Clinical, histological and ultrastructural features of a possibly virus-induced oral leukoplakia

Two male patients with oral leukoplakias exhibiting a peculiar type of apparent dysplastic changes have been followed for 4 and 6 years, and a series of biopsies have been examined by light and electron microscopy. The apparent lack of normal epithelial stratification below the keratinized cell layers was mainly caused by the frequent appearance of large ballooned cells and multinuclear giant cells. The centre of the large ballooned cells contained aggregations of chromatin and evenly-dispersed microtubulus surrounded by a thick rim of tonofibril bundles. In the peripheral cytoplasm large numbers of smooth-surfaced endoplasmic reticulum were found, but no Golgi apparatus was observed. In addition, several autophagocytic bodies were recorded. Along the cell membrane only a few desmosomes were present, whereas aggregations of digested desmosomes were found in the cytoplasm. On the basis of the ultrastructural findings, it is suggested that the large ballooned cells represented epithelial cells arrested in early stages of mitotic division. The epithelial cells in interphase exhibited a normal ultrastructure except for large nucleoli with varying degrees of condensation of nucleolonema and vacuolization. Further, atypical dense granular aggregations and strands of fine fibrillar material were recorded in the nuclei. It is suggested that this new type of oral leukoplakia has a viral etiology.