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Vergier V, Czarny K, Brau JJ, Le Pelletier F, Taihi I. Proliferative Verrucous Leukoplakia Presenting as a Ring Around the Collar and Cancer: A Case Report. Cureus 2024; 16:e56077. [PMID: 38618314 PMCID: PMC11009891 DOI: 10.7759/cureus.56077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Proliferative verrucous leukoplakia (PVL) is an oral mucosa lesion with a high rate of malignant transformation. The diagnosis is often difficult, especially when the initial lesion is a simple homogeneous white leukoplakia, and when located only on the gingiva or palate. Moreover, the anatomopathological analysis is non-specific in the initial stages. The gingival PVL localisation (gPVL) is described as the most aggressive form with the highest rate of malignant transformation. Cases with a unique gingival localisation are rare, described with a "ring around the collar" clinical form. Considering the difficulty of early diagnosis of gPVL, we report the case of a 72-year-old woman, who presented "white lesions on her gingiva" with a slight discomfort in February 2019. The lesion was initially limited to the buccal part of the mandibular right gingiva, but rapidly extended to all the lingual and buccal mandibular gingiva during follow-up, leading to a diagnosis of gPVL. Two biopsies were performed, which concluded a verrucous hyperplasia and papilloma with a lichenoid part. The diagnosis of gPVL was made after a six-month follow-up based on clinical and anatomopathological factors. The gPVL transformed into a squamous cell carcinoma (SCC) after 18 months of follow-up. A surgical right mandibular bone excision with an autologous left fibula graft associated with radiotherapy was performed. Three years after the surgery, the patient remains under monitoring, with several gPVL and SCC recurrences treated. This case highlights that gPVL is a rare and aggressive form of PVL, with a high risk of fast malignant transformation. Knowledge about its aetiology, anatomic pathology, and biological markers is highly needed to speed up the diagnosis and develop specific follow-up and treatment.
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Affiliation(s)
- Valentin Vergier
- Department of Dentistry, Faculty of Health, Université Paris Cité, Montrouge, FRA
- Department of Dentistry, Charles Foix Hospital, Assistance Publique-Hôpitaux de Paris, Ivry-sur-Seine, FRA
- Orofacial Pathologies, Imaging, and Biotherapies Laboratory (URP 2496 BRIO), Université Paris Cité, Montrouge, FRA
| | - Katarzyna Czarny
- Department of Dentistry, Faculty of Health, Université Paris Cité, Montrouge, FRA
- Department of Maxillo-facial Plastic Surgery and Stomatology, Gonesse Hospital, Gonesse, FRA
| | - Jean-Jacques Brau
- Odontology and Maxillofacial Prosthesis Unit, Department of Cervicofacial Cancerology, Gustave Roussy Cancer Center, Villejuif, FRA
| | - François Le Pelletier
- Department of Pathology, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FRA
| | - Ihsène Taihi
- Department of Dentistry, Faculty of Health, Université Paris Cité, Montrouge, FRA
- Orofacial Pathologies, Imaging, and Biotherapies Laboratory (URP 2496 BRIO), Université Paris Cité, Montrouge, FRA
- Department of Oral Surgery, Rothschild Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FRA
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Herreros-Pomares A, Hervás D, Bagan-Debón L, Jantus-Lewintre E, Gimeno-Cardona C, Bagan J. On the Oral Microbiome of Oral Potentially Malignant and Malignant Disorders: Dysbiosis, Loss of Diversity, and Pathogens Enrichment. Int J Mol Sci 2023; 24:ijms24043466. [PMID: 36834903 PMCID: PMC9961214 DOI: 10.3390/ijms24043466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
The role of dysbiosis in the development and progression of oral potentially malignant disorders (OPMDs) remains largely unknown. Here, we aim to characterize and compare the oral microbiome of homogeneous leucoplakia (HL), proliferative verrucous leukoplakia (PVL), oral squamous cell carcinoma (OSCC), and OSCC preceded by PVL (PVL-OSCC). Fifty oral biopsies from HL (n = 9), PVL (n = 12), OSCC (n = 10), PVL-OSCC (n = 8), and healthy (n = 11) donors were obtained. The sequence of the V3-V4 region of the 16S rRNA gene was used to analyze the composition and diversity of bacterial populations. In the cancer patients, the number of observed amplicon sequence variants (ASVs) was lower and Fusobacteriota constituted more than 30% of the microbiome. PVL and PVL-OSCC patients had a higher abundance of Campilobacterota and lower Proteobacteria than any other group analyzed. A penalized regression was performed to determine which species were able to distinguish groups. HL is enriched in Streptococcus parasanguinis, Streptococcus salivarius, Fusobacterium periodonticum, Prevotella histicola, Porphyromonas pasteri, and Megasphaera micronuciformis; PVL is enriched in Prevotella salivae, Campylobacter concisus, Dialister pneumosintes, and Schaalia odontolytica; OSCC is enriched in Capnocytophaga leadbetteri, Capnocytophaga sputigena, Capnocytophaga gingivalis, Campylobacter showae, Metamycoplasma salivarium, and Prevotella nanceiensis; and PVL-OSCC is enriched in Lachnospiraceae bacterium, Selenomonas sputigena, and Prevotella shahii. There is differential dysbiosis in patients suffering from OPMDs and cancer. To the best of our knowledge, this is the first study comparing the oral microbiome alterations in these groups; thus, additional studies are needed.
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Affiliation(s)
- Alejandro Herreros-Pomares
- Department of Biotechnology, Universitat Politècnica de València, 46022 Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), 28029 Madrid, Spain
- Correspondence: (A.H.-P.); (J.B.)
| | - David Hervás
- Department of Applied Statistics and Operational Research, and Quality, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Leticia Bagan-Debón
- Medicina Oral Unit, Stomatology Department, Valencia University, 46010 Valencia, Spain
| | - Eloísa Jantus-Lewintre
- Department of Biotechnology, Universitat Politècnica de València, 46022 Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), 28029 Madrid, Spain
| | | | - José Bagan
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), 28029 Madrid, Spain
- Medicina Oral Unit, Stomatology Department, Valencia University, 46010 Valencia, Spain
- Department of Stomatology and Maxillofacial Surgery, Hospital General Universitario de Valencia, 46014 Valencia, Spain
- Precancer and Oral Cancer Research Group, Valencia University, 46010 Valencia, Spain
- Correspondence: (A.H.-P.); (J.B.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Gilligan G, Garola F, Piemonte E, Leonardi N, Panico R, Warnakulasuriya S. Lichenoid proliferative leukoplakia, lichenoid lesions with evolution to proliferative leukoplakia or a continuum of the same precancerous condition? A revised hypothesis. J Oral Pathol Med 2020; 50:129-135. [PMID: 33225541 DOI: 10.1111/jop.13133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple white plaques of the oral mucosa are usually associated with potentially malignant disorders such as oral lichen planus, oral lichenoid lesions and proliferative verrucous leukoplakia. Previous studies in the current literature describe a potential clinical overlap in these entities. The aim of this study is to review clinicopathological and evolutive features of these Oral Potentially Malignant Disorders highlighting the dynamic changes of diagnoses. DISCUSSION It was previously hypothesized that a subset of patients with oral lichen planus or oral lichenoid diagnosis, could develop multiple white plaques during the natural history of the disease, fulfilling diagnostic criteria for proliferative verrucous leukoplakia. Consequently, these entities could, under certain conditions, obey a continuum of the same precancerous condition in the context of the field cancerization theory, increasing the risk of malignant transformation. Nevertheless, there is limited scientific evidence concerning this issue. CONCLUSION Further studies are needed to understand the biological and evolutive features of the link between these oral potentially malignant disorders. Regardless of its diagnosis, these patients with multifocal white lesions must be carefully monitored to detect early malignant transformation.
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Affiliation(s)
- Gerardo Gilligan
- Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Federico Garola
- Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eduardo Piemonte
- Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Nicolás Leonardi
- Oral Medicine Department, Dentistry School, Health Sciences Faculty, Universidad Católica de Córdoba, Córdoba, Argentina
| | - René Panico
- Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, WHO Collaborating Centre for Oral Cancer, London, UK
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Llorens C, Soriano B, Trilla-Fuertes L, Bagan L, Ramos-Ruiz R, Gamez-Pozo A, Peña C, Bagan JV. Immune expression profile identification in a group of proliferative verrucous leukoplakia patients: a pre-cancer niche for oral squamous cell carcinoma development. Clin Oral Investig 2021; 25:2645-57. [PMID: 32918120 DOI: 10.1007/s00784-020-03575-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To explore the pathophysiology of proliferative verrucous leukoplakia, a rare oral disorder that exhibits high rates of recurrence and malignant transformation, through a RNAseq case-control study. MATERIAL AND METHODS We obtained oral biopsies from 10 patients with verrucous leukoplakia lesions and from the mucosa of 5 healthy individuals for sequencing using RNAseq technology. Using bioinformatic methods, we investigated gene expression and enrichment differences between patients both with and without the disorder. We applied network biology methods to investigate functional relations among those genes that were differentially deregulated. RESULTS We detected 140 differentially expressed genes with distinct roles in immune surveillance, tissue and organ morphogenesis, development, and organization. Of these 140 genes, 111 have been previously described as cancer expression biomarkers, being oral squamous cell carcinoma the most represented type of cancer among them. Of these 140 genes, 26 were prioritized for further investigation as biomarkers using larger sample sizes. CONCLUSIONS The gene expression patterns of healthy and unhealthy patients differed in 140 genes whose deregulation has a functional impact on normal functioning of the immune system. This immune expression profile provides a plausible hypothesis to explain the transformation to oral squamous cell carcinoma observed in 6 of the 10 assayed cases. CLINICAL RELEVANCE By determining the molecular bases of the proliferative verrucous leukoplakia disorder and identifying early biomarkers of malignancy, this can allow us to develop new treatment strategies.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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Rintala M, Vahlberg T, Salo T, Rautava J. Proliferative verrucous leukoplakia and its tumor markers: Systematic review and meta‐analysis. Head Neck 2018; 41:1499-1507. [DOI: 10.1002/hed.25569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/29/2018] [Accepted: 11/21/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Mirjami Rintala
- Faculty of Medicine, Department of Oral Pathology, Institute of DentistryUniversity of Turku Turku Finland
| | - Tero Vahlberg
- Biostatistics, Department of Clinical MedicineUniversity of Turku and Turku University Hospital Turku Finland
| | - Tuula Salo
- Helsinki University Central Hospital Helsinki Finland
- Department of Oral Pathology, Institute of DentistryUniversity of Helsinki Helsinki Finland
- Finland Cancer and Translational Medicine Research UnitUniversity of Oulu Oulu Finland
- Medical Research Center Oulu Oulu Finland
| | - Jaana Rautava
- Faculty of Medicine, Department of Oral Pathology, Institute of DentistryUniversity of Turku Turku Finland
- Department of PathologyTurku University Hospital Turku Finland
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Okoturo E, Risk J, Schache A, Shaw R, Boyd M. Molecular pathogenesis of proliferative verrucous leukoplakia: a systematic review. Br J Oral Maxillofac Surg 2018; 56:780-785. [DOI: 10.1016/j.bjoms.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/17/2018] [Indexed: 01/10/2023]
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Chakrabarti S, Banerjee D, Qayyumi BN, Nair D, Nair S, Kane S, Chaturvedi P. Oral Cancer with Verrucous Pattern is Not Associated with Human Papilloma Virus in Indian Population. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_122_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: The etiology of verrucous lesions of the oral cavity is debatable, and many western studies attribute it to human papillomavirus (HPV) infection. Although most Indian studies have found a strong association with tobacco chewing, the role of HPV has not been studied in the Indian context. Materials and Methods: A prospective study was conducted on the clinicopathological profile of 21 consecutive patients of verrucous lesions of the oral cavity. The patients were evaluated on the basis of addictions, pretreatment biopsy, p16 immunohistochemistry (IHC), and histopathological parameters. Results: Preoperative incisional biopsy revealed no dysplasia in 52.38%, mild-to-moderate dysplasia in 19.04%, and invasive carcinoma in 28.57% of the patients. About 67% of patients underwent surgical excision in our institute all of whom had invasive malignancy on final histopathology. This included 42.85% patients whose initial biopsy was no or mild dysplasia. All of the patients were negative for p16 IHC. Conclusions: Verrucous lesions in Indian population are caused by smokeless tobacco unlike that in the western countries where HPV is the main etiology. Clinical distinction between benign and malignant lesions is difficult, and we recommend complete surgical excision of the lesion with adequate margins whenever possible.
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Affiliation(s)
- Swagnik Chakrabarti
- Departments of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devmalya Banerjee
- Departments of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Deepa Nair
- Departments of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Departments of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Subhada Kane
- Departments of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Departments of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Upadhyaya JD, Fitzpatrick SG, Islam MN, Bhattacharyya I, Cohen DM. A Retrospective 20-Year Analysis of Proliferative Verrucous Leukoplakia and Its Progression to Malignancy and Association with High-risk Human Papillomavirus. Head Neck Pathol 2018; 12:500-10. [PMID: 29427033 DOI: 10.1007/s12105-018-0893-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/05/2018] [Indexed: 01/21/2023]
Abstract
Proliferative verrucous leukoplakia (PVL) is defined as an aggressive, relentless and recalcitrant form of leukoplakia that has a high propensity for malignant transformation. The aim of this study was to evaluate the malignant potential of PVL and determine its possible association with high-risk human papillomavirus (HPV). Twenty cases with a clinical and biopsy proven diagnosis of PVL were collected from the University of Florida Oral Medicine clinic database. Immunohistochemistry was performed to evaluate the expression of p16INK4A and p53 genes in the PVL lesions. The lesions were also tested for high-risk HPV by DNA in-situ hybridization. The average age of the patients at the time of first biopsy was 62.7 years. Most patients had multiple sites of involvement, gingiva being the most common location. The lesions progressed to malignancy in approximately 50% of patients. The expression of p16INK4A gene was considered negative, with at least a 50-65% immunoreactivity observed in only three cases that progressed to malignancy. No expression of high-risk HPV was detected, whereas p53 staining was positive in less than 25% of the cells demonstrating gene expression. No definite association between PVL and high-risk HPV infection could be established. Due to the high transformation potential of PVL, early recognition with aggressive treatment, including multiple biopsies, and continued close clinical follow-up, remain the mainstay of favorable management of this condition.
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Zil-E-Rubab, Baig S, Zaman U, Lucky MH. Human papilloma virus 16/18: Fabricator of trouble in oral squamous cell carcinoma. Int J Infect Dis 2018; 69:115-119. [PMID: 29432879 DOI: 10.1016/j.ijid.2018.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/22/2018] [Accepted: 02/03/2018] [Indexed: 12/21/2022] Open
Abstract
AIM To find out the association between Human Papilloma Virus (HPV) genotypes 16/18 in Pakistani patients with oral squamous cell carcinoma (OSCC). METHODS DNA from oral rinse of 300 subjects was taken. The subjects included 100 cases with OSCC and 200 controls. Samples were analyzed by both conventional and real time PCR using "HPV consensus Gp5+/Gp6+ and HPV 16, 18 specific primers". RESULTS Out of 300 persons, 74/300 (25%) were found to be infected with HPV: "46/100(46%) from cases and 74/200(14%) from controls". The distribution was: HPV16, 6/300 (8%): 4/100 (9%) from OSCC group and 2/200 (8%) from controls while HPV 18 was 9/300(12%): 5/100(11%) from cases and 4/200(16%) from controls. Out of 300 subjects, 26(35%) were infected by "both HPV 16/18 (23(50%) from cases and 3(12%) from controls". Persons who were infected with HPV 16&18 had higher chances to develop OSCC as compared to those who didn't have HPV 16/18 (AOR: 21.4, 95% CI: 5.73 - 80.8). CONCLUSION The exposure to high risk strains of Human papilloma virus (16/18) in combination can be fabricotor of trouble (p<0.001, Adjusted odds ratio; 21.42) in OSCC.
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Affiliation(s)
- Zil-E-Rubab
- MDRL Laboratory, Department of Biochemistry, Ziauudin University, 4/B Shahra e Ghalib, Clifton-6, Karachi, Pakistan.
| | - Saeeda Baig
- MDRL Laboratory, Department of Biochemistry, Ziauudin University, 4/B Shahra e Ghalib, Clifton-6, Karachi, Pakistan.
| | - Uzma Zaman
- MDRL Laboratory, Department of Biochemistry, Ziauudin University, 4/B Shahra e Ghalib, Clifton-6, Karachi, Pakistan.
| | - Mohammad Haris Lucky
- MDRL Laboratory, Department of Biochemistry, Ziauudin University, 4/B Shahra e Ghalib, Clifton-6, Karachi, Pakistan.
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15
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Staines K, Rogers H. Oral leukoplakia and proliferative verrucous leukoplakia: a review for dental practitioners. Br Dent J 2017; 223:655-61. [PMID: 29097794 DOI: 10.1038/sj.bdj.2017.881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 02/08/2023]
Abstract
Objectives To provide an overview of the current thinking in terms of the diagnosis and management of oral leukoplakia and proliferative verrucous leukoplakia as relevant to general dental practitioners.Data sources, data selection, data extraction, data synthesis We searched the MEDLINE Ovid, EMBASE databases and the Cochrane Library, (1990 to 16 April 2017), restricting our search to English language with the following key words: leukoplakia, white patch, proliferative verrucous leukoplakia, precancerous lesion, premalignant lesions, potentially malignant oral conditions and potentially malignant oral disorders. The two authors selected key papers and engaged in collaborative data extraction and synthesis of the selected reference material.Conclusions General dental practitioners (GDPs) are likely to encounter patients with a known or yet undiagnosed oral leukoplakia in their clinical practice. The diagnosis is clinically based as there are no pathognomonic histopathological features. The definition of leukoplakia has evolved over the years. The importance of recognition and appropriate management relating to this condition is described particularly as it is one of the oral potentially malignant lesions. The inferred increased risk of malignant transformation is well documented however controversy still persists in terms of the appropriate management for these lesions. Proliferative verrucous leukoplakia is a recalcitrant, often widespread and multifocal distinct type of leukoplakia. It is considered to have a high rate of malignant transformation with implications in terms of lifelong monitoring both clinically and histopathologically. A high index of suspicion is important for general dental practitioners in order to identify such lesions that would require onward referral for further investigation and management.
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16
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Ai R, Tao Y, Hao Y, Jiang L, Dan H, Ji N, Zeng X, Zhou Y, Chen Q. Microenvironmental regulation of the progression of oral potentially malignant disorders towards malignancy. Oncotarget 2017; 8:81617-35. [PMID: 29113419 DOI: 10.18632/oncotarget.20312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
Oral potentially malignant disorders (OPMD) develop in a complex tissue microenvironment where they grow sustainably, acquiring oral squamous cell carcinoma (OSCC) characteristics. The malignant tumor depends on interactions with the surrounding microenvironment to achieve loco-regional invasion and distant metastases. Unlike abnormal cells, the multiple cell types in the tissue microenvironment are relatively stable at the genomic level and, thus, become therapeutic targets with lower risk of resistance, decreasing the risk of OPMD acquiring cancer characteristics and carcinoma recurrence. However, deciding how to disrupt the OPMD and OSCC microenvironments is itself a daunting challenge, since their microenvironments present opposite capacities, resulting in diverse consequences. Furthermore, recent studies revealed that tumor-associated immune cells also participate in the process of differentiation from OPMD to OSCC, suggesting that reeducating stromal cells may be a new strategy to prevent OPMD from acquiring OSCC characteristics and to treat OSCC. In this review, we discuss the characteristics of the microenvironment of OPMD and OSCC as well as new therapeutic strategies.
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17
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Borgna SC, Clarke PT, Schache AG, Lowe D, Ho MW, McCarthy CE, Adair S, Field EA, Field JK, Holt D, Risk JM, Rajlawat BP, Triantafyllou A, Shaw RJ. Management of proliferative verrucous leukoplakia: Justification for a conservative approach. Head Neck 2017. [PMID: 28640498 DOI: 10.1002/hed.24845] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Proliferative verrucous leukoplakia (PVL) is a progressive, multifocal, exophytic form of leukoplakia with high rates of malignant transformation. The purpose of this study was to evaluate a cohort of patients with PVL in a single tertiary referral clinic. METHOD Cases meeting accepted diagnostic criteria were reviewed with regard to their pathology, demographic characteristics, management, and outcomes. Human papillomavirus (HPV) testing was undertaken on a subset. RESULTS Almost half of the 48 patients with PVL (48%; n = 23) underwent malignant transformation after a median 23.4 months. The characteristics of this cohort were similar to those previously described, but management was notably more conservative. Conservative management of PVL was used in 92% of our patients, but the clinical outcomes seem comparable with previously described cohorts in which PVL was predominantly treated by surgical excision. All HPV testing was negative. CONCLUSION Aggressive surgical intervention in the premalignant phase of PVL may not influence the rate of malignant transformation.
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Affiliation(s)
- Scott C Borgna
- Royal Brisbane and Women's Hospital Metro North Hospital and Health Service, Department of Oral and Maxillofacial Surgery, Brisbane, Queensland, Australia
| | - Peter T Clarke
- Department of Restorative Dentistry, Central Manchester Foundation Trust, Manchester, United Kingdom
| | - Andrew G Schache
- Mersey Head and Neck Oncology Research Group (MHNORG), Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Division of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Derek Lowe
- Division of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael W Ho
- Mersey Head and Neck Oncology Research Group (MHNORG), Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Leeds Teaching Hospitals NHS Trust, Oral and Maxillofacial Surgery, Leeds Dental Institute, Leeds, United Kingdom
| | - Caroline E McCarthy
- Mersey Head and Neck Oncology Research Group (MHNORG), Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, United Kingdom
| | - Stephen Adair
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, United Kingdom
| | - E Anne Field
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, United Kingdom
| | - John K Field
- Mersey Head and Neck Oncology Research Group (MHNORG), Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, United Kingdom
| | - Deborah Holt
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, United Kingdom
| | - Janet M Risk
- Mersey Head and Neck Oncology Research Group (MHNORG), Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Bijay P Rajlawat
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, United Kingdom
| | - Asterios Triantafyllou
- Pathology Department, Liverpool Clinical Laboratories and School of Dentistry, University of Liverpool, Liverpool, United Kingdom
| | - Richard J Shaw
- Mersey Head and Neck Oncology Research Group (MHNORG), Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, United Kingdom.,Division of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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19
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Martinez-Lopez A, Blasco-Morente G, Perez-Lopez I, Naranjo-Diaz MJ, Aneiros-Fernandez J, Ruiz-Villaverde R, Tercedor-Sanchez J. Successful treatment of proliferative verrucous leukoplakia with 5% topical imiquimod. Dermatol Ther 2016; 30. [PMID: 27647537 DOI: 10.1111/dth.12413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/14/2016] [Accepted: 07/26/2016] [Indexed: 11/29/2022]
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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21
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
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Abstract
Human papillomaviruses (HPVs) are epitheliotropic viruses with an affinity for keratinocytes and are principally found in the anogenital tract, urethra, skin, larynx, tracheobronchial and oral mucosa. On the basis of high, but variable frequency of HPV in oral squamous cell carcinoma (OSCC), malignant potential of HPV infection has been hypothesized but not definitely confirmed. The aim of this review was to highlight the genomic structure and possible mechanism of infection and carcinogenesis by HPV in the oral mucosa and to review the frequency of HPV prevalence in OSCC and oral potentially malignant disorders. A computer database search was performed through the use of PubMed from 1994 to 2014. Search keywords used were: HPV and oral cancer, HPV and oral leukoplakia, HPV and oral lichen planus, HPV and OSCC, HPV and verrucous carcinoma, HPV and proliferative verrucous leukoplakia, HPV and oral papilloma.
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Affiliation(s)
- Shikha Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sunita Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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23
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Dalla Torre D, Burtscher D, Edlinger M, Sölder E, Widschwendter A, Rasse M, Puelacher W. Comparison of the prevalence of human papilloma virus infection in histopathologically confirmed premalignant oral lesions and healthy oral mucosa by brush smear detection. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:333-9. [DOI: 10.1016/j.oooo.2014.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 11/04/2014] [Accepted: 11/20/2014] [Indexed: 01/20/2023]
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- M Pentenero
- Unit of Oral Medicine and Oral Oncology, Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
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Akrish S, Ben-Izhak O, Sabo E, Rachmiel A. 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 2015; 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] [What about the content of this article? (0)] [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.
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Blioumi E, Chatzidimitriou D, Pazartzi C, Katopodi T, Tzimagiorgis G, Emmanouil-Nikoloussi EN, Markopoulos A, Kalekou C, Lazaridis N, Diza E, Antoniades D. Detection and typing of human papillomaviruses (HPV) in malignant, dysplastic, nondysplastic and normal oral epithelium by nested polymerase chain reaction, immunohistochemistry and transitional electron microscopy in patients of northern Greece. Oral Oncol 2014; 50:840-7. [PMID: 25043883 DOI: 10.1016/j.oraloncology.2014.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/24/2014] [Accepted: 06/12/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the role of HPV in oral carcinogenesis, we examined the prevalence of HPV in malignant, potentially malignant and normal oral epithelium and studied the relation of HPV prevalence with other factors obtained from the patient's records. MATERIALS AND METHODS Our material consisted of 291 tissue specimens from 258 individuals. From every individual formalin fixed and paraffin embedded tissues were examined by nested Polymerase Chain Reaction (NPCR) for the detection of HPV DNA and by immunohistochemistry (IHC) for the in situ detection of HPV L1 protein. Positive PCR products were sequenced in order to type HPVs. Also 33 fresh tissues were obtained, fixed and used to detect HPV particles by transitional electron microscopy (TEM). RESULTS HPV was detected in 32.9% of the tissue specimens by NPCR, in 4.7% by immunohistochemistry and in 28.1% by TEM. In detail, by nested PCR HPV L1 DNA was detected in 40% of normal tissues, 40% of fibromas, 35.8% of non-dysplastic leukoplakias, 31.6% of dysplastic leukoplakias and 22.2% of oral squamous cell carcinomas. The HPV viral load of 96.5% of the samples was very low (1 viral copy per 10(2)-10(4) cells). HPV16 prevails in all histological groups in 89-100%. CONCLUSION We conclude that HPV does not seem, from the specific sample examined, to play a substantial role in oral carcinogenesis. However, it cannot be excluded that HPV could be involved in oral carcinogenesis only in cases with high viral load or at early stages of carcinogenesis possibly through the hit-and-run mechanism.
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Affiliation(s)
- E Blioumi
- Department of Stomatology, School of Dentistry, Aristotle University of Thessaloniki, Greece.
| | - D Chatzidimitriou
- B' Department of Microbiology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Ch Pazartzi
- Department of Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Greece
| | - Th Katopodi
- Department of Biology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - G Tzimagiorgis
- Department of Biochemistry, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - E-N Emmanouil-Nikoloussi
- Department of Histology, Embryology and Anthropology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - A Markopoulos
- Department of Stomatology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - C Kalekou
- Department of Stomatology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - N Lazaridis
- Department of Orofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - E Diza
- Department of Microbiology, AHEPA University General Hospital of Thessaloniki, Greece
| | - D Antoniades
- Department of Stomatology, School of Dentistry, Aristotle University of Thessaloniki, Greece
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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.
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Affiliation(s)
- Pallavi Parashar
- Department of Diagnostic and Biological Sciences, University of Colorado School of Dental Medicine, Aurora, CO 80045, USA.
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29
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Sciubba JJ, Helman JI. Current Management Strategies for Verrucous Hyperkeratosis and Verrucous Carcinoma. Oral Maxillofac Surg Clin North Am 2013; 25:77-82. [DOI: 10.1016/j.coms.2012.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Abstract
Human papillomavirus (HPV) infections have received considerable attention in recent years. Of the 120 or so known types of the virus, some cause a variety of benign wart-like lesions of the skin and genital and oral mucosae, whilst others are aetiologically associated with cervical and anogenital cancers. Recent epidemiologic evidence suggests that HPV may also be an independent risk factor for oropharyngeal cancer. In this context it has been suggested that HPV virus may modulate the process of carcinogenesis in some tobacco and alcohol induced oropharyngeal cancers and act as the primary oncogenic agent for inducing carcinogenesis among non-smokers. Dental practitioners have a major role in detecting all lesions of the oral mucosa caused, or possibly caused, by HPV. This paper briefly reviews the current state of knowledge of molecular and clinical aspects of HPV infections of the oral mucosa.
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Affiliation(s)
- S R Prabhu
- School of Dentistry and Health Sciences, Charles Sturt University, Orange, New South Wales.
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31
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Sadasivan A, Thankappan K, Rajapurkar M, Shetty S, Sreehari S, Iyer S. Verrucous lesions of the oral cavity treated with surgery: Analysis of clinico-pathologic features and outcome. Contemp Clin Dent 2012; 3:60-3. [PMID: 22557899 PMCID: PMC3341761 DOI: 10.4103/0976-237x.94548] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Verrucous lesions of the oral cavity can be of varied histopathology. The present study evaluates the clinico-pathological features of verrucous lesions of the oral cavity and analyzes the treatment outcomes. Materials and Methods: This is a retrospective study of 15 consecutive patients who presented with verrucous lesions of the oral cavity, during the 5-year period from January 2006 to December 2010. Demographic, clinico-pathological features, treatment details, and outcomes were analyzed. Results: Fifteen patients with verrucous lesions of the oral cavity were treated with surgery as the primary modality. The mean age was 62.8 years (range 35–85 years). Wide excision of the primary lesion with adequate mucosal and soft-tissue margins was carried out. Free-flap reconstruction was done in eight patients. All patients remain loco-regionally controlled with good functional speech and swallowing outcome. Conclusions: Verrucous lesions of the oral cavity are a distinct clinical entity with varied histopathology. A surgical excision with wide margins and appropriate reconstruction is necessary to optimize the disease and functional outcome.
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Affiliation(s)
- Anjana Sadasivan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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32
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Affiliation(s)
- Rocco R Addante
- Section of Maxillofacial Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA
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33
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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.
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Feller L, Lemmer J. Oral Leukoplakia as It Relates to HPV Infection: A Review. Int J Dent 2012; 2012:540561. [PMID: 22505902 DOI: 10.1155/2012/540561] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/02/2011] [Accepted: 12/19/2011] [Indexed: 12/13/2022] Open
Abstract
Leukoplakia is the most common potentially malignant lesion of the oral cavity and can be categorised according to its clinical appearance as homogeneous or nonhomogenous. Tobacco and areca nut use, either alone or in combination are the most common risk factors for oral leukoplakia, but some oral leukoplakias are idiopathic. Some leukoplakias arise within fields of precancerized oral epithelium in which the keratinocytes may be at different stages of cytogenetic transformation. Leukoplakias may unpredictably regress, may remain stable, or may progress to carcinoma. There is a greater risk of carcinomatous transformation of idiopathic leukoplakia, of non-homogenous leukoplakia, of leukoplakia affecting the floor of the mouth; the ventrolateral surface of the tongue and the maxillary retromolar and adjoining soft palate (collectively called high-risk sites), of leukoplakia with high-grade epithelial dysplasia, and of leukoplakia in which the keratinocytes carry cytogenetic alterations associated with carcinomatous transformation. Although there appears to be some link between human papillomavirus (HPV) and oral leukoplakia, there is little evidence to support a causal relationship either between HPV infection and oral leukoplakia or between HPV-infected leukoplakic keratinocytes and their carcinomatous transformation.
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35
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Woo SB. Diseases of the oral mucosa. McKee's Pathology of the Skin 2012:362-436. [DOI: 10.1016/b978-1-4160-5649-2.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Jayaprakash V, Reid M, Hatton E, Merzianu M, Rigual N, Marshall J, Gill S, Frustino J, Wilding G, Loree T, Popat S, Sullivan M. Human papillomavirus types 16 and 18 in epithelial dysplasia of oral cavity and oropharynx: a meta-analysis, 1985-2010. Oral Oncol 2011; 47:1048-54. [PMID: 21816661 DOI: 10.1016/j.oraloncology.2011.07.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 07/01/2011] [Accepted: 07/09/2011] [Indexed: 12/20/2022]
Abstract
Human papillomavirus (HPV) types 16 and 18 are causally related to a sub-set of oral cavity and oropharyngeal squamous cell cancers. However, a clear estimate of the prevalence of HPV-16/18 in oral cavity and oropharyngeal dysplasia (OOPD) is not available. This literature review and meta-analysis was conducted to provide a prevalence estimate for HPV-16/18 in OOPD. Twenty-two studies that reported prevalence of HPV-16 and/or 18 in 458 OOPD lesions were analyzed. Meta-analysis was used to evaluate the prevalence of HPV-16/18 and logistic regression was used for stratified analysis by age, gender, and histological grade. The overall prevalence of HPV-16/18 in OOPD lesions was 24.5% [95% confidence interval (CI), 16.4-36.7%)]. The individual prevalence for HPV-16 alone was 24.4%. The prevalence of HPV-16/18 in oral cavity lesions alone was 25.3% (95% CI, 14.2-45.2%). The odds of detection of HPV-16/18 in dysplastic lesions in males were twice that of females [odds ratio (OR), 2.44]. HPV-16/18 were 3 times more common in dysplastic lesions (OR, 3.29; 95% CI, 1.95-5.53%) and invasive cancers (OR, 3.43; 95% CI, 2.07-5.69%), when compared to normal biopsies. There was no significant difference in HPV-16/18 rates between dysplastic lesions and cancers or between mild, moderate or severe dysplastic lesions. This meta-analysis provides a quantification of the prevalence of HPV types 16/18 in OOPD lesions. These results also support the assumption that HPV-16/18 infection occurs during the early phase of the oral cavity and oropharyngeal carcinogenesis.
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37
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/15/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
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38
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Syrjänen S, Lodi G, von Bültzingslöwen I, Aliko A, Arduino P, Campisi G, Challacombe S, Ficarra G, Flaitz C, Zhou HM, Maeda H, Miller C, Jontell M. Human papillomaviruses in oral carcinoma and oral potentially malignant disorders: a systematic review. Oral Dis 2011; 17 Suppl 1:58-72. [PMID: 21382139 DOI: 10.1111/j.1601-0825.2011.01792.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Human papillomavirus (HPV) in oral carcinoma (OSCC) and potentially malignant disorders (OPMD) is controversial. The primary aim was to calculate pooled risk estimates for the association of HPV with OSCC and OPMD when compared with healthy oral mucosa as controls. We also examined the effects of sampling techniques on HPV detection rates. METHODS Systematic review was performed using PubMed (January 1966-September 2010) and EMBASE (January 1990-September 2010). Eligible studies included randomized controlled, cohort and cross-sectional studies. Pooled data were analysed by calculating odds ratios, using a random effects model. Risk of bias was based on characteristics of study group, appropriateness of the control group and prospective design. RESULTS Of the 1121 publications identified, 39 cross-sectional studies met the inclusion criteria. Collectively, 1885 cases and 2248 controls of OSCC and 956 cases and 675 controls of OPMD were available for analysis. Significant association was found between pooled HPV-DNA detection and OSCC (OR = 3.98; 95% CI: 2.62-6.02) and even for HPV16 only (OR = 3.86; 95% CI: 2.16-6.86). HPV was also associated with OPMD (OR = 3.87; 95% CI: 2.87-5.21). In a subgroup analysis of OPMD, HPV was also associated with oral leukoplakia (OR = 4.03; 95% CI: 2.34-6.92), oral lichen planus (OR = 5.12; 95% CI: 2.40-10.93), and epithelial dysplasia (OR = 5.10; 95% CI: 2.03-12.80). CONCLUSIONS The results suggest a potentially important causal association between HPV and OSCC and OPMD.
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Affiliation(s)
- S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland.
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Meleti M, Mergoni G, Manfredi M, Merigo E, Guidotti R, Sarraj A, Simonazzi T, Bonanini M, Vescovi P. Leucoplachia verrucosa proliferativa. Analisi retrospettiva di 12 casi. Dental Cadmos 2011. [DOI: 10.1016/j.cadmos.2011.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Ge L, Wu Y, Wu LY, Zhang L, Xie B, Zeng X, Lin M, Zhou HM. Case report of rapidly progressive proliferative verrucous leukoplakia and a proposal for aetiology in mainland China. World J Surg Oncol 2011; 9:26. [PMID: 21352571 PMCID: PMC3056810 DOI: 10.1186/1477-7819-9-26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 02/27/2011] [Indexed: 11/10/2022] Open
Abstract
Proliferative verrucous leukoplakia (PVL) is a rare oral leukoplakia and has four features such as chronic proliferation, multiple occurrences, refractoriness to treatment and high rate of malignant transformation. As mentioned above, most PVL cases processed to malignancy over many years, sometimes 20 years. However, this report described a case of rapid progress, which had malignant transformation in a short period. Additionally, the aetiology of PVL was discussed and immunity was proposed as the possible cause.
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Affiliation(s)
- Lin Ge
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, Sichuan, PR. China
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41
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Abstract
In this review article, the clinical and histopathological characteristics of oral premalignant lesions, and primarily oral leukoplakia, are noted and the risk factors for malignant transformation of oral leukoplakia are discussed. Malignant transformation rates of oral leukoplakia range from 0.13 to 17.5%. The risk factors of malignant transformation in the buccal mucosa and labial commissure are male gender with chewing tobacco or smoking in some countries such as India, or older age and/or being a non-smoking female in other countries. Some authors have reported that leukoplakia on the tongue or the floor of the mouth showed a high risk of malignant transformation, although others have found no oral subsites at high risk. In concurrence with some authors, the authors of this review view epithelial dysplasia as an important risk factor in malignant transformation; however, there are conflicting reports in the literature. Many authors believe that nonhomogeneous leukoplakia is a high risk factor without exception, although different terms have been used to describe those conditions. The large size of lesions and widespread leukoplakia are also reported risk factors. According to some studies, surgical treatment decreased the rate of malignant transformation; however, many review articles state that no definitive treatment including surgery can decrease the malignant transformation rate of oral leukoplakia because of the lack of randomized control trials of treatment. Tobacco chewing and smoking may be causative agents for cancerization of oral leukoplakia in some groups, and evidence for a role of human papilloma virus in the malignant transformation of oral leukoplakia is inconsistent. Further research to clarify its role in malignant transformation is warranted.
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42
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Abstract
Proliferative verrucous leukoplakia (PVL) is of uncertain etiology but may be associated with human papillomavirus (HPV) infection. Proliferative verrucous leukoplakia is seen mainly in older women, beginning as a simple slow-growing, persistent leukoplakia that tends to spread and become multifocal and affect the gingival frequently. In time, PVL develops exophytic, wart-like or erythroplakic areas that become squamous carcinomas. Proliferative verrucous leukoplakia appears to resist to all attempts at therapy and often recurs.
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Affiliation(s)
- J Bagan
- Valencia University and Hospital General Universitario de Valencia, Valencia, Spain.
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43
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Feller L, Khammissa RA, Wood NH, Lemmer J. Epithelial maturation and molecular biology of oral HPV. Infect Agent Cancer 2009; 4:16. [PMID: 19930727 PMCID: PMC2788520 DOI: 10.1186/1750-9378-4-16] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 11/25/2009] [Indexed: 12/12/2022] Open
Abstract
Human papillomavirus (HPV) is widespread and can cause latent infection in basal cells, with low HPV DNA copy-number insufficient for transmission of infection; can cause subclinical infection that is active but without clinical signs; or can cause clinical infection leading to benign, potentially malignant or malignant lesions. The HPV cycle is influenced by the stage of maturation of the infected keratinocytes, and the production of virions is restricted to the post-mitotic suprabasal epithelial cells where all the virus genes are expressed.Low-risk HPV genotypes are associated with the development of benign oral lesions, whereas high-risk HPV genotypes are implicated in the development of malignant epithelial neoplasms. The rôle of high-risk HPV as a causative agent in epithelial malignancy is different at different anatomical sites: it is almost invariably implicated in squamous cell carcinoma of the uterine cervix, fairly frequently implicated in squamous cell carcinoma of the oropharynx, and it is seldom implicated in squamous cell carcinoma of the mouth.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Limpopo, Medunsa Campus, South Africa.
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44
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45
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Kresty LA, Mallery SR, Knobloch TJ, Li J, Lloyd M, Casto BC, Weghorst CM. Frequent alterations of p16INK4a and p14ARF in oral proliferative verrucous leukoplakia. Cancer Epidemiol Biomarkers Prev 2009; 17:3179-87. [PMID: 18990760 DOI: 10.1158/1055-9965.epi-08-0574] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Proliferative verrucous leukoplakia (PVL) represents a rare but highly aggressive form of oral leukoplakia with > 70% progressing to malignancy. Yet, PVL remains biologically and genetically poorly understood. This study evaluated the cell cycle regulatory genes, p16INK4a and p14ARF, for homozygous deletion, loss of heterozygosity, and mutation events in 20 PVL cases. Deletion of exon 1beta, 1alpha, or 2 was detected in 40%, 35%, and 0% of patients, respectively. Deletions of exons 1alpha and 1beta markedly exceed levels reported in non-PVL dysplasias and approximate or exceed levels reported in oral squamous cell carcinomas. Allelic imbalance was assessed for markers reported to be highly polymorphic in squamous cell carcinomas and in oral dysplasias. Loss of heterozygosity was detected in 35.3%, 26.3%, and 45.5% of PVLs for the markers IFNalpha, D9S1748, and D9S171, respectively. INK4a and ARF sequence alterations were detected in 20% and 10% of PVL lesions, accordingly. These data show, for the first time, that both p16INK4a and p14ARF aberrations are common in oral verrucous leukoplakia; however, the mode and incidence of inactivation events differ considerably from those reported in non-PVL oral premalignancy. Specifically, concomitant loss of p16INK4a and p14ARF occurred in 45% of PVL patients greatly exceeding loss reported in non-PVL dysplastic oral epithelium (15%). In addition, p14ARF exon 1beta deletions were highly elevated in PVLs compared with non-PVL dysplasias. These data illustrate that molecular alterations, even within a specific genetic region, are associated with distinct histologic types of oral premalignancy, which may affect disease progression, treatment strategies, and ultimately patient prognosis.
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Affiliation(s)
- Laura A Kresty
- University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Clinical Cancer Research Building, Miami, FL 33136, USA.
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46
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Gandolfo S, Castellani R, Pentenero M. Proliferative Verrucous Leukoplakia: A Potentially Malignant Disorder Involving Periodontal Sites. J Periodontol 2009; 80:274-81. [DOI: 10.1902/jop.2009.080329] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Abstract
The recently reported increase in the incidence of oral cancer in a younger population, especially in young women, in the absence of the traditional risk factors has raised concern. Of particular interest is the increased incidence of carcinoma of the tongue, which has been suggested to be a distinct entity. Although there are conflicting data on incidence and sex distribution, studies suggest that the physiologic response to risk factors by men and women and the clinical behavior of these cancers in the younger population may be different than the normal variant. Effort is currently being made to elucidate the etiology and pathogenesis of oral cancer in the younger population.
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Affiliation(s)
- Maria B Papageorge
- Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA 02111, USA.
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48
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van der Waal I, Reichart PA. Oral proliferative verrucous leukoplakia revisited. Oral Oncol 2008; 44:719-21. [PMID: 18061520 DOI: 10.1016/j.oraloncology.2007.09.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 08/10/2007] [Accepted: 09/20/2007] [Indexed: 01/15/2023]
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49
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Abstract
The oral cavity contains many organs and tissues compressed in a small area. Accordingly oral tumors have a wide variety of appearances. Reactive hyper-plastic lesions include epulis,morsicatio,traumatic ulcer or palatal hyperplasia. These benign lesions must be separated clinically and histologically from precancerous and neoplastic lesions. In leukoplakia,the individual risk can be estimated by clinical signs. Nevertheless histopathology is mandatory because precancerous lesions usually precede or accompany most oral cancers. Amalgam tattoo,oral nevi and melanoacanthoma have to be considered as differential diagnoses of oral melanoma. Accurate clinico-pathological diagnosis is mandatory to insure appropriate therapy. Oral soft tissue tumors such as Kaposi sarcoma and multiple mucosal neuromas in MEN 2b require interdisciplinary management. Diseases affecting the minor salivary glands which may be encountered by dermatologists include mucocele, necrotizing sialometa-plasia,and tumors such as pleomorphic adenoma.
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Affiliation(s)
- Dieter Krahl
- Institute of Dermatohistology, Heidelberg, Germany.
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50
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Abstract
BACKGROUND Proliferative verrucous leukoplakia (PVL) is a distinct clinical form of oral leukoplakia defined by its progressive clinical course, changing clinical and histopathological features, and potential to develop into cancer. PVL behaves in a more aggressive and relentless manner than the more innocuous white oral lesions that it can resemble clinically. METHODS A PubMed search was conducted which identified studies that examined patients with PVL and reported data meeting inclusion criteria. RESULTS PVL is seen much more frequently in females and most often diagnosed after the sixth decade of life. Tobacco use is not strongly linked to the presence of PVL (63% of patients did not use tobacco products). Most (74%) of the patients with PVL progressed to oral carcinoma. CONCLUSION PVL is a persistent and progressive oral lesion that requires very close follow-up along with early and aggressive treatment to increase the chances of a favorable outcome.
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Affiliation(s)
- Robert J Cabay
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612-7213, USA
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