees of atipia, connective tissue behavior, and inter-observers agreement, as well. Forty eigth cases were studied. Among the clinical features presented, the loss of vermilion-skin demarcation was highlighted in 44 patients (91,67%). In the connective tissue, elastose was found in 100% of the patients with varied degrees of inflammatory infiltrate and vessel dilatation. The presence of dysplasia was also seen in the whole sample, but one. The interobservers agreement degree by Kappa varied from substantial to perfect. We conclude that all AC lesions had multicentric aspect; the actinic radiation had important role in the aetiology of (AC) and habits like using tobacco and alcohol, although without scientific comprovation, seem to participate in the development of this condition; non-atrophic areas showed high index of significance (p > 0.01) regarding to the loss of polarity the basal cells when compared to atrophic ones; and solar elastose, inflammatory infiltrate and vessel dilatation frequently observed, although with varied intensity and aspects.
Descrição
Palavras-chave
Patologia bucal, Tecido conjuntivo, Boca - histologia
Como citar
BERTINI, Fernanda. Análise clínico-histológica da queilite actínica: uma abordagem interexaminadores e correlação de áreas atróficas e não atróficas. 2004. 103 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Odontologia de São José dos Campos, 2004.