Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Minimally Invasive Laser-Assisted Biopsy of the Oral Lesions for Oral Graft-Versus-Host Disease after Hematopoietic Stem-Cell Transplantation

조혈줄기세포이식후 발생한 이식편대숙주병의 구강병소에 대한 최소침습적 레이저조직생검 증례

  • Kim, Yun-Mi (Department of Advanced General Dentistry, College of Dentistry, Yonsei University) ;
  • Yun, Hee-Jung (Department of Advanced General Dentistry, College of Dentistry, Yonsei University) ;
  • Kim, Hyun-Sil (Department of Oral Pathology, College of Dentistry, Yonsei University) ;
  • Kim, Kee-Deog (Department of Advanced General Dentistry, College of Dentistry, Yonsei University) ;
  • Jung, Bock-Young (Department of Advanced General Dentistry, College of Dentistry, Yonsei University) ;
  • Pang, Nan-Sim (Department of Advanced General Dentistry, College of Dentistry, Yonsei University) ;
  • Park, Won-Se (Department of Advanced General Dentistry, College of Dentistry, Yonsei University)
  • 김윤미 (연세대학교 치과대학 통합진료학과) ;
  • 윤희정 (연세대학교 치과대학 통합진료학과) ;
  • 김현실 (연세대학교 치과대학 구강병리학교실) ;
  • 김기덕 (연세대학교 치과대학 통합진료학과) ;
  • 정복영 (연세대학교 치과대학 통합진료학과) ;
  • 방난심 (연세대학교 치과대학 통합진료학과) ;
  • 박원서 (연세대학교 치과대학 통합진료학과)
  • Received : 2012.04.20
  • Accepted : 2012.07.25
  • Published : 2012.09.30
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Abstract

Hematopoietic stem-cell transplantation (HSCT) is a treatment for immune deficiency, autoimmune diseases, and hematopoietic malignancies. The main complication of allogenic HSCT is graft-versus-host disease (GVHD). Oral mucosal biopsy is needed for a definitive diagnosis and treatment planning of GVHD, but this procedure causes bleeding and bacteremia in a poor general condition. We evaluated the efficacy of laser-assisted biopsy as a minimally invasive treatment. Three cases were described in this article. All patients' medical records, clinical photographs, and histopathologic findings were reviewed. All patients felt comfortable and no severe complications occurred. The quality of the obtained biopsy material was adequate for a definitive diagnosis of GVHD. Laser-assisted, minimally invasive biopsy of the oral mucosa does not cause bleeding, and it reduces the chances of infection, bacteremia, and postoperative scarring compared to the usual histopathologic biopsy procedure. It would thus be advantageous to use this procedure to biopsy GVHD patients.

조혈줄기세포이식은 면역 결핍 질환, 자가 면역 질환, 악성 조혈 종양의 주된 치료법이다. 이종 조혈줄기세포이식의 주요한 합병증은 이식편대 숙주질환이다. 구강 점막 생검은 이식편대 숙주 질환의 확진과 치료계획 수립을 위해 필요하나 영양 결핍과 화학 요법으로 인해 전신상태가 불량한 환자에게 출혈과 균혈증을 일으킨다. 본 논문에서는 레이저를 이용한 최소 침습적 조직생검의 효능을 평가하였다. 모두 3개의 증례가 소개되었고 모든 환자의 의료 기록, 임상 사진, 조직병리학적 결과가 레이저를 이용한 조직생검의 효능을 평가하기 위해 검토되었다. 모든 환자는 생검 후 불편감이 없었고 심각한 합병증이 발생하지 않았다. 생검 조직의 질이 이식편대 숙주 질환을 확진하는 데에 적당했다. 구강 점막의 레이저를 이용한 최소 침습적 생검은 통상의 조직병리학적 생검에 비해 출혈을 일으키지 않아 감염과 균혈증, 술 후 흉터 생성을 줄이므로 이식편대 숙주 질환의 확진에 이로울 것이다.

Keywords

References

  1. Schubert MM, Correa ME. Oral graft-versus-host disease. Dent Clin North Am 2008; 52(1):79-109, viii-ix. https://doi.org/10.1016/j.cden.2007.10.004
  2. Demarosi F, Lodi G, Carrassi A, Moneghini L, Sarina B, Sardella A. Clinical and histopathological features of the oral mucosa in allogeneic haematopoietic stem cell transplantation patients. Exp Oncol 2007; 29(4):304-308.
  3. Imanguli MM, Alevizos I, Brown R, Pavletic SZ, Atkinson JC. Oral graft-versus-host disease. Oral Dis 2008; 14(5):396-412. https://doi.org/10.1111/j.1601-0825.2008.01448.x
  4. Treister NS, Woo SB, O'Holleran EW, Lehmann LE, Parsons SK, Guinan EC. Oral chronic graft-versushost disease in pediatric patients after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2005; 11(9):721-731. https://doi.org/10.1016/j.bbmt.2005.06.002
  5. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet 2009; 373(9674): 1550-1561. https://doi.org/10.1016/S0140-6736(09)60237-3
  6. Filipovich AH, Weisdorf D, Pavletic S et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11(12):945-956. https://doi.org/10.1016/j.bbmt.2005.09.004
  7. Lee SJ, Vogelsang G, Gilman A et al. A survey of diagnosis, management, and grading of chronic GVHD. Biol Blood Marrow Transplant 2002; 8(1):32-39. https://doi.org/10.1053/bbmt.2002.v8.pm11846354
  8. Asai T. Burn in the mouth during oral laser surgery. Anaesthesia 1997; 52(8):806-807.
  9. Bradley PF. A review of the use of the neodymium YAG laser in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 1997; 35(1):26-35. https://doi.org/10.1016/S0266-4356(97)90005-X
  10. Deppe H, Horch HH. Laser applications in oral surgery and implant dentistry. Lasers Med Sci 2007; 22(4):217-221. https://doi.org/10.1007/s10103-007-0440-3
  11. Sohn DS, Lee JS, An KM, Romanos GE. Erbium, chromium:yttrium-scandium-gallium-garnet laserassisted sinus graft procedure. Lasers Med Sci 2009; 24(4):673-677. https://doi.org/10.1007/s10103-009-0645-8
  12. Apel C, Meister J, Ioana RS, Franzen R, Hering P, Gutknecht N. The ablation threshold of Er:YAG and Er:YSGG laser radiation in dental enamel. Lasers Med Sci 2002; 17(4):246-252. https://doi.org/10.1007/s101030200036
  13. Harashima T, Kinoshita J, Kimura Y et al. Morphological comparative study on ablation of dental hard tissues at cavity preparation by Er:YAG and Er,Cr:YSGG lasers. Photomed Laser Surg 2005; 23(1):52-55. https://doi.org/10.1089/pho.2005.23.52
  14. Ishii J, Fujita K, Komori T. Laser surgery as a treatment for oral leukoplakia. Oral Oncol 2003; 39(8): 759-769. https://doi.org/10.1016/S1368-8375(03)00043-5
  15. Ishikawa I, Aoki A, Takasaki AA. Potential applications of Erbium:YAG laser in periodontics. J Periodontal Res 2004; 39(4):275-285. https://doi.org/10.1111/j.1600-0765.2004.00738.x
  16. Zaffe D, Vitale MC, Martignone A, Scarpelli F, Botticelli AR. Morphological, histochemical, and immunocytochemical study of CO2 and Er:YAG laser effect on oral soft tissues. Photomed Laser Surg 2004; 22(3):185-189. https://doi.org/10.1089/1549541041438678
  17. Ball LM, Egeler RM. Acute GvHD: pathogenesis and classification. Bone Marrow Transplant 2008; 41 Suppl 2:S58-64. https://doi.org/10.1038/bmt.2008.56
  18. Nakamura S, Hiroki A, Shinohara M et al. Oral involvement in chronic graft-versus-host disease after allogeneic bone marrow transplantation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82(5):556-563. https://doi.org/10.1016/S1079-2104(96)80203-4
  19. Soares AB, Faria PR, Magna LA et al. Chronic GVHD in minor salivary glands and oral mucosa: histopathological and immunohistochemical evaluation of 25 patients. J Oral Pathol Med 2005; 34(6):368-373. https://doi.org/10.1111/j.1600-0714.2005.00322.x
  20. Shulman HM, Kleiner D, Lee SJ et al. Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report. Biol Blood Marrow Transplant 2006; 12(1):31-47.