1
|
Dou CB, Fu YH, Yu ZL, Jia J. Proliferative verrucous leukoplakia: Report of a case and literature review. Oral Oncol 2024; 150:106720. [PMID: 38350263 DOI: 10.1016/j.oraloncology.2024.106720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/03/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Chun-Bo Dou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; Dongfeng Stomatological Hospital, Hubei University of Medicine, 442000 Shiyan, China
| | - Yi-Hui Fu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 430079 Wuhan, China
| | - Zi-Li Yu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 430079 Wuhan, China.
| | - Jun Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 430079 Wuhan, China.
| |
Collapse
|
2
|
Pilana Vithanage Kalani Shihanika H, Nadisha P, Bogahawatte Samarakoon Mudiyanselage Samadarani S, Ruwan Duminda J, Sriyani P, Tilakaratne WM. Controversies in verruco papillary lesions of the oral cavity-A systematic review. Oral Dis 2023; 29:3049-3060. [PMID: 35801381 DOI: 10.1111/odi.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Verruco papillary lesions (VPL) in the oral cavity encompass a spectrum of lesions starting from benign, potentially malignant to entirely malignant tumors. Much of the controversies in these entities occur due to lack of consensus on the disease characteristics and the management. This systematic review was conducted to identify and describe different lesions categorized as VPL in the oral cavity and their association with malignancy. METHODS An electronic literature search was conducted in MEDLINE (via PubMed), Scopus, LILAC, IMSEAR, and CENTRAL databases, which retrieved a total of 1020 abstracts. These abstracts were managed through Rayyan and Mendeley software, and only 28 studies with high quality were included in the systematic review. RESULTS Studies were published from 1992 to 2021. From the extracted data, nine different entities under the umbrella term VPL were identified associated with malignancy. We describe the clinical and histopathological characteristics of these and propose a uniform framework for nomenclature. CONCLUSIONS Lack of well-planned research with adequate follow-up duration and inadequate quality standards are major barriers for the lack of evidence. The use of uniform nomenclature, as proposed in this study, and research at the molecular level will greatly reduce the controversies in understanding oral VPL associated with malignancy.
Collapse
Affiliation(s)
- Hettiarachchi Pilana Vithanage Kalani Shihanika
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Piyarathne Nadisha
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Jayasinghe Ruwan Duminda
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Perera Sriyani
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | |
Collapse
|
3
|
Alsoghier A, AlBagieh H, AlSahman L, Alshagroud R, AlSahman R. Proliferative verrucous/multifocal leukoplakia: Updates and literature review "case report". Medicine (Baltimore) 2023; 102:e33783. [PMID: 37233434 PMCID: PMC10219708 DOI: 10.1097/md.0000000000033783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
RATIONALE Proliferative verrucous leukoplakia (PVL) is a multifocal, slowly evolving lesion that resists all types of treatment and has a high propensity for malignant transformation into oral squamous cell carcinoma. Lack of awareness and acquaintance with white lesions of the oral cavity makes it difficult to diagnose. Besides being rare, PVL significantly aggressive, so clinicians need to be aware of it carefully. Therefore, it is recommended to have the earliest possible diagnosis and total excision of this lesion. We report this case to present typical clinical and histologic features of PVL so a For the purpose of sensitizing clinician. PATIENT CONCERN A 61-year-old female came to the clinic concerning of recurring painless, white patch on the tongue 2 months ago, associated with oropharyngeal dryness. DIAGNOSES This case satisfies these major and minor criteria to diagnosed PVL. INTERVENTION An excisional biopsy of the lesion was done to check for the presence of dysplasia, as lesions were persisting. Hemostasis was achieved with single interrupted sutures. OUTCOME no recurrence has been observed since excisional 1 year follow-up. LESSON The key feature is early detection, precisely in cases of PVL it is critical for better treatment outcomes, lifesaving, quality-of-life enhancement. To detect and treat any potential pathologies, clinicians should meticulously examine the oral cavity and patients have to be aware and informed of the importance of regular screenings. This lesion is resistant to the presently available treatment modalities; therefore, total excision with free surgical margins is critical combined with a lifelong follow-up.
Collapse
Affiliation(s)
- Abdullah Alsoghier
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University Riyadh, Riyadh, Saudi Arabia
| | - Hamad AlBagieh
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University Riyadh, Riyadh, Saudi Arabia
| | - Lujain AlSahman
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University Riyadh, Riyadh, Saudi Arabia
| | - Rana Alshagroud
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University Riyadh, Riyadh, Saudi Arabia
| | - Roba AlSahman
- Faculty of Dentistry, Royal College of Surgeons, Ireland, Dublin
| |
Collapse
|
4
|
Paglioni MDP, Khurram SA, Ruiz BII, Lauby-Secretan B, Normando AG, Ribeiro ACP, Brandão TB, Palmier NR, Lopes MA, da Silva Guerra EN, Meleti M, Migliorati CA, Carvalho AL, de Matos LL, Kowalski LP, Santos-Silva AR. Clinical predictors of malignant transformation and recurrence in oral potentially malignant disorders: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:573-587. [PMID: 36153299 DOI: 10.1016/j.oooo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We performed a systematic review dedicated to pooling evidence for the associations of clinical features with malignant transformation (MT) and recurrence of 3 oral potentially malignant disorders (OPMDs) (actinic cheilitis [AC], oral leukoplakia [OL], and proliferative verrucous leukoplakia [PVL]). STUDY DESIGN We selected studies that included clinical features and risk factors (age, sex, site, size, appearance, alcohol intake, tobacco use, and sun exposure) of OL, PVL, and AC associated with recurrence and/or MT. RESULTS Based on the meta-analysis results, non-homogeneous OL appears to have a 4.53 times higher chance of recurrence after treatment. We also found 6.52 higher chances of MT of non-homogeneous OL. Another clinical feature related to higher MT chances is the location (floor of the mouth and tongue has 4.48 higher chances) and the size (OL with >200 mm2 in size has 4.10 higher chances of MT). Regarding habits, nonsmoking patients with OL have a 3.20 higher chance of MT. The only clinical feature related to higher chances of MT in patients with PVL was sex (females have a 2.50 higher chance of MT). CONCLUSIONS Our study showed that some clinical features may indicate greater chances of recurrence after treatment and MT of OPMD.
Collapse
Affiliation(s)
- Mariana de Pauli Paglioni
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Syed Ali Khurram
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Blanca Iciar Indave Ruiz
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Béatrice Lauby-Secretan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Ana Gabriela Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Thais Bianca Brandão
- São Paulo Cancer Institute (ICESP), Dentistry Department, São Paulo, Brazil; Odontologia Oncológica D'or, São Paulo, Brazil
| | - Natália Rangel Palmier
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Marco Meleti
- Cantro Universitario di Odontoiatria-Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Leandro Luongo de Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School, São Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| |
Collapse
|
5
|
Barba-Montero C, Lorenzo-Pouso AI, Gándara-Vila P, Blanco-Carrión A, Marichalar-Mendía X, García-García A, Pérez-Sayáns M. Lichenoid areas may arise in early stages of proliferative verrucous leukoplakia: A long-term study of 34 patients. J Oral Pathol Med 2022; 51:573-581. [PMID: 35596256 PMCID: PMC9541998 DOI: 10.1111/jop.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/07/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Proliferative verrucous leukoplakia is considered an uncommon oral potentially malignant disorder with a high malignant transformation rate. The objective of this paper was to define its cancer incidence and related risk factors. Methods A retrospective audit of 34 patients diagnosed with proliferative verrucous leukoplakia from a university‐based unit, during the period from 1995 to 2019 was performed. The mean number of visits was 23 ± 18.6. The follow‐up was divided into four‐time intervals to evaluate the clinical presentation, number of lesions, dysplasia grade, and malignant transformation rate. Results The majority of patients were females 29 (85.3%), with verrucous component (77.8%), with a gingival presentation (31.8%), and with a preceding lichenoid area (44.1%). Eleven patients (32.4%) were affected by oral cancer during the follow‐up, developing a total of 15 carcinomas. The mean age of malignant transformation was 67.2 ± 12.9 years, particularly 8 ± 8.5 from the onset of the lesions. Warty forms presented a higher mean estimate for malignant transformation (15.2 years, 95% confidence interval 4.4–26 years) than nodular forms (1.9 years, 95% confidence interval 1.9–1.9) (p = 0.019). Patients with an initial proliferative verrucous leukoplakia diagnosis suffered a higher risk of malignancy, particularly 15.55 times (95% confidence interval 1.69–143.17; p = 0.015) than those who did present a preceding area with lichenoid morphology. Conclusion Proliferative verrucous leukoplakia presented a high malignant transformation rate and sometimes displayed preceding oral lichenoid areas in early stages. Further studies are needed to understand the impact of these lichenoid areas in proliferative verrucous leukoplakia progression.
Collapse
Affiliation(s)
- Catalina Barba-Montero
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain
| | - Alejandro Ismael Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain
| | - Pilar Gándara-Vila
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| | - Andrés Blanco-Carrión
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| | - Xabier Marichalar-Mendía
- Department of Nursing, Faculty of Medicine and Nursing, University of Basque Country, Leioa, Spain
| | - Abel García-García
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| |
Collapse
|
6
|
Lafuente Ibáñez de Mendoza I, Lorenzo Pouso AI, Aguirre Urízar JM, Barba Montero C, Blanco Carrión A, Gándara Vila P, Pérez Sayáns M. Malignant development of proliferative verrucous/multifocal leukoplakia: A critical systematic review, meta-analysis and proposal of diagnostic criteria. J Oral Pathol Med 2022; 51:30-38. [PMID: 34558734 DOI: 10.1111/jop.13246] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Proliferative verrucous/multifocal leukoplakia (PVML) is an oral potentially malignant disorder (OPMD) that exhibits high rates of malignant development (MD). This study aimed to analyse the risk of MD of PVML, as well as to investigate the possible risk factors associated with its malignization. METHODS A bibliographical search of the PubMed, Embase, Web of Science, and Scopus databases was conducted. PVML MD rates were calculated as a pooled proportion, and the risk factors were calculated as risk ratios, using fixed and random models based on the presence of heterogeneity. RESULTS From a total of 417 records, 16 articles were retrieved for inclusion. The subgroup analysis revealed a higher MD rate in the studies that were conducted in America, and, likewise, said studies involved a longer follow-up time (>6 years). There was a non-significant lower risk of malignization among males. A negative correlation was observed between MD and the year in which the studies were published. CONCLUSIONS The pooled MD of PVML was 65.8% (95% CI: 55.3-76.2, p < 0.001). Prospective studies of PVML must be designed using simple and universal clinical diagnostic criteria to be able to make an early diagnosis of this important OPMD and acknowledge the frequency of MD.
Collapse
Affiliation(s)
| | - Alejandro I Lorenzo Pouso
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes Group), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Catalina Barba Montero
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes Group), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Andrés Blanco Carrión
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes Group), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pilar Gándara Vila
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes Group), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Mario Pérez Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes Group), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| |
Collapse
|
7
|
Alkan U, Bachar G, Nachalon Y, Zlotogorsky A, Gal Levin E, Kaplan I. Proliferative verrucous leukoplakia: a clinicopathological comparative study. Int J Oral Maxillofac Surg 2022; 51:1027-1033. [DOI: 10.1016/j.ijom.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
|
8
|
Prognosis Parameters of Oral Carcinomas Developed in Proliferative Verrucous Leukoplakia: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13194843. [PMID: 34638327 PMCID: PMC8507842 DOI: 10.3390/cancers13194843] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary Proliferative verrucous leukoplakia is considered by the WHO as an oral potentially malignant disorder that presents the highest tendency to recurrence and malignant transformation rate. However, to date limited evidence-based prognostic data for oral carcinomas developed in patients with proliferative verrucous leukoplakia (PVL-OC) have been published, and these carcinomas probably perform better than conventional oral carcinomas. In this study we present a systematic review and meta-analysis to evaluate the current evidence in relation to the prognosis of oral carcinomas developed in patients PVL-OC. Abstract Proliferative verrucous leukoplakia (PVL) is contemplated by the World Health Organization (WHO) as an oral potentially malignant disorder (OPMD) with a high the highest malignant transformation ratio among all OPMD (approximately 50%). Our aim was to evaluate the current evidence in relation to the prognosis of oral carcinoma developed in patients with proliferative verrucous leukoplakia (PVL-OC). We searched PubMed, Embase, Web of Science and Scopus for published studies (upper date limit = June 2021). We evaluated the quality of studies (QUIPS tool). We carried out meta-analyses, examined inter-study heterogeneity through subgroup and meta-regression analyses, and performed sensitivity and small-study effects analyses to test the stability and reliability of results. 23 studies met inclusion criteria (505 patients with PVL, of which 288 developed a total of 504 carcinomas). The meta-analyzed overall mortality rate was 21.29% (pooled proportions [PP] = 95% confidence intervals [CI] = 8.77–36.36) for PVL-OC, clearly lower than the 34.7–50% mortality rate for conventional oral cancer reported in previous studies. In comparison with a single study reporting on conventional oral cancers, mortality was significantly lower for PVL-OC (hazard ratio = 0.29 [95%CI = 0.10–0.89], p = 0.03). Univariable meta-regression verified that case series that presented higher proportions of verrucous carcinomas showed a better survival of PVL-OC (p = 0.05), but not with higher proportion of oral squamous cell carcinomas (p = 0.74). Significant differences were not found for other relevant variables such as follow up period (p = 0.44) or multiple tumor development (p = 0.74). In conclusion, PVL-OC show favorable prognostic parameters, especially with regard to the mortality rate.
Collapse
|
9
|
Palaia G, Bellisario A, Pampena R, Pippi R, Romeo U. Oral Proliferative Verrucous Leukoplakia: Progression to Malignancy and Clinical Implications. Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13164085. [PMID: 34439238 PMCID: PMC8391406 DOI: 10.3390/cancers13164085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary Proliferative verrucous leukoplakia (PVL) was recognized in 2005 by the World Health Organization as a rare subtype of true oral leukoplakia, with unknown etiology. Since its first description in 1985, several diagnostic criteria have been proposed over the years. The aim of this systematic review is to investigate the percentage of patients diagnosed with proliferative verrucous leukoplakia who progressed to oral verrucous carcinoma (OVC) or conventional oral squamous cell carcinoma (OSCC). Abstract Aim: The aim of the present systematic review was to investigate the risk of malignant transformation of proliferative verrucous leukoplakia (PVL). Materials and Methods: the search was carried out using a combination of terms (leukoplakia OR leucoplakia) AND (multifocal OR proliferative) on the following databases: PubMed, Scopus, Web of Science (WOS Core Collection), Cochrane Library, selecting only articles published since 1985 and in the English language. Demographic, disease-related, and follow-up data extracted from the studies included in the qualitative synthesis were combined. Weighted means ± standard deviations were calculated for continuous variables, while categorical variables were reported as frequencies and percentages. Dichotomous outcomes were expressed as odd ratios (ORs) with 95% confidence intervals (CIs). Odd ratios for individual studies were combined using a random-effects meta-analysis, conducted using Review Manager 5.4 Software (Cochrane Community, Oxford, England). Results: twenty-two articles were included, with a total of 699 PVL patients, undergoing a mean follow-up of 7.2 years. Sixty-six percent of patients were females, with a mean age of 70.2 years, and 33.3% were males, with a mean age of 59.6 years. Most patients were non-smokers and non-alcohol users, and the gingiva/alveolar ridge mucosa was the most involved anatomical site by both PVL appearance and malignant transformation. A total of 320 PVL patients developed oral verrucous carcinoma (OVC) or conventional oral squamous cell carcinoma (OSCC) because of malignant transformation of PVL lesions (45.8%). A statistically significant 3.8-fold higher risk of progression to conventional OSCC was found compared to OVC in PVL patients, with women being 1.7 times more likely to develop oral cancer than men, as a consequence of PVL progression. Moreover, a statistically significant higher likelihood of developing conventional OSCC in female PVL patients than in males was found. In 46.5% of patients with PVL malignant transformation, multiple carcinomas, in different oral sites, occurred during follow-up. Conclusions: PVL is an aggressive lesion, which, in a high percentage of cases (almost 50%), undergoes malignant transformation, mainly toward OSCC. The female gender is most affected, especially in the elderly, with a negative history for alcohol and tobacco consumption.
Collapse
Affiliation(s)
- Gaspare Palaia
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy; (G.P.); (R.P.); (U.R.)
| | - Amelia Bellisario
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy; (G.P.); (R.P.); (U.R.)
- Correspondence:
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Roberto Pippi
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy; (G.P.); (R.P.); (U.R.)
| | - Umberto Romeo
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy; (G.P.); (R.P.); (U.R.)
| |
Collapse
|
10
|
Herreros-Pomares A, Llorens C, Soriano B, Zhang F, Gallach S, Bagan L, Murillo J, Jantus-Lewintre E, Bagan J. Oral microbiome in Proliferative Verrucous Leukoplakia exhibits loss of diversity and enrichment of pathogens. Oral Oncol 2021; 120:105404. [PMID: 34225130 DOI: 10.1016/j.oraloncology.2021.105404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/17/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Oral microbiome plays an important role in oral diseases. Among them, proliferative verrucous leucoplakia (PVL) is an uncommon form of progressive multifocal leukoplakia with a worryingly rate of malignant transformation. Here, we aimed to characterize the oral microbiome of PVL patients and compare it with those of healthy controls. MATERIAL AND METHODS Oral biopsies from ten PVL patients and five healthy individuals were obtained and used to compare their microbial communities. The sequence of the V3-V4 region of 16S rRNA gene was used as the taxonomic basis to estimate and analyze the composition and diversity of bacterial populations present in the samples. RESULTS Our results show that the oral microbial composition and diversity are significantly different among PVL patients and healthy donors. The average number of observed operational taxonomic units (OTUs) was higher for healthy donors than for PVL, proving a loss of diversity in PVL. Several OTUs were found to be more abundant in either group. Among those that were significantly enriched in PVL patients, potential protumorigenic pathogens like Oribacterium sp. oral taxon 108, Campylobacter jejuni, uncultured Eubacterium sp., Tannerella, and Porphyromonas were identified. CONCLUSION Oral microbiome dysbiosis was found in patients suffering from PVL. To the best of our knowledge, this is the first study investigating the oral microbiome alterations in PVL and, due to the limited number of participants, additional studies are needed. Oral microbiota-based biomarkers may be helpful in predicting the risks for the development of PVL.
Collapse
Affiliation(s)
- Alejandro Herreros-Pomares
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain; CIBERONC, Valencia, Spain
| | - Carlos Llorens
- Biotechvana, Parc Cientific, Universitat de València, Paterna, Valencia, Spain
| | - Beatriz Soriano
- Biotechvana, Parc Cientific, Universitat de València, Paterna, Valencia, Spain
| | - Feiyu Zhang
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain
| | - Sandra Gallach
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain; CIBERONC, Valencia, Spain; TRIAL Mixed Unit, Centro de Investigación Príncipe Felipe-Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain
| | - Leticia Bagan
- Medicina Oral Unit, Stomatology Department, Valencia University, Spain
| | - Judith Murillo
- Department of Stomatology and Maxillofacial Surgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Eloísa Jantus-Lewintre
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain; CIBERONC, Valencia, Spain; TRIAL Mixed Unit, Centro de Investigación Príncipe Felipe-Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain; Department of Biotechnology, Universitat Politècnica de València, Valencia, Spain.
| | - José Bagan
- CIBERONC, Valencia, Spain; Medicina Oral Unit, Stomatology Department, Valencia University, Spain; Department of Stomatology and Maxillofacial Surgery, Hospital General Universitario de Valencia, Valencia, Spain.
| |
Collapse
|
11
|
Ramos-García P, González-Moles MÁ, Mello FW, Bagan JV, Warnakulasuriya S. Malignant transformation of oral proliferative verrucous leukoplakia: A systematic review and meta-analysis. Oral Dis 2021; 27:1896-1907. [PMID: 34009718 DOI: 10.1111/odi.13831] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the available evidence on the malignant transformation (MT) of oral proliferative verrucous leukoplakia (PVL). MATERIAL AND METHODS We searched six main electronic and three grey literature databases in a two-phase process. Cohort studies investigating MT of PVL were eligible for inclusion. The risk of bias (RoB) was assessed using a specific tool developed by the Joanna Briggs Institute. Proportion meta-analyses were performed using a random-effects model. RESULTS Study selection resulted in the inclusion of 17 studies. The pooled proportion of MT was 43.87% (95% CI = 31.93-56.13). Females (64.02%, 95% CI = 54.87-72.75) were more affected by PVL than males (35.98%, 95% CI = 27.25-45.13). Gingiva (39.6%) and buccal mucosa (21.6%) were the most frequent PVL sites. No conclusive results were found between MT and sex or age distribution, tobacco, or alcohol consumption. Gingiva was the most common site for MT (39.9%), and the most frequent histopathological subtype was conventional squamous cell carcinoma (62.1%). Four studies were classified as low, nine as moderate, and four as high RoB. CONCLUSION The MT pooled proportion was 43.87%. Among OPMDs, PVL has the highest risk to transform to malignancy. Development and agreement on diagnostic criteria for PVL would reduce the heterogeneity among future studies.
Collapse
Affiliation(s)
- Pablo Ramos-García
- School of Dentistry, University of Granada, Granada, Spain.,Biohealth Research Institute (IBS), Granada, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, Granada, Spain.,Biohealth Research Institute (IBS), Granada, Spain
| | - Fernanda Weber Mello
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Jose V Bagan
- Oral Medicine, Valencia University, Valencia, Spain.,Department of Stomatology and Maxillofacial Surgery, Hospital General Universitario de Valencia, Valencia, Spain
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.,WHO Collaborating Centre for Oral Cancer, London, UK
| |
Collapse
|
12
|
Herreros-Pomares A, Llorens C, Soriano B, Bagan L, Moreno A, Calabuig-Fariñas S, Jantus-Lewintre E, Bagan J. Differentially methylated genes in proliferative verrucous leukoplakia reveal potential malignant biomarkers for oral squamous cell carcinoma. Oral Oncol 2021; 116:105191. [PMID: 33657465 DOI: 10.1016/j.oraloncology.2021.105191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/31/2020] [Accepted: 01/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To explore the pathophysiology of proliferative verrucous leucoplakia (PVL) through a methylated DNA immunoprecipitation and high-throughput sequencing (MeDIP-seq) case-control study. MATERIALS AND METHODS Oral biopsies from ten PVL patients and five healthy individuals were obtained and used to compare their epigenetic patterns. Network biology methods and integrative analyses of MeDIP-seq and RNAseq data were applied to investigate functional relations among differentially methylated genes (DMGs). The value of selected genes as malignant biomarkers was evaluated in a large cohort of oral squamous cell carcinoma (OSCC) patients from TCGA. RESULTS A total of 4647 differentially methylated regions were found, with a prominent state of hypermethylation in PVL patients. At the gene level, differentially methylated regions (DMRs) covered 826 genes with distinct roles, including transcription factors and binding proteins with functions in cell adhesion, migration, proliferation, regulation of transcription, bone morphogenesis, and cell signalling. Network analysis revealed three major hubs, two of them collecting proteins related to the response of the patients to PVL and treatment and one hub collecting proteins related to PVL and cancer. The integrative analysis revealed 8 genes (ARTN, CD8A, GATA3, HOXD10, MYO7A, OSR2, PLCB1, and SPOCK2) significantly upregulated in PVL compared to control and 5 genes (ANKRD6, DLG2, GPX3, PITX2, and ZNF736) significantly downregulated. The status of de-regulation found for PVL patients was concordant with what was found for OSCC samples compared to normal adjacent tissue. CONCLUSION Our findings show the potential of methylation markers in PVL and suggest novel OSCC diagnostic biomarkers which may boost the development of novel epigenetic-based therapies.
Collapse
Affiliation(s)
- Alejandro Herreros-Pomares
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain; CIBERONC, Valencia, Spain
| | - Carlos Llorens
- Biotechvana, Parc Cientific, Universitat de València, Paterna, Valencia, Spain
| | - Beatriz Soriano
- Biotechvana, Parc Cientific, Universitat de València, Paterna, Valencia, Spain
| | - Leticia Bagan
- Medicina Oral Unit, Stomatology Department, Valencia University, Spain
| | - Andrea Moreno
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain; TRIAL Mixed Unit, Centro de Investigación Príncipe Felipe-Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain
| | - Silvia Calabuig-Fariñas
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain; CIBERONC, Valencia, Spain; TRIAL Mixed Unit, Centro de Investigación Príncipe Felipe-Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain; Department of Pathology, Universitat de València, Valencia, Spain
| | - Eloísa Jantus-Lewintre
- Molecular Oncology Laboratory, Fundación Hospital General Universitario de Valencia, Valencia, Spain; CIBERONC, Valencia, Spain; TRIAL Mixed Unit, Centro de Investigación Príncipe Felipe-Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain; Department of Biotechnology, Universitat Politècnica de València, Valencia, Spain.
| | - José Bagan
- CIBERONC, Valencia, Spain; Medicina Oral Unit, Stomatology Department, Valencia University, Spain; Department of Stomatology and Maxillofacial Surgery, Hospital General Universitario de Valencia, Valencia, Spain.
| |
Collapse
|
13
|
Upadhyaya JD, Fitzpatrick SG, Islam MN, Bhattacharyya I, Narayana N, Cohen DM. Marginal linear gingival leukoplakia progressing to "ring around the collar"-An ominous sign of proliferative verrucous leukoplakia. J Periodontol 2020; 92:273-285. [PMID: 32725623 DOI: 10.1002/jper.19-0621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/30/2020] [Accepted: 04/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Potentially malignant lesions of the gingiva may frequently present as well-demarcated white lesions confined to the marginal gingiva. These lesions often become thick and verrucoid and spread along the marginal gingiva to encircle the tooth. Some cases of marginal gingival leukoplakia, over time, progress to extensively involve the gingiva fulfilling the criteria for proliferative verrucous leukoplakia (PVL). The objective of this study is to raise awareness of this pattern of leukoplakia by reporting a series of cases of marginal gingival leukoplakia. METHODS An Institutional Review Board approved retrospective search of University of Florida and University of Nebraska Medical Center oral biopsy services was performed for all gingival biopsies. Inclusion criteria included cases exhibiting marginal gingival leukoplakia, and with accompanying clinical images. RESULTS A total of 30 cases of marginal gingival leukoplakia were included. All cases presented as well-demarcated leukoplakias, either on the buccal or lingual gingival margin, or circumferentially forming a "ring around the collar" of single or multiple teeth. Eight patients had recurrent lesions and 12 had multifocal involvement. Six of the 12 patients with multifocal involvement presented with a "ring around the collar." The histopathologic diagnoses were representative of benign lesions in seven cases, premalignant in 13, and malignant or suggestive of malignancy in 10 cases. Seven patients had carcinoma at the time of first biopsy, whereas 6 cases showed progression at time of follow-up. CONCLUSION This study aims to raise awareness that marginal gingival leukoplakia may represent potentially malignant lesions, and if circumferential and/or thick, may be the first manifestation of PVL.
Collapse
Affiliation(s)
- Jasbir D Upadhyaya
- Department of Applied Dental Medicine, Section of Diagnostic Sciences, Southern Illinois University School of Dental Medicine, Alton, IL
| | - Sarah G Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL
| | - Nagamani Narayana
- Department of Oral Biology, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL
| |
Collapse
|
14
|
Bugshan A, Farooq I. Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis. F1000Res 2020; 9:229. [PMID: 32399208 PMCID: PMC7194458 DOI: 10.12688/f1000research.22941.1] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a commonly occurring head and neck cancer. It has a high prevalence in certain parts of the world, and is associated with a high mortality rate. In this review, we describe metastasis related to OSCC, and disorders that could lead to OSCC with common etiological factors. In addition, a brief account of the diagnosis of OSCC and role of salivary biomarkers in its early detection has also been highlighted. Google Scholar and PubMed search engines were searched with keywords including “oral squamous cell carcinoma”, “OSCC”, “oral cancer”, “potentially malignant disorders in oral cavity”, “etiological factors of OSCC”, “diagnosis of OSCC”, and “salivary biomarkers and OSCC” to gather the literature for this review. The review concludes that OSCC has the potential for regional as well as distant metastasis, and many potentially malignant diseases can transform into OSCC with the help of various etiological factors. Diagnosis of OSCC involves traditional biopsy, but salivary biomarkers could also be utilized for early recognition.
Collapse
Affiliation(s)
- Amr Bugshan
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Imran Farooq
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| |
Collapse
|
15
|
Torrejon-Moya A, Jané-Salas E, López-López J. Clinical manifestations of oral proliferative verrucous leukoplakia: A systematic review. J Oral Pathol Med 2020; 49:404-408. [PMID: 31990082 DOI: 10.1111/jop.12999] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/08/2020] [Accepted: 01/20/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this systematic review was to gather the available evidence about proliferative verrucous leukoplakia. This systematic review was conducted to answer the question: "What are the main clinical features of PVL patients?". MATERIAL AND METHODS A systematic review of the literature was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. An electronic research was carried out using different electronic databases; PubMed, and Scopus. Inclusion criteria were papers which reported at least 10 patients with proliferative verrucous leukoplakia and were published not more than 10 years ago. RESULTS A total of 285 records were identified through databases, although only 6 of them were eligible. Most patients were women, above 60 years of age (67.4). Additionally, 28 of them were non-smokers (66.6%) and 24 were non-habitual drinkers (57.1%). The most common locations were gingiva (50.9%), buccal mucosa (44.9%), and tongue (40.6%) CONCLUSION: Level C can be established to conclude the proliferative verrucous leukoplakia demographic data, risk factors, malignant transformation, and location. A strict follow-up on these patients should be mandatory, even after surgical management since they have a high recurrence rate and a malignant transformation.
Collapse
Affiliation(s)
- Aina Torrejon-Moya
- Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Enric Jané-Salas
- School of Dentistry, University of Barcelona, Spain/Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
| | - José López-López
- School of Dentistry, University of Barcelona, Spain/Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
| |
Collapse
|
16
|
Iocca O, Sollecito TP, Alawi F, Weinstein GS, Newman JG, De Virgilio A, Di Maio P, Spriano G, Pardiñas López S, Shanti RM. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck 2019; 42:539-555. [PMID: 31803979 DOI: 10.1002/hed.26006] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Potentially malignant disorders of the oral cavity (OPMD) are a heterogeneous group of lesions associated with a variable risk of malignant transformation (MT) to invasive cancer. Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral erythroplakia (OE), oral submucous fibrosis (OSF), and proliferative verrucous leukoplakia (PVL) are among the most common of these lesions. Oral dysplasia is a mucosal area characterized by cellular and architectural derangement, which may be associated with OPMDs or not. OBJECTIVE To define the MT rate of OPMDs and the risk of development into cancer of mild vs moderate/severe oral dysplasia. This in order to implement adequate follow-up strategies and treatment decisions. STUDY DESIGN We performed a systematic review and meta-analysis on studies reporting the MT rates of OPMDs and oral dysplasia. Ninety-two studies were included for the analysis. Cumulative rates were reported for OPMDs overall and as a subgroup, a comparison was made of mild vs moderate/severe dysplasia. Meta-regression on OPMD and year of publication was also performed. MAIN OUTCOME AND MEASURES Overall MT rates of OPMDs and odds ratio of MT of mild vs moderate/severe dysplasia. RESULTS Overall MT rate across all OPMD groups was 7.9% (99% confidence interval [CI] 4.9%-11.5%). MT rates of the specific OPMD subgroups were as follows: LP 1.4% (99% CI 0.9%-1.9%), LE 9.5 (5.9%-14.00%), OLL 3.8% (99% CI 1.6%-7.00%), OSF 5.2% (99% CI 2.9%-8.00%), OE 33.1% (99% CI 13.6%-56.1%), and PVL 49.5% (99% CI 26.7%-72.4%). Regarding the dysplasia grades comparison, the meta-analysis showed that moderate/severe dysplasia is meaningfully associated to a much greater risk of MT compared to mild dysplasia with an odds ratio of 2.4 (95% CI 1.5-3.8) [Correction added on 27 December 2019, after first online publication: CI updated from 99% to 95%.]. Heterogeneity was not significant. Annual MT rates were approximated based on the average follow-up as reported in the various subgroups. Lichen planus had an annual MT of 0.28%, OLL of 0.57%, leukoplakia of 1.56%, PVL of 9.3%, and OSF of 0.98%. Mild dysplasia had an annual MT of 1.7%, while severe dysplasia of 3.57%. Meta-regression showed a significant negative correlation of PVL MT rate and year of the study (P value <.001). CONCLUSIONS AND RELEVANCE OPMDs and oral dysplasia are relatively common conditions that general practitioners, head and neck, and oral medicine specialists, face in their everyday practice. Our analysis confirms the significant risk of MT of these lesions, although variable among the subgroups. Moderate/severe dysplasia bears a much higher risk of cancer evolution than mild dysplasia. It is important to raise public health awareness on the MT rates of these conditions, at the same time efficacious communication with the patient is of utmost importance. This, coupled with strict follow-up measures and optimal treatment strategies, would help in reducing the transformation of these oral conditions into invasive cancer.
Collapse
Affiliation(s)
- Oreste Iocca
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Faizan Alawi
- Department of Pathology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Gregory S Weinstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Armando De Virgilio
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Pasquale Di Maio
- Giovanni Borea Civil Hospital, Department of Otolaryngology-Head and Neck Surgery, Sanremo, Italy
| | - Giuseppe Spriano
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Simón Pardiñas López
- Periodontology and Oral Surgery, Clínica Médico Dental Pardiñas, Cell Therapy and Regenerative Medicine Group, Centre for Advanced Scientific Research (CICA) and Biomedical Research Institute of A Coruña (INIBIC) Strategic Group, Universidade da Coruña (UDC), University Hospital Complex of A Coruña (CHUAC), Galician Health Service (SERGAS), A Coruña, Spain
| | - Rabie M Shanti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA
| |
Collapse
|
17
|
Proliferative Verrucous Leukoplakia of the Gingiva: An Early Lesion Refractory to Surgical Excision. Case Rep Dent 2019; 2019:5785060. [PMID: 31772784 PMCID: PMC6854949 DOI: 10.1155/2019/5785060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 11/20/2022] Open
Abstract
This report describes a case of proliferative verrucous leukoplakia (PVL) of the gingiva with no discernible aetiology, which presented in a 36-year-old female. The initial nonscrapable gingival lesion was treated with CO2 laser ablation, and the histopathological evaluation was carried out. The presence of koilocytic cells in the superficial epithelium led to immunohistochemical investigations with p16 antibody, which showed strong nuclear positivity and slight cytoplasmic positivity in >50% of the cells with >25% confluency. However, it was not possible to confirm the presence of HPV infection with further investigations due to logistic reasons. The lesion recurred twice within a short time despite the surgical resection following the first recurrence. Thus, this paper presents a case of proliferative verrucous leukoplakia, which demonstrated a significant resistance to routine treatment protocols recommended in the management of such lesions.
Collapse
|
18
|
Clinicopathologic analysis of verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma as part of the clinicopathologic spectrum of oral proliferative verrucous leukoplakia: A literature review and analysis. Pathol Res Pract 2019; 215:152670. [PMID: 31630872 DOI: 10.1016/j.prp.2019.152670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Proliferative verrucous leukoplakia is classified as a potentially malignant disorder because of its high rate of malignant transformation. PVL progresses in a series of clinical stages where the early stage represents multiple, multifocal leukoplakias with a high recurrence rate. The intermediate and late stages are clinically exophytic lesion, diagnosed microscopically as verrucous hyperplasia that often progresses into verrucous carcinoma and/or squamous cell carcinoma. There is no single histologic definition and the diagnosis is retrospective following observed progression of the disorder. The goal of the current study was to conduct a literature review and analysis of PVL in the later stages to gain further knowledge on their clinicopathologic features. DATA SOURCES Medline's PubMed and Google Scholar were searched for adequately documented cases from 1985 to 2018. References of published articles were searched for additional cases. REVIEW METHODS Overall, 57 manuscripts were analyzed. 35/57 manuscripts provided adequate data on the clinicopathologic features in the premalignant and malignant stages. RESULTS Malignant transformation rate was 50% (average of 57 months). Gingiva, palate and buccal mucosa were the most common locations. Clinicopathologic features included; well differentiated carcinoma (78%), perineural invasion (3%), lymph node metastasis (4%); distant metastasis (0%), average duration of illness (65 months), DOD-dead of disease (44%). Moderate dysplasia, severe dysplasia and carcinoma in situ were exceptionally uncommon in the premalignant stages (0.8%). CONCLUSION Prognostic factors such as perineural invasion, lymph node metastasis and distant metastasis were uncommon occurrences which may have practical implications on treatment. Further studies are needed to substantiate our findings.
Collapse
|
19
|
Second primary tumors in proliferative verrucous leukoplakia: a series of 33 cases. Clin Oral Investig 2019; 24:1963-1969. [PMID: 31440840 DOI: 10.1007/s00784-019-03059-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe the number of second primary malignancies in a series of 33 patients with proliferative verrucous leukoplakia (PVL), detailing the mean time between primary malignancies and their clinical characteristics. MATERIALS AND METHODS Two groups of patients were included in this study: group 1 comprised 33 PVL patients who had developed ≥ 2 oral squamous cell carcinoma (OSCC) and group 2 comprised 48 PVL patients without malignant degeneration. We compared the groups with regard to age, gender, oral location, and number of oral sites affected. For patients in group 1, we determined the locations, clinical forms, and TNM stages of oral cancers. We also recorded the intervals of time between instances of oral cancer for all patients. RESULTS The groups did not differ significantly in age; however, group 1 included more women (p < 0.05). The follow-up period and number of oral PVL locations were greater in group 1 (p < 0.01). Moreover, in group 1, as the number of OSCCs increased, the intervals between them became shorter. The gingiva was the most common site. The mean number of cancers in group 1 was 3.15; five second primary tumors were diagnosed in one patient. CONCLUSIONS Multiple cancers in PVL patients were more frequently located on the gingiva in the form of erythroleukoplastic areas. In addition, the interval between new cancers decreased over time. CLINICAL RELEVANCE This is the series with the highest number of cases described with second primary tumors in PVL.
Collapse
|
20
|
Bagan J, Murillo‐Cortes J, Leopoldo‐Rodado M, Sanchis‐Bielsa JM, Bagan L. Oral cancer on the gingiva in patients with proliferative leukoplakia: A study of 30 cases. J Periodontol 2019; 90:1142-1148. [DOI: 10.1002/jper.18-0620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/26/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Jose Bagan
- Oral Medicine University of ValenciaStomatology and Maxillofacial Surgery, University General HospitalFundación de Investigación Hospital General Valencia Valencia Spain
| | - Judith Murillo‐Cortes
- Maxillofacial SectionService of Stomatology and Maxillofacial Surgery University General Hospital Valencia Spain
| | - Manuel Leopoldo‐Rodado
- Service of Stomatology and Maxillofacial Surgery University General Hospital Valencia Spain
| | - Jose M. Sanchis‐Bielsa
- Service of Stomatology and Maxillofacial Surgery University General Hospital Valencia Spain
| | | |
Collapse
|
21
|
Bombeccari GP, Garagiola U, Candotto V, Pallotti F, Carinci F, Giannì AB, Spadari F. Diode laser surgery in the treatment of oral proliferative verrucous leukoplakia associated with HPV-16 infection. Maxillofac Plast Reconstr Surg 2018; 40:16. [PMID: 30105220 PMCID: PMC6064714 DOI: 10.1186/s40902-018-0156-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 12/29/2022] Open
Abstract
Background Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation. Evidence-based information regarding optimal PVL management is lacking, due to the paucity of data. The present report describes a case of PVL associated with HPV-16 infection and epithelial dysplasia treated by diode laser surgery, and the outcome of disease clinical remission over a 2-year follow-up period. Case report A 61-year-old Caucasian male with oral verrucous hyperkeratosis presented for diagnosis. The lesions were localized on the maxillary gingiva and palatal alveolar ridge. Multiple biopsy specimens have been taken by mapping the keratotic lesion area. Microscopic examination was compatible with a diagnosis of PVL with focal mild dysplasia, localized in the right maxillary gingiva. Polymerase chain reaction (PCR) was done for human papillomavirus (HPV) detection which revealed presence of HPV DNA, and the genotype revealed HPV 16 in the sample. The PVL in the right gingival area was treated on an outpatient basis by excision with a diode laser. This approach resulted in good clinical response and decreased morbidity over a 2-year follow-up period. Conclusions This case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and HPV-16 infection.
Collapse
Affiliation(s)
- Gian Paolo Bombeccari
- 1Maxillo-Facial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Della Commenda 10, 20122 Milan, Italy
| | - Umberto Garagiola
- 1Maxillo-Facial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Della Commenda 10, 20122 Milan, Italy
| | - Valentina Candotto
- 1Maxillo-Facial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Della Commenda 10, 20122 Milan, Italy
| | - Francesco Pallotti
- 2Unit of Anatomical Pathology, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Carinci
- 3Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Aldo Bruno Giannì
- 1Maxillo-Facial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Della Commenda 10, 20122 Milan, Italy
| | - Francesco Spadari
- 1Maxillo-Facial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Della Commenda 10, 20122 Milan, Italy
| |
Collapse
|
22
|
Bombeccari GP, Giannì AB, Pallotti F, Spadari F. Oral proliferative verrucous leukoplakia: A challenge for clinical management. Head Neck 2018; 40:1605-1606. [DOI: 10.1002/hed.25322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/09/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Gian Paolo Bombeccari
- Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Aldo Bruno Giannì
- Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Francesco Pallotti
- Unit of Anatomical Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; University of Milan; Milan Italy
| | - Francesco Spadari
- Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| |
Collapse
|
23
|
Villa A, Menon RS, Kerr AR, De Abreu Alves F, Guollo A, Ojeda D, Woo SB. Proliferative leukoplakia: Proposed new clinical diagnostic criteria. Oral Dis 2018; 24:749-760. [PMID: 29337414 DOI: 10.1111/odi.12830] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/13/2017] [Accepted: 01/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to characterize proliferative verrucous leukoplakia (PVL) from a clinical and histopathological standpoint and suggest an updated classification. SUBJECTS AND METHODS Records of patients seen at three oral medicine centers with a clinical diagnosis of PVL were reviewed for clinical and histopathological features and malignant transformation (MT). RESULTS There were 42 patients (median age: 69 years [range: 36-88]; 35 females). 12.2% were current smokers. Family history of cancer was present in 43.7% of patients. Partial demarcation of lesion margins was present in 31.3% of lesions, followed by verrucous (27.5%), smooth (22.7%) erythematous (22.3%), and fissured (18.3%) appearance. Large and contiguous and multisite and non-contiguous lesions comprised 57.1% (24/42) and 35.7% (15/42) of PVL cases, respectively. 19.1% had prominent erythema (erythroleukoplakia). The most common histopathological diagnosis at first visit was hyperkeratosis without dysplasia (22/42; 56.4%). MT occurred in 71.4% patients after a median of 37 months [range: 1-210] from initial visit; erythroleukoplakia exhibited MT in 100% of cases. CONCLUSION The generic term "proliferative leukoplakia (PL)" may be more appropriate than PVL because 18.3% were fissured and 22.7% erythematous. We also propose the term proliferative erythroleukoplakia to more accurately describe the subset of PL with prominent erythema, which had the highest MT rate.
Collapse
Affiliation(s)
- A Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - R S Menon
- Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - A R Kerr
- Department of Oral & Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY, USA
| | - F De Abreu Alves
- Stomatology Department at AC Camargo Cancer Center, Sao Paulo, Brazil
| | - A Guollo
- Stomatology Department at AC Camargo Cancer Center, Sao Paulo, Brazil
| | - D Ojeda
- Department of Comprehensive Dentistry, School of Dentistry, UT Health San Antonio, San Antonio, TX, USA
| | - S B Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| |
Collapse
|
24
|
Gupta RK, Rani N, Joshi B. Proliferative verrucous leukoplakia misdiagnosed as oral leukoplakia. J Indian Soc Periodontol 2018; 21:499-502. [PMID: 29551871 PMCID: PMC5846249 DOI: 10.4103/jisp.jisp_189_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Correct diagnosis of white lesions of the oral cavity is sometimes difficult, because some oral white lesions behave differently and tend to change their appearance with time. Clinicians often wrongly diagnose such lesions as oral leukoplakias and treat simply. Lesions recur and turn malignant. Proliferative verrucous leukoplakia (PVL) is a distinct form of oral leukoplakia characterized by a high recurrence rate and high rate of transformation into oral squamous cell carcinoma. We present herein a case of PVL which was misdiagnosed as oral leukoplakia and progressed to oral carcinoma.
Collapse
Affiliation(s)
- Rajesh Kumar Gupta
- Department of Periodontology and Oral Implantology, Bhojia Dental College and Hospital, Budh, Baddi, Himachal Pradesh, India
| | - Nidhi Rani
- Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharat Joshi
- Department of Periodontology, Swami Devi Dyal Dental College and Hospital, Barwala, Haryana, India
| |
Collapse
|
25
|
Speight PM, Khurram SA, Kujan O. Oral potentially malignant disorders: risk of progression to malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:612-627. [PMID: 29396319 DOI: 10.1016/j.oooo.2017.12.011] [Citation(s) in RCA: 261] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
Abstract
Oral potentially malignant disorders (OPMDs) have a statistically increased risk of progressing to cancer, but the risk varies according to a range of patient- or lesion-related factors. It is difficult to predict the risk of progression in any individual patient, and the clinician must make a judgment based on assessment of each case. The most commonly encountered OPMD is leukoplakia, but others, including lichen planus, oral submucous fibrosis, and erythroplakia, may also be seen. Factors associated with an increased risk of malignant transformation include sex; site and type of lesion; habits, such as smoking and alcohol consumption; and the presence of epithelial dysplasia on histologic examination. In this review, we attempt to identify important risk factors and present a simple algorithm that can be used as a guide for risk assessment at each stage of the clinical evaluation of a patient.
Collapse
Affiliation(s)
- Paul M Speight
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Syed Ali Khurram
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| |
Collapse
|
26
|
Whitefield S, Raiser V, Shuster A, Kleinman S, Shlomi B, Kaplan I. The Spectrum of Oral Lesions Presenting Clinically With Papillary-Verrucous Features. J Oral Maxillofac Surg 2017; 76:545-552. [PMID: 28923272 DOI: 10.1016/j.joms.2017.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We sought to study the spectrum of oral pathologies presenting clinically with papillary-verrucous features. MATERIALS AND METHODS A 10-year (2007 to 2016) retrospective study of oral papillary lesions was undertaken. All biopsy reports that included a clinical description of papillary or verrucous architecture were retrieved. The data collected included clinical features, size, color, location, histopathologic diagnosis, age, and gender. RESULTS The study included 137 patients, with a total of 150 lesions. The ages ranged from 10 weeks to 84 years (mean, 49 years). Histopathologically, 60% of cases were human papillomavirus (HPV) related, 19% showed hyperplasia, 11% had hyperplastic candidiasis, 7% were dysplastic or malignant, and 3% were benign of unknown etiology. Among the 7% of lesions diagnosed with dysplasia or malignancy, only 60% were suspected to have malignancy at the time of biopsy. HPV-related lesions and hyperplasia were most frequently found on the tongue (38% and 41%, respectively) and soft palate (21% and 14%, respectively). Hyperplastic candidiasis was most frequently found on the buccal mucosa and tongue (35% and 24%, respectively). Squamous cell carcinoma was found in 1.3% of total lesions and verrucous carcinoma in 1.3%. Of the verrucous or papillary malignant lesions, 50% were found on the gingiva. Most malignant lesions occurred in the 40- to 60-year age group. CONCLUSIONS The results of this study suggest that, because of the wide spectrum of entities presenting clinically with a papillary-verrucous architecture, biopsy is necessary for diagnosis. The clinical presentation allowed for overall accurate diagnosis in only 47% of cases and 60% accuracy in dysplastic or malignant cases. It is of considerable importance to correctly identify those lesions that are HPV related but at the same time to rule out those lesions that are unrelated to HPV to help alleviate a patient's anxiety. Most important, biopsy is mandatory for the recognition of malignant lesions with a papillary-verrucous architecture, which may mimic other benign entities in the group of papillary-verrucous lesions.
Collapse
Affiliation(s)
- Sara Whitefield
- Resident in Oral Medicine and Private Practitioner, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Vadim Raiser
- Head of Maxillofacial Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Shuster
- Attending Surgeon, Goldschleger School of Dental Medicine, Tel Aviv University, and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shlomi Kleinman
- Senior Surgeon, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Benjamin Shlomi
- Former Head of Maxillofacial Unit (Retired), Goldschleger School of Dental Medicine, Tel Aviv University, and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilana Kaplan
- Professor and Oral Pathologist, Goldschleger School of Dental Medicine and Sackler School of Medicine, Tel Aviv University, and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
27
|
Capella DL, Gonçalves JM, Abrantes AAA, Grando LJ, Daniel FI. Proliferative verrucous leukoplakia: diagnosis, management and current advances. Braz J Otorhinolaryngol 2017; 83:585-593. [PMID: 28209441 PMCID: PMC9444738 DOI: 10.1016/j.bjorl.2016.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/17/2016] [Accepted: 12/08/2016] [Indexed: 01/04/2023] Open
Abstract
Introduction Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. Objective To analyze the studies about Proliferative verrucous leukoplakia and develop a concise update. Methods A Pubmed search identifying studies (laboratory research, case series and reviews of literature) that examined patients with Proliferative verrucous leukoplakia was realized. Results There are not enough studies about Proliferative verrucous leukoplakia in the literature. The few found studies not present a consensus about its etiology and diagnosis criteria. Although several treatment strategies have been proposed, most of them still show a high recurrence rate. Conclusion More research about Proliferative verrucous leukoplakia is necessary to understand and treat this disease.
Collapse
Affiliation(s)
- Diogo Lenzi Capella
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-graduação em Odontologia, Florianopolis, SC, Brazil
| | - Jussara Maria Gonçalves
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-graduação em Odontologia, Florianopolis, SC, Brazil
| | | | - Liliane Janete Grando
- Universidade Federal de Santa Catarina (UFSC), Departamento de Patologia, Florianopolis, SC, Brazil
| | - Filipe Ivan Daniel
- Universidade Federal de Santa Catarina (UFSC), Departamento de Patologia, Florianopolis, SC, Brazil.
| |
Collapse
|
28
|
Syomkin VA, Rabinovich OF, Babichenko II, Bezrukov AA. [Leukoplakia: clinical and pathological diagnosis]. STOMATOLOGIIA 2017; 96:72-76. [PMID: 36475409 DOI: 10.17116/stomat201796172-76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Leukoplakia is one of the most common obligate precancerous lesions of the oral mucosa. leukoplakia treatment is carried out in conjunction with surgery. Removed tissues are sent to pathological examination. The article describes clinical signs and corresponding pathological processes most often revealed by histological study.
Collapse
Affiliation(s)
- V A Syomkin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - O F Rabinovich
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - I I Babichenko
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A A Bezrukov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| |
Collapse
|
29
|
Shivhare P, Gupta A, Yadav M, Konidena A, Shankarnarayan L. Evaluation of different diagnostic criteria of diseases manifesting the oral cavity - A review. Part-1. J Oral Biol Craniofac Res 2016; 6:135-41. [PMID: 27195212 DOI: 10.1016/j.jobcr.2015.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 12/28/2015] [Indexed: 12/26/2022] Open
Abstract
There are many disorders affecting the oral cavity, which can cause difficulty in diagnosis for an oral physician. A criterion is defined as 'a principle or standard by which something may be judged or decided'. Several criteria have been given by different authors or committee, which further aids in diagnosis of certain disease. This article encompasses a collection and analysis of all the criteria of diseases affecting the oral cavity, which will be beneficial for an oral physician in their routine clinics.
Collapse
Affiliation(s)
- Peeyush Shivhare
- Senior Lecturer, Department of Oral Medicine and Radiology, Narsinhbhai Patel Dental College and Hospital, India
| | - Ashish Gupta
- Department of Oral Medicine and Radiology, India
| | - Monu Yadav
- Department of Oral Medicine and Radiology, Carrier Dental College, Lucknow, India
| | - Arvinda Konidena
- Professor, Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College, Barwala, India
| | - Lata Shankarnarayan
- Professor, Head of the Department, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
| |
Collapse
|
30
|
Garcia-Pola MJ, Llorente-Pendás S, González-Garcia M, García-Martín JM. The development of proliferative verrucous leukoplakia in oral lichen planus. A preliminary study. Med Oral Patol Oral Cir Bucal 2016; 21:e328-34. [PMID: 27031060 PMCID: PMC4867206 DOI: 10.4317/medoral.20832] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 01/17/2016] [Indexed: 11/05/2022] Open
Abstract
Background Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus. Material and Methods The clinical and histopathological characteristics of 14 cases of OLP that progress towards a plaque-like and verrucous form were indicated, with monitoring over a period of six to 24.3 years. Results The female/male ratio was 11/3, (78.6 and 21.4%). The mean age when the first biopsy was undertaken was 56.4 years old. None of the patients smoked during the study. As bilateral reticular was clinically diagnostic criterion, the second most frequent clinical form was the plaque form (n=10; 71.4%), followed by the atrophic (n=6; 42.8%), and erosive forms (n=4; 28.5%). Clinically it spread towards attached gingival mucosa and the hard palate. In the histopathologic study, there were a predominance of hyperkeratosis and verrucous epithelial hyperplasia. Three of the cases progressed to a squamous cell carcinoma, and one patient developed two verrucous carcinoma. Conclusions Further research is needed to demonstrate if proliferative multifocal oral lichen planus and proliferative multifocal oral leukoplakia are the same disorder but have different behaviour of malignancy for reasons of origin. Key words:Oral lichen planus, proliferative verrucous oral leukoplakia, malignant oral lichen planus, multifocal verrucous oral lichen planus, proliferative verrucous oral lichen planus.
Collapse
Affiliation(s)
- M-J Garcia-Pola
- Faculty of Medicine, Catedrático José Serrano, 33006, Oviedo, Spain,
| | | | | | | |
Collapse
|
31
|
Ottavioli A, Campana F, Catherine JH, Massereau E, Del Grande J, Ordioni U. [Proliferative verrucous leukoplakia: Three cases and literature review]. Ann Dermatol Venereol 2016; 143:187-96. [PMID: 26832120 DOI: 10.1016/j.annder.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 09/30/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this study was to collect epidemiological, aetiopathogenic, clinical, histological and therapeutic data concerning proliferative verrucous leucoplakia (PVL) and to report three new cases. PATIENTS AND METHODS A literature review performed using the Medline database enabled us to collate 39 studies involving 607 cases. Three new cases were added. RESULTS PVL is a rare disease characterized by extensive and multifocal oral leucoplakic lesions. Its histological pattern depends on the stage of the disease: hyperkeratosis, verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma. The aetiopathogenesis of PVL is poorly understood and there is no clear consensus concerning therapy. Malignant transformation occurs in over 50 % of cases. DISCUSSION Diagnosis of PVL is difficult because of the presenting signs, which can be mistaken for those of other diseases. Management may be complicated and long-term follow-up is essential.
Collapse
Affiliation(s)
- A Ottavioli
- Service d'odontologie, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France
| | - F Campana
- Centre massilien de la face, 24, avenue du Prado, 13006 Marseille, France
| | - J-H Catherine
- Service d'odontologie, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France; UMR 7268 ADES, Aix-Marseille/EFS/CNRS, faculté de médecine-secteur Nord, boulevard Pierre-Dramard, 13344 Marseille cedex 15, France
| | - E Massereau
- Service d'odontologie, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France
| | - J Del Grande
- Service d'anatomie pathologique et de cytologie, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France
| | - U Ordioni
- Service d'odontologie, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France; Centre massilien de la face, 24, avenue du Prado, 13006 Marseille, France.
| |
Collapse
|
32
|
Bezrukov AA, Syomkin VA. [Surgical treatment of patients with oral leukoplakia]. STOMATOLOGII︠A︡ 2016. [PMID: 28635839 DOI: 10.17116/stomat201695553-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study was to elaborate lingual nerve sparing procedure of submandibular gland duct stones extraction. The study involved 43 patients with syalolithiasis treated in Oral Surgery Unit of Central Research Institute of Dentistry and Maxillofacial Surgery in 2013-2015. It was shown that to prevent lingual nerve and artery injury submandibular salivary gland duct should be dissected to the level of obstruction thus allowing adequate visualization of anatomical correlations especially when removing stones from the distal part of the duct.
Collapse
Affiliation(s)
- A A Bezrukov
- Central Research Institute of Dentistry and Maxillofacial Surgery Moscow, Russia
| | - V A Syomkin
- Central Research Institute of Dentistry and Maxillofacial Surgery Moscow, Russia
| |
Collapse
|
33
|
Bagan L, Sáez GT, Tormos MC, Labaig-Rueda C, Murillo-Cortes J, Bagan JV. Salivary and serum interleukin-6 levels in proliferative verrucous leukoplakia. Clin Oral Investig 2015; 20:737-43. [DOI: 10.1007/s00784-015-1551-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
|
34
|
Abadie WM, Partington EJ, Fowler CB, Schmalbach CE. Optimal Management of Proliferative Verrucous Leukoplakia. Otolaryngol Head Neck Surg 2015; 153:504-11. [DOI: 10.1177/0194599815586779] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 04/23/2015] [Indexed: 11/16/2022]
Abstract
Objective Proliferative verrucous leukoplakia (PVL) is a rare and recalcitrant form of leukoplakia. The purpose of this review is to further characterize the risk factors, clinical course, and optimal treatment for this highly aggressive, premalignant lesion. Data Sources Twenty-six articles on PVL with a total of 329 PVL cases. Review Methods A systematic review of the literature using Ovid, PubMed, Cochrane Database, and gray literature was conducted of all PVL cases reported between 1985 and 2014. Inclusion criteria required reporting of patient follow-up and recurrence rates. Data were analyzed using descriptive statistics. Student t test and Fisher exact test were used to identify factors associated with malignant transformation. Results The mean patient age was 63.9 years. Most patients were female (66.9%) and nontobacco users (65.22%). Mean follow-up was 7.4 years, with an average of 9.0 biopsies per patient during this period. Proliferative verrucous leukoplakia exhibited histopathologic features along a progressive spectrum, evolving from leukoplakia to verrucous hyperplasia and ultimately invasive carcinoma. Surgery was the most common treatment implemented, but recurrence rates among 222 patients reached 71.2%. Subgroup analysis of 277 patients identified a 63.9% malignant transformation rate, and 39.6% of patients died of their disease. Age, sex, and tobacco use were not identified as risk factors associated with progression to cancer. Conclusions Proliferative verrucous leukoplakia is a rare form of leukoplakia with a high rate of malignant transformation. It necessitates high clinical suspicion, to include a lifetime of close follow-up and repeat biopsies by a health care provider well versed in oral carcinoma.
Collapse
Affiliation(s)
- Wesley M. Abadie
- Department of Otolaryngology, Mike O’Callaghan Federal Medical Center, Nellis AFB, Nevada, USA
| | - Erin J. Partington
- Division of Otolaryngology, University of Alabama–Birmingham, Birmingham, Alabama, USA
| | - Craig B. Fowler
- Division of Oral and Maxillofacial Pathology, University of Kentucky School of Dentistry, Lexington, Kentucky, USA
| | - Cecelia E. Schmalbach
- Division of Otolaryngology, University of Alabama–Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
35
|
Pentenero M, Meleti M, Vescovi P, Gandolfo S. Oral proliferative verrucous leucoplakia: are there particular features for such an ambiguous entity? A systematic review. Br J Dermatol 2015; 170:1039-47. [PMID: 24471527 DOI: 10.1111/bjd.12853] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 12/31/2022]
Abstract
Proliferative verrucous leucoplakia (PVL) is a distinct, particularly aggressive form of oral leucoplakia. Given the low prevalence of PVL, data are sparse and are mostly from case reports, case series and only a few case-control studies, meaning that the literature is able to provide only weak evidence. The present systematic literature review aims to collate the available evidence on the following issues: patient demographics, aetiology, lesion location(s), malignant potential, location and histopathological features of transformed lesions, disease-specific survival rates and treatment response. Electronic databases were searched for studies in the English language reporting original data from at least 10 patients with PVL on the target issues of the present review. The retrieved data were merged and a descriptive analysis performed. The 20 studies selected indicated that PVL does not seem to be correlated with the major risk factors for oral carcinoma (tobacco, alcohol and/or areca nut/betel leaf chewing). The disorder affects mainly adult/elderly women and has a very high malignant transformation rate, particular site distribution and particular location and histopathological features of transformed lesions. The present results may be limited by some articles being unintentionally excluded as they were not found during the electronic search, a lack of worldwide accepted diagnostic criteria for PVL, and overlapping data from multiple studies performed in a limited number of centres. Despite these potential drawbacks, the present results demonstrate that PVL does have particular features.
Collapse
Affiliation(s)
- M Pentenero
- Unit of Oral Medicine and Oral Oncology, Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | | | | | | |
Collapse
|
36
|
Oral squamous cell carcinoma associated with proliferative verrucous leukoplakia compared with conventional squamous cell carcinoma--a clinical, histologic and immunohistochemical study. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:318-25. [PMID: 25547823 DOI: 10.1016/j.oooo.2014.10.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/13/2014] [Accepted: 10/29/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Proliferative verrucous leukoplakia (PVL), a potentially malignant disorder, often undergoes malignant transformation to oral squamous cell carcinoma. The aim of our study was to document and compare the histologic, immunohistochemical, and clinical features and the survival rates of carcinoma arising in patients with PVL (p-scca) with conventional squamous cell carcinoma (c-scca) in order to determine if p-scca should be categorized as a separate clinical entity. MATERIALS AND METHODS A retrospective review of 11 patients with PVL, 38 with p-scca tumors and 49 with c-scca tumors: buccal mucosa (n = 28) and gingiva or palate (n = 21). Immunohistochemistry was performed by using antibodies directed against p16, p53, and ki67. RESULTS P-scca had lower clinical stage (P = .0001), smaller tumor size (P = .0033), no lymph node metastasis (P = .0002) or distant metastasis (P = .05), and better short term (P = .03), but not long term (P = .12) survival. Microscopically, p-scca tumor thickness was significantly less (P = .0001). P-53 overexpression was more common in p-scca (P = .0043) but not ki67 or p16 overexpression. CONCLUSIONS P-scca, compared with c-scca, presented with significantly better prognostic factors and short-term survival rates and longer duration of disease. Our results suggest that p-scca may represent a distinct entity, which may have practical implications when deciding on treatment. Further studies on a larger cohort of patients are recommended.
Collapse
|
37
|
Candau-Alvarez A, Dean-Ferrer A, Alamillos-Granados FJ, Heredero-Jung S, García-García B, Ruiz-Masera JJ, Arévalo-Arévalo R, Zafra-Camacho F, Valenzuela-Salas B. Verrucous carcinoma of the oral mucosa: an epidemiological and follow-up study of patients treated with surgery in 5 last years. Med Oral Patol Oral Cir Bucal 2014; 19:e506-11. [PMID: 24880446 PMCID: PMC4192576 DOI: 10.4317/medoral.19683] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/02/2014] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. MATERIAL AND METHODS This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. RESULTS Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. CONCLUSIONS In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients.
Collapse
|
38
|
Gillenwater AM, Vigneswaran N, Fatani H, Saintigny P, El-Naggar AK. Proliferative verrucous leukoplakia: recognition and differentiation from conventional leukoplakia and mimics. Head Neck 2014; 36:1662-8. [PMID: 24115154 DOI: 10.1002/hed.23505] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 09/14/2012] [Accepted: 09/10/2013] [Indexed: 12/24/2022] Open
Abstract
The majority of conventional leukoplakia remains constant and only a subset progress to high-grade dysplasia or invasive carcinoma. A less recognized form known as proliferative verrucous leukoplakia (PVL) represents a unique progressive and elusive variant. Identifying patients with this form can only be achieved through the keen clinical observation of the temporal gross and histologic progression in individual patients with squamous cell carcinoma. The difficulty in the early diagnosis of PVL stems from the overlapping clinical and pathologic features with conventional multifocal leukoplakia with dysplasia. We present the current view on the clinicopathologic and biological characteristics of PVL and discuss their diagnosis, differential diagnosis, and management.
Collapse
Affiliation(s)
- Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | |
Collapse
|
39
|
Abidullah M, Kiran G, Gaddikeri K, Raghoji S, Ravishankar T S. Leuloplakia - review of a potentially malignant disorder. J Clin Diagn Res 2014; 8:ZE01-4. [PMID: 25302287 DOI: 10.7860/jcdr/2014/10214.4677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/04/2014] [Indexed: 11/24/2022]
Abstract
Leukoplakias are oral white lesions that have not been diagnosed as any other specific disease. They are grouped under premalignant lesions, now redesignated as potentially malignant disorders. Their significance lies in the fact that they have propensity for malignant transformation at a higher rate when compared to other oral lesions. This article reviews aetiology, epidemiology, clinical characteristics, histopathologic features, malignant potential and treatment of oral leukoplakia.
Collapse
Affiliation(s)
- Mohammed Abidullah
- Assistant Professor, Department of Oral & Maxillofacial Pathology, GDCH , Hyderabad. A.P., India
| | - G Kiran
- Assistant Professor, Department of Oral & Maxillofacial Pathology, S.B Patil Dental College and Hospital , Bidar, Karnataka, India
| | - Kavitha Gaddikeri
- Assistant Professor, Department of Oral & Maxillofacial Pathology, GDCH , Hyderabad. A.P., India
| | - Swetha Raghoji
- Assistant Professor, Department of Oral & Maxillofacial Pathology, GDCH , Hyderabad. A.P., India
| | - Shilpa Ravishankar T
- Assistant Professor, Department of Oral & Maxillofacial Pathology, GDCH , Hyderabad. A.P., India
| |
Collapse
|
40
|
García-Chías B, Casado-De La Cruz L, Esparza-Gómez GC, Cerero-Lapiedra R. Diagnostic criteria in proliferative verrucous leukoplakia: evaluation. Med Oral Patol Oral Cir Bucal 2014; 19:e335-9. [PMID: 24608210 PMCID: PMC4119307 DOI: 10.4317/medoral.19424] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/03/2013] [Indexed: 11/12/2022] Open
Abstract
Objectives: to evaluate the ability of the diagnostic criteria proposed by Cerero et al in 2010 to perform an early diagnose in patients with proliferative verrucous leukoplakia.
Study Design: retrospective study with patients diagnosed with leukoplakia at Oral Medicine Service at Oral Medicine and Surgery Department at Dentistry Faculty at Universidad Complutense of Madrid.
Results: the criteria were applied in 116 patients, turning positive in 40 cases. Out of these, 24 (60%) had been previously diagnosed with PVL. Most frequent criteria were major criteria A and E, concerning lesion’s site and histopathology, and minor criteria b and c, concerning sex and smoking habit.
Conclusions: diagnostic criteria developed by Cerero et al can be a useful tool for an early diagnose of PVL, as in 60% of the cases, the criteria would have allowed to make an early diagnose of the disease.
Key words:Proliferative verrucous leukoplakia, criteria, diagnose, early.
Collapse
Affiliation(s)
- Begoña García-Chías
- Department of Medicine and Buccofacial Surgery, Faculty of Dentistry, Complutense University of Madrid, Spain,
| | | | | | | |
Collapse
|
41
|
Abstract
UNLABELLED Proliferative Verrucous Leukoplakia (PVL) is a multifocal form of progressive leukoplakia with a high rate of malignant transformation that requires early recognition by oral health care providers for proper management. BACKGROUND AND PURPOSE PVL will frequently appear as an innocuous white lesion or lesions that can easily be overlooked or considered clinically insignificant, yet it has a high rate of malignant transformation. There is limited in-depth knowledge about the pathobiology of PVL. Oral health care providers lack familiarity with this lesion; consequently the intent of this article is to increase awareness of the clinical aspects of PVL. METHODS Case reports, case series and review articles provide a profile of PVL. CONCLUSION It is essential that health care providers performing intraoral examinations are aware that PVL is a distinct and rare form of multifocal oral leukoplakia. PVL commonly affects females above the age of 62. Currently, little is known about its etiopathogenesis. Additionally, no specific treatment modality has proven to be effective in aborting its progression. Because of its high recurrence potential and relentless progression to squamous cell carcinoma, all recurrent and multifocal white lesions of the oral cavity should be viewed with suspicion.
Collapse
Affiliation(s)
- Pallavi Parashar
- Department of Diagnostic and Biological Sciences, University of Colorado School of Dental Medicine, Aurora, CO 80045, USA.
| |
Collapse
|
42
|
Abstract
Proliferative verrucous leukoplakia (PVL) is a rare less recognized form of oral leukoplakia. Patients with this condition represent a unique clinically and pathologically progressive characteristic from conventional leukoplakia. Because of the lack of defined pathologic lesions, identifying patients with the early diagnosis of PVL is challenging. This is largely due to the overlapping clinical and pathologic early features with conventional multifocal leukoplakia with dysplasia. The diagnosis can only be achieved through the keen clinical observation of the temporal progression in individual patients to verrucous and/or conventional squamous carcinoma. We present a brief view of the clinicopathologic and biological characteristics of PVL and discuss diagnosis, differential diagnosis, and management.
Collapse
|
43
|
Issrani R, Prabhu N, Keluskar V. Oral proliferative verrucous leukoplakia: A case report with an update. Contemp Clin Dent 2013; 4:258-62. [PMID: 24015023 PMCID: PMC3757896 DOI: 10.4103/0976-237x.114887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
White lesions both physiologic as well as pathologic are relatively frequent in the oral cavity, the most common pathology being oral leukoplakia (OL). There are many variants of OL, one of which is oral proliferative verrucous leukoplakia (OPVL). OPVL is a rare clinico-pathological entity, which is slow growing, long-term progressive lesion, but remains an enigmatic and difficult to define. The etiology of OPVL remains still unclear. Tobacco use does not seem to have a significant influence on the appearance of OPVL. These lesions may occur both in smokers and non-smokers. It is observed more frequently in women and elderly patients over 60 years at the time of diagnosis. The buccal mucosa and tongue are the most frequently involved sites. It develops initially as a white plaque of hyperkeratosis that eventually becomes a multifocal disease with confluent, exophytic and proliferative features. Various published case series have presented OPVL as a disease with aggressive biological behavior due to its high probability of recurrence and a high rate of malignant transformation. Prognosis is poor for this seemingly harmless-appearing white lesion of the oral mucosa. This article describes the clinical aspects and histologic features of an OPVL case that demonstrated the typical behavior pattern in a long-standing, persistent lesion and discusses this relatively rare entity in light of current information.
Collapse
Affiliation(s)
- Rakhi Issrani
- Department of Oral Medicine and Radiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | | | | |
Collapse
|
44
|
Arduino PG, Bagan J, El-Naggar AK, Carrozzo M. Urban legends series: oral leukoplakia. Oral Dis 2013; 19:642-59. [PMID: 23379968 DOI: 10.1111/odi.12065] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 11/29/2012] [Accepted: 12/18/2012] [Indexed: 02/06/2023]
Abstract
To date, the term oral leukoplakia (OL) should be used to recognize 'predominantly white plaques of questionable risk, having excluded (other) known diseases or disorders that carry no increased risk of cancer'. In this review, we addressed four controversial topics regarding oral leukoplakias (OLs): (i) Do tobacco and alcohol cause OLs?, (ii) What percentage of OLs transform into oral squamous cell carcinoma (OSCC)?, (iii) Can we distinguish between premalignant and innocent OLs?, and (iv) Is proliferative verrucous leukoplakia (PVL) a specific entity or just a form of multifocal leukoplakia? Results of extensive literature search suggest that (i) no definitive evidence for direct causal relationship between smoked tobacco and alcohol as causative factors of OLs, (ii and iii) the vast majority of OLs follow a benign course and do not progress into a cancer, and no widely accepted and/or validated clinical and/or biological factors can predict malignant transformation, and (iv) the distinction between multifocal/multiple leukoplakias and PVL in their early presentation is impossible; the temporal clinical progression and the high rate of recurrences and development of cancer of PVL are the most reliable features for diagnosis.
Collapse
Affiliation(s)
- P G Arduino
- Department of Surgical Sciences, Oral Medicine Section, Lingotto Dental School, University of Turin, Italy.
| | | | | | | |
Collapse
|
45
|
Gouvêa AF, Santos Silva AR, Speight PM, Hunter K, Carlos R, Vargas PA, de Almeida OP, Lopes MA. High incidence of DNA ploidy abnormalities and increased Mcm2 expression may predict malignant change in oral proliferative verrucous leukoplakia. Histopathology 2013; 62:551-62. [PMID: 23347057 DOI: 10.1111/his.12036] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 09/24/2012] [Indexed: 12/14/2022]
Abstract
AIMS To assess the DNA content of cases of oral proliferative verrucous leukoplakia (PVL) and correlate the DNA ploidy findings with the expression of Mcm2, geminin, and Ki67, and with clinicopathological data. METHODS AND RESULTS DNA quantification was performed by image cytometry using the ACIS III Automated Cellular Imaging System. Expression of Ki67, Mcm2 and geminin was determined by immunohistochemistry. There were 21 cases of PVL, the female/male ratio was 6:1, and the average age was 65.5 years. Seventeen patients (81.0%) did not report tobacco and alcohol consumption. Nine patients (42.9%) developed verrucous or squamous cell carcinoma. Levels of Mcm2 expression showed a positive correlation with increasingly severe epithelial changes (P = 0.03). Twenty patients had their DNA examined by ACIS III, and 19 (95%) showed aneuploidy. The frequency and severity of aneuploidy (P < 0.0001), the mean values of the DNA heterogeneity index (P < 0.0001) and the 5n-exceeding fractions (P = 0.0007) increased according to epithelial alterations. Abnormal DNA content was observed even in the more indolent lesions. CONCLUSIONS Mcm2 expression and DNA ploidy analysis could be used to predict areas of malignant transformation. The clinicopathological findings associated with the immunohistochemical and DNA ploidy results support the distinct and aggressive profile of this entity.
Collapse
Affiliation(s)
- Adriele F Gouvêa
- Department of Oral Diagnosis, Piracicaba Dental School, Campinas State University, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Meisel P, Holtfreter B, Biffar R, Suemnig W, Kocher T. Association of periodontitis with the risk of oral leukoplakia. Oral Oncol 2012; 48:859-63. [DOI: 10.1016/j.oraloncology.2012.02.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
|
47
|
Abstract
Proliferative verrucous leukoplakia is multifocal and progressive lesion with a high rate of malignant transformation. This short review highlights the diagnosis, traditional treatment and the current management of the disease. A MEDLINE search for the specific English word including proliferative verrucous leukoplakia in the last two years (2009-2010). This study indicates the current evidence for the diagnosis and the management of proliferative verrucous leukoplakia to help the specialist in this domain for early diagnosis of proliferative verrucous leukoplakia according to the new criteria of diagnosis to prevent the recurrence and any malignant transformation.
Collapse
|
48
|
Carbone M, Broccoletti R, Gambino A, Carrozzo M, Tanteri C, Calogiuri PL, Conrotto D, Gandolfo S, Pentenero M, Arduino PG. Clinical and histological features of gingival lesions: a 17-year retrospective analysis in a northern Italian population. Med Oral Patol Oral Cir Bucal 2012; 17:e555-61. [PMID: 22322515 PMCID: PMC3476015 DOI: 10.4317/medoral.17809] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 11/15/2011] [Indexed: 12/02/2022] Open
Abstract
Objectives: Only few studies on gingival lesions considered large enough populations and contemporary literature does not provide a valid report regarding the epidemiology of gingival lesions within the Italian population. The histopathological and clinical appearance of 538 gingival lesions from northern Italians are described and discussed here.
Study Design: The case records of patients referred for the diagnosis and management of gingival lesions, from October 1993 to October 2009, were reviewed. Data regarding the histological type of lesion were also obtained from the biopsy register for each case, and blindly re-examined.
Results: We reported a greater frequency of benign lesions (reactive and/or inflammatory) in non-plaque/non-calculus induced gingival disorders. We confirmed an unambiguous prevalence of oral squamous cell carcinoma above all other malignant neoplasia, and a prevalence of neoplastic malignant lesions in the maxilla, with a slight increase in females and a drift of the incidence peak from the seventh to the eighth decade. There was a prevalence of precancerous gingival lesions in the maxilla, with a higher incidence in females and with a drift from the sixth to the seventh decade. We also reported a prevalence of oral lichen planus and lichenoid lesions as major manifestations of desquamative gingivitis.
Conclusions: The high frequency of gingival involvement of such different diseases emphasizes the importance of histological characterization and differential diagnosis for periodontists, but more prospective studies are needed to better describe the true incidence of the non-plaque related gingival diseases.
Key words:Gingival lesions, clinical appearance, histological analysis.
Collapse
Affiliation(s)
- Mario Carbone
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, Lingotto Dental School, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Bagan JV, Jiménez-Soriano Y, Diaz-Fernandez JM, Murillo-Cortés J, Sanchis-Bielsa JM, Poveda-Roda R, Bagan L. Malignant transformation of proliferative verrucous leukoplakia to oral squamous cell carcinoma: A series of 55 cases. Oral Oncol 2011; 47:732-5. [DOI: 10.1016/j.oraloncology.2011.05.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/15/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
|