Histopathologic and ultrastructural studies of oral mucosa with Candida infection

Eighteen oral mucosal biopsies with Candida infection were studied with light and electron microscopy. Under light microscopy, candidal infected oral mucosa was classified with epithelial hyperplasia, 15 cases and epithelial dysplasia, three cases. Four of 15 epithelial hyperplasias showed marked parakeratosis, and high grade acanthosis with many eosinophilic cells in the spinous cell layers. Epithelial dysplasia was characterized by atrophy of the spinous cell layers and increased nucleocytoplasmic ratio in the basal cell layers. Ultrastructurally, candidal infected oral mucosa showed numerous small desmosomes and the interdigitation of cytoplasmic membranes between spinous cells in both epithelial hyperplasia and epithelial dysplasia. Moreover, eosinophilic spinous cells, observed predominantly in epithelial hyperplasia showed intricate arrangement of dense tonofibrils. These ultrastructural findings seemed to give rise to mechanical strength between spinous cells in oral mucous epithelium with Candida infection. Results in this study suggest that excessive hyperplasia of candidal infected oral mucosa might be a protective reaction to the invasion of candidal pseudohyphae, but not associated with precancerous conditions.