Deskuamatif Gingivitis Bulgusu Olan Hastalıkların Tanısı İçin İdeal Biyopsi Tekniği Nedir?
Özet
Deskuamatif gingivitis (DG), diş etinde deskuamasyon, erezyon, ülser ve büllerle karakterize klinik bir terim olup; oral liken planus (OLP), müköz membran pemfigoid (MMP) ve pemfigus vulgaris (PV) gibi geniş bir hastalık spektrumunu kapsar. Bu hastalıkların doğru teşhisi, prognoz ve tedavi süreçlerinin belirlenmesi açısından kritik öneme sahiptir. Kesin tanı için klinik muayenenin yanı sıra laboratuvar incelemeleri gereklidir ve bu süreçte insizyonel biyopsi altın standart olarak kabul edilir. DG'li dokular oldukça frajil olduğundan biyopsinin her aşamasında teknik bir hassasiyet gösterilmelidir. Lokal anestezi dokunun içine değil, çevresine yapılmalı ve örnekler epitel kaybını önlemek adına lezyonun kenarındaki perilezyonel bölgelerden alınmalıdır. Biyopsi alımında bistüri, punch ve lazer gibi yöntemler kullanılmakta olup, histopatolojik inceleme için Hematoksilen-Eozin (HE) boyaması ile Direkt İmmünfloresan (DİF) çalışmalarının birlikte yürütülmesi önerilir. HE için örnekler formaldehitte, DİF için ise Michel solüsyonunda saklanır. Sonuç olarak, belirgin klinik bulguların yokluğunda, ayırıcı tanı ve displazi gibi önemli patolojilerin gözden kaçmaması adına HE ve DİF incelemelerinin kombine edilmesi en ideal yaklaşımı oluşturmaktadır.
Desquamative gingivitis (DG) is a clinical term characterized by desquamation, erosion, ulceration, and bullae on the gingiva, encompassing a wide spectrum of diseases such as oral lichen planus (OLP), mucous membrane pemphigoid (MMP), and pemphigus vulgaris (PV). Accurate diagnosis of these diseases is of critical importance for determining prognosis and treatment pathways. In addition to clinical examination, laboratory investigations are required for a definitive diagnosis, and incisional biopsy is accepted as the gold standard in this process. Since DG-affected tissues are highly fragile, technical precision must be maintained at every stage of the biopsy. Local anesthesia should be administered around the tissue rather than directly into it, and specimens must be obtained from perilesional areas at the margin of the lesion to prevent epithelial loss. Scalpel, punch, and laser methods are utilized in biopsy collection, and it is recommended to conduct Hematoxylin-Eosin (HE) staining concurrently with Direct Immunofluorescence (DIF) studies for histopathological evaluation. Specimens are preserved in formaldehyde for HE and in Michel's solution for DIF. In conclusion, in the absence of distinct clinical findings, combining HE and DIF examinations constitutes the most ideal approach to ensure differential diagnosis and to avoid overlooking significant pathologies such as dysplasia.
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