Global gene expression profile of proliferative verrucous leukoplakia and its underlying biological disease mechanisms

BACKGROUND

Proliferative verrucous leukoplakia (PVL) is a rare and enigmatic oral potentially malignant disorder which almost invariably results in oral squamous cell carcinoma (OSCC). The aims of this project were to use transcriptome profiling to characterise PVL gene expression patterns for biomarker identification and gain insight into the molecular aetiopathogenesis of PVL.

METHODS

Forty-three oral cavity mucosal biopsies from 32 patients with oral lesions clinically compatible with either PVL or non-PVL conventional oral leukoplakia (OLK) underwent transcriptome profiling by RNA sequencing. Data was analysed by hierarchical clustering, differential gene expression, functional enrichment and network analysis, sparse partial least squares discriminant analysis sPLS-DA, and immune cell phenotypic estimation.

RESULTS

We found 464 genes significantly differentially expressed at least 2-fold between PVL and non-PVL OLK (193 up and 271 down). HOX genes, including HOXA1 and HOXB7, keratin-associated proteins (KRTAPs) and olfactory receptor G proteins (OR) were significantly upregulated in PVL. Other upregulated genes in PVL included FOS, WNT16 and IFNA1. Pathway analysis showed that there was a significant downregulation of connective tissue signalling in PVL. Classifying multivariate models based upon 22 genes discriminated PVL from non-PVL OLK. Bioinformatic profiling showed that immune cell profiles in PVL and OLK were similar except that fibroblast markers were reduced in PVL.

CONCLUSION

These results demonstrate that PVL and conventional OLK are molecularly distinct with upregulation of many cancer-associated genes. They provide insight into the pathogenesis of PVL and show that biomarker based molecular diagnostics is feasible to discriminate and inform diagnosis and management.

Well-differentiated Squamous Cell Carcinoma With Sarcomatous Differentiation in Patient With a History of Recurrent Verrucous Carcinoma

Human papillomavirus-independent vulvar squamous cell carcinoma has a peak incidence in about the eighth decade of life. A variable portion of the vulvar squamous cell carcinoma are human papillomavirus-independent comprising 20% to 80% of all cases. Verrucous carcinoma (VC) is part of the spectrum of human papillomavirus-independent carcinomas and its combination with well-differentiated squamous cell carcinoma with sarcomatous differentiation is an extremely unusual neoplasm. The available literature on VC is currently limited to case reports and small single-institution studies. Here, we present a case concerning an 81-year-old woman with a history of chronic itching, swelling, and lichen sclerosis with variable-sized multiple white-pink plaques of the vulva. The pathologic diagnosis of VC was made. The patient later on developed multiple lesions of biopsy proved VC and most recent biopsy shows well-differentiated squamous cell carcinoma with abrupt sarcomatous differentiation. A review of the literature shows the rarity of this lesion of the female genital tract. Clinicians and patients should be aware of the aggressive behavior of cancers and adjust their surgical management together with the follow-up strategy. To the best of our knowledge, this is the first description of a VC and well-differentiated squamous cell carcinoma with abrupt sarcomatous differentiation occurring in the vulva.

Proliferative verrucous leukoplakia/multifocal leukoplakia in patients with and without oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSF) and proliferative verrucous leukoplakia (PVL) are established as oral potentially malignant disorders. Dual pathology of the two conditions is not commonly encountered in clinical practice. This study aims to present a case series of multifocal leukoplakia in patients with and without OSF to outline the clinical behavior and challenges in the management of this high-risk group in clinical practice.

MATERIAL AND METHODS

We retrospectively analyzed cases of six Indian patients (four with OSF) managed over a period of 5.5 to 13 years at the Government Dental College, Nagpur. Patient data consisting of age, gender, medical history, habits, clinical findings, and biopsy reports were recorded at the initial visit. During follow-up visits, the clinicopathological data were reassessed. When surgical intervention failed to arrest the disease or when surgery was contraindicated metronomic therapy with Folitrax 15 mg once a week and Celecoxib 100mg twice daily was initiated.

RESULTS

All patients developed PVL after the initial pathology diagnosis of OSF or oral leukoplakia. Initial lesions were either homogenous or non-homogenous leukoplakia. All patients developed multiple recurrences, regional or systemic metastasis. Despite thorough interventions, the patients died of, or with the disease.

CONCLUSIONS

The occurrence of two or more oral potentially malignant disorders poses challenges in patient management and possibly presents a higher risk of malignant transformation. More clinical trials are necessary to assess the benefits of metronomic therapy for patients diagnosed with aggressive PVL concurrently found with OSF.

[Research progress in the diagnosis and management of proliferative verrucous leukoplakia]

Proliferative verrucous leukoplakia (PVL) is one of the oral potentially malignant disorders (OPMD) with the highest malignant potential. PVL tends to be easily misdiagnosed owing to the resemblance in clinical manifestations between PVL and other diseases such as oral leukoplakia or oral lichen planus. PVL is considered as a special type of oral leukoplakia by some scholars, which is characterized by its tendency of recurrence and metastasis, along with its high risk of malignant transformation. So far, the accurate clinic diagnosis and management of PVL are still intractable due to the lack of definite histopathological definition, unified diagnostic criteria and effective treatment modalities. This review aims to provide the clinical practitioners with a series of advices on the clinical diagnosis and management of PVL by systematically reviewing the diagnostic logistics, therapeutic strategies, malignant transformation detection based on tremendous relevant data and evidence-based medicine.

Detection of variable genotypes in common human papillomavirus-associated invasive penile squamous cell carcinomas: a study of 177 human papillomavirus-positive cases

Human papillomavirus (HPV) is detected in 30-50% of invasive penile carcinomas, and it is frequently associated with basaloid and warty morphological features. Based on this heterogeneity and different clinical behaviors, we hypothesized a variation in their HPV genotypic composition. To test this, we evaluated 177 HPV-positive cases: basaloid (114), warty-basaloid (28), and warty (condylomatous) (35) invasive carcinomas. HPV DNA detection and genotyping was performed using the SPF-10/DEIA/LiPA25 system. Nineteen HPV genotypes were detected. High-risk HPVs predominated (96%), and low-risk HPVs were rarely present. Most common genotype was HPV16 followed by HPVs 33 and 35. According to the genotypes identified, 93% of the cases would be covered with current vaccination programs. There was a significant variation in the distribution of HPV16 and non-HPV16 genotypes according to histological subtype. HPV16 was significantly frequent in basaloid (87%) and was less frequent in warty carcinomas (61%). This molecular difference, along with their distinctive macro-microscopic and prognostic features, makes basaloid and warty carcinomas unique. The gradual decreasing frequency of HPV16 demonstrated in basaloid, warty-basaloid, and warty carcinomas suggest that the basaloid cell, present in those types in decreasing proportions, may be responsible for the differences.

WHO 2022 classification of penile and scrotal cancers: updates and evolution

Squamous cell carcinoma (SCC) is the most common malignant tumour of the penis. The 2022 WHO classification reinforces the 2016 classification and subclassifies precursor lesions and tumours into human papillomavirus (HPV)-associated and HPV-independent types. HPV-associated penile intraepithelial neoplasia (PeIN) is a precursor lesion of invasive HPV- associated SCC, whereas differentiated PeIN is a precursor lesion of HPV-independent SCC. Block-type positivity of p16 immunohistochemistry is the most practical daily utilised method to separate HPVassociated from HPVindependent penile SCC. If this is not feasible, the term SCC, not otherwise specified (NOS) is appropriate. Certain histologies that were previously classified as "subtypes" are now grouped, and coalesced as "patterns", under the rubric of usual type SCC and verrucous carcinoma (e.g. usual-type SCC includes pseudohyperplastic and acantholytic/pseudoglandular carcinoma, and carcinoma cuniculatum is included as a pattern of verrucous carcinoma). If there is an additional component of the usual type of invasive SCC (formerly termed hybrid histology), the tumour would be a mixed carcinoma (e.g. carcinoma cuniculatum or verrucous carcinoma with usual invasive SCC); in such cases, reporting of the relative percentages in mixed tumours may be useful. The consistent use of uniform nomenclature and reporting of percentages will inform the refinement of future reporting classification schemes and guidelines/recommendations. The classification of scrotal tumours is provided for the first time in the fifth edition of the WHO Blue book, and it follows the schema of penile cancer classification for both precursor lesions and the common SCC of the scrotum. Basal cell carcinoma of the scrotum may have a variable clinical course and finds a separate mention.

Crafting a prognostic nomogram for the overall survival rate of cutaneous verrucous carcinoma using the surveillance, epidemiology, and end results database

BACKGROUND

The aim of this study was to establish and verify a predictive nomogram for patients with cutaneous verrucous carcinoma (CVC) who will eventually survive and to determine the accuracy of the nomogram relative to the conventional American Joint Committee on Cancer (AJCC) staging system.

METHODS

Assessments were performed on 1125 patients with CVC between 2004 and 2015, and the results of those examinations were recorded in the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided at a ratio of 7:3 into the training (n = 787) and validation (n = 338) cohorts. Predictors were identified using stepwise regression analysis in the COX regression model for create a nomogram to predict overall survival of CVC patients at 3-, 5-, and 8-years post-diagnosis. We compared the performance of our model with that of the AJCC prognosis model using several evaluation metrics, including C-index, NRI, IDI, AUC, calibration plots, and DCAs.

RESULTS

Multivariate risk factors including sex, age at diagnosis, marital status, AJCC stage, radiation status, and surgery status were employed to determine the overall survival (OS) rate (P<0.05). The C-index nomogram performed better than the AJCC staging system variable for both the training (0.737 versus 0.582) and validation cohorts (0.735 versus 0.573), which AUC (> 0.7) revealed that the nomogram exhibited significant discriminative ability. The statistically significant NRI and IDI values at 3-, 5-, and 8-year predictions for overall survival (OS) in the validation cohort (55.72%, 63.71%, and 78.23%, respectively and 13.65%, 20.52%, and 23.73%, respectively) demonstrate that the established nomogram outperforms the AJCC staging system (P < 0.01) in predicting OS for patients with cutaneous verrucous carcinoma (CVC). The calibration plots indicate good performance of the nomogram, while decision curve analyses (DCAs) show that the predictive model could have a favorable clinical impact.

CONCLUSION

This study constructed and validated a nomogram for predicting the prognosis of patients with CVC in the SEER database and assessed it using several variables. This nomogram model can assist clinical staff in making more-accurate predictions than the AJCC staging method about the 3-, 5-, and 8-year OS probabilities of patients with CVC.

Buschke-Lowenstein Tumors: A Review and Proposed Classification System

ABSTRACT

Buschke-Lowenstein (B-L) tumors or giant condylomata are large fungating lesions that are caused by human papillomavirus (HPV) and develop in the anogenital region. Although uncommon, physicians and surgeons who treat sexually transmitted diseases or other diseases involving the anogenital area will encounter these patients. The purpose of this study is to review the current literature regarding these lesions. We evaluated every published study in PubMed and Embase from 1925 to 2020, concentrating on the clinical data included in each report, such as presentation and treatment. We also evaluated each work for any definition used and found that there is no accepted definition for these lesions. As such, we provide an inclusive, workable definition. In addition, there are many misconceptions about B-L that continue to be propogated as more case reports are published every year. After evaluating every published case, we refute the fact that these lesions have a high mortality or a high malignancy rate. Furthermore, we refute that these lesions are synonymous with verrucous carcinoma. In addition to a definition, we also propose a simple grading system that we hope can be used to assist in the study and management of these patients moving forward. Although the literature is very heterogenous regarding B-L, they are caused by HPV and are distinct from verrucous carcinoma. Because of the majority of information is based on case reports, the literature concentrates on treatment, but more work is clearly needed to delineate the association with specific HPV types and optimal management of this disease.

[Mass Screening of Oral Cancer in Eastern Shimane Prefecture during 2015-2019]

The Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, has been conducting mass screening of oral cancer using oral abrasion cytology by oral surgeons in eastern Shimane prefecture for public awareness and its early detection. As a result, 3(0.09%)cases of oral cancer were identified. Case 1: The patient was diagnosed with well-differentiated squamous cell carcinoma in the floor of the mouth(pT1N0M0, Stage Ⅰ)after undergoing Matsue city oral cancer screening in 2016. Case 2: The patient underwent oral cancer screening in Izumo city in 2018 and was diagnosed with verrucous carcinoma in the back of the tongue(pT1N0M0, Stage Ⅰ). Case 3: The patient was diagnosed with highly differentiated squamous cell carcinoma of the palate(pT1N0M0, Stage Ⅰ)after undergoing the Izumo city oral cancer screening in 2019. Awareness of oral cancer is important, and cancer screening by oral surgeons using cytology is highly useful and should be continued in the future.

Buschke-Löwenstein tumour: a rare and challenging entity

Buschke-Löwenstein tumour (BLT) is rare and locally aggressive, and malignant transformation is a possibility. Because there is no consensus on the best treatment approach, the authors present a treatment algorithm based on several case reports. A 57-year-old male patient resorted to surgical consultation with a giant perianal cauliflower-like mass. A BLT was diagnosed. Due to the involvement of the anal sphincter, a wide local excision saving the rectum failed. Abdominoperineal resection was performed. Malignant transformation was diagnosed, and adjuvant radiotherapy was delivered. Clinical evolution was uneventful. Aggressive behaviour despite the absence of malignancy is the hallmark of BLT. The common presentation is an anal mass with a cauliflower-like appearance. Anal verrucous carcinoma and squamous cell carcinoma are the major differential diagnoses. BLT treatment is challenging. Surgery is the first-line treatment, raging from wide local excision to abdominoperineal resection. To improve outcomes, chemoradiation can be used in combination with surgery. Long-term follow-up is mandatory.

Epithelioma cuniculatum of the sole of the foot mimicking an infection

Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in advanced cases. We report a case a 76-year-old patient with a 5-year-old lesion on the sole of the foot, which was originally treated as a wart without improvement while the lesion slowly evolved. The patient was referred to our center with a diagnosis of chronic osteomyelitis. An excisional biopsy revealed an invasive keratinizing squamous carcinoma. In this advanced phase of the disease the only possible treatment was a Syme amputation.

Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn's disease-a unique case report

BACKGROUND

Crohn's disease (CD) is a chronic inflammatory disorder which leads to anorectal fistulas. In rare cases, patients develop anal squamous cell carcinoma (ASCC) within these lesions. There is limited literature regarding ASCC in patients with CD. Here, we report on a unique case of advanced verrucous carcinoma (VC), a rare variant of squamous cell carcinoma, developing on the grounds of extensive chronic anorectal fistulas in CD.

METHODS AND RESULTS

A 54-year-old male patient with a 20-year history of CD presented with a large inflammatory tumor at the perineal region with multiple discharging perianal fistulas. Histopathological analysis of the perineal mass revealed a VC. Subsequent surgery with radical tumor resection and terminal colostomy resulted in a large perineal cavity and a partially exposed sacrum. The defect extended to a total of 35 × 25 × 25 cm. Reconstruction was achieved through a two-step approach. A first surgical step established an arteriovenous (AV) loop in the upper thigh. Subsequently, a free latissimus dorsi (LD) myocutaneous flap was harvested and anastomosed with the AV loop, allowing for satisfactory closure of the defect and reconstruction of the perianal and perineal region.

CONCLUSION

Radical surgical excision with negative margins is the therapy of choice for VC. This case report demonstrates a curative treatment option with special emphasis on the reconstructive possibilities of a unique case of extended perianal and perineal VC associated with chronic anorectal fistulas in CD.

[Diagnosis and treatment of verrucous laryngeal cancer--a case report]

A male patient of 71 years old was admitted due to repeated hoarseness for two years which got worse accompanied with dyspnea so that to receive tracheotomy in another hospital more than one month ago. The two vocal cord biopsies carried out in the other hospital before showed vocal keratosis and squamous cell hyperplasia. Electronic laryngoscopy result showed normal epiglottis. a lot of saliva at hypopharynx, and rough arytenoid mucosa. The supraglottic area was remarkably swollen and the glottal area can not be observed clearly. The biopsy of throat was unable to conduct. Barium swallow examination revealed no obvious space-occupying lesion in piri form fossa or esophagus. Larynx CT scan showed a space-occupying lesion in the laryngeal cavity on the right side of the neck involving the thyroid cartilage. The patient was finally treated by total laryngectomy. cervical infected tissue resection. grafting transposition with pectoralis major flap and tracheostomy. The postoperative pathology showed laryngeal verrucous carcinoma.

[Study of αB-crystallin and its possible role of anti-apoptosis in oral verrucous carcinoma]

PURPOSE

To investigate the expression of αB-crystallin and its possible role of anti-apoptosis in oral verrucous carcinoma.

METHODS

The expression of αB-crystallin and activated caspase-3 was detected in oral verrucous carcinoma, oral squamous carcinoma and normal mucosa by immunohistochemistry, and their relationship was investigated. SPSS 16.0 software package was used for statistical analysis. Nonparametric test and spearman correlation test were performed.

RESULTS

The expression of αB-crystallin in oral verrucous carcinoma and oral squamous carcinoma was significantly higher than that in normal mucosa(P<0.05). And in oral verrucous carcinoma, the increase of expression of αB-crystallin coincided with the decrease of expression of activated caspase-3(P<0.05).

CONCLUSION

αB-crystallin may play a role of anti-apoptosis by inhibiting the activation of caspase-3 in oral verrucous carcinoma.

[Establishment of xenografted model of oral verrucous carcinoma with focal squamous cell carcinoma metastasizing to the cervical lymph nodes in nude mice]

PURPOSE

To use the excised cervical lymph node tissue from oral verrucous carcinoma patient with focal squamous cell carcinoma subcutaneously to establish a xenografted model in nude mice.

METHODS

The xenograft tumors were finally removed for histopathological study and the mice were laparotomized to examine metastatic tumors in livers, kidneys, lungs.

RESULTS

The tumor formation rate was 87.5%(7/8),and the appearance of transplanted tumors was like that in human and HE staining showed that the cancer cells of those tumors models and mesenchymal components remained morphologically like the original tumor. The liver, renal, lung and lymph nodes didn't show obvious metastasis.

CONCLUSION

The xenografted model is successfully established with a higher formation rate, and the model morphologically resembles the human tumor.

[Proliferative verrucous leukoplakia. Report of five cases]

BACKGROUND

Proliferative verrucous leukoplakia (PVL) is a rare variant of oral leukoplakia (OL) with a high tendency for malignant transformation. PVL starts as a flat hyperkeratosis. During the course of the disease verrucous lesions develop. AIM OF THE STUDY, MATERIAL AND METHODS: Due to the scarcity of reports on PVL five cases of PVL are presented. Clinical and histopathological findings in five female patients with PVL were evaluated retrospectively.

RESULTS

The clinical appearance of PVL was characteristic as compared to criteria described in the literature. The average period of observation in these cases was short (1.7 years). There were 3.6 different localizations observed per patient. The buccal mucosa, gingiva, and edentulous alveolar ridge were most often affected. One patient had already developed squamous cell carcinoma prior to referral. The others developed malignancies during follow-up. Recurrences and secondary malignancies could not be avoided using different therapeutic modalities. Two patients died from PVL. The characteristic spectrum of histopathological findings in PVL was observed. Homogeneous flat leukoplakias are characterized by acanthosis, hyperkeratosis, and often parakeratosis. Epithelial dysplasia is not seen. The proliferative verrucous stage of the disease is characterized by papillomatous epithelial growths with signs of slight epithelial dysplasia and subepithelial infiltration with immunocompetent cells. Stages of transformation may result in verrucous carcinoma or squamous cell carcinoma.

CONCLUSIONS

PVL is associated with a very high rate of malignant transformations. These, as well as recurrences, cannot be avoided with present-day therapies. In order to define the biological profile of PVL more clearly, multicenter studies are necessary to reveal possible etiologic factors and concepts for therapy.

Verrucous carcinoma, hyperplasia and leukoplakia of the oral mucosa: a clinico-histopathological and histometric study

Thirteen cases of verrucous leucoplakia (VL), 3 of verrucous hyperplasia (VH) and 19 of verrucous carcinoma (VC) were evaluated by means of 4 clinical features, 12 microscopic parameters and 6 epithelial histometric measurements. No significant clinical differences were detected, but histologic data showed that orthokeratinization was more frequent in VL and VH, while parakeratinization proved more common in VC. Sharp epithelial projections predominated in all three lesion types, though lymphoplasmatic infiltration and Russell bodies were more frequent in VH. Histometrically, there were statistical differences between VL or VH vs VC in three parameters, namely connective tissue-epithelial interface (Ice), epithelial height (He) and connective tissue-epithelial interface plus verrucous epithelial surface (Ice + Sve). To conclude, in this series, VH failed to exhibit significant clinical or histologic differences vs VL or VC, but histometric analysis was able to detect epithelial differences between both premalignant lesions and VC.