Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Tumours of the Oral Cavity and Mobile Tongue

The fifth chapter of the upcoming fifth edition of the 2022 World Health Organization Classification of Tumours of the Head and Neck titled Tumours of the oral cavity and mobile tongue, has had some modifications from the 2017 fourth edition. A new section "Non-neoplastic Lesions", introduces two new entries: necrotizing sialometaplasia and melanoacanthoma. The combined Oral potentially malignant disorders and Oral epithelial dysplasia section in the 2015 WHO has now been separated and submucous fibrosis and HPV-associated dysplasia are also discussed in separate sections. Carcinoma cuniculatum and verrucous carcinoma are described in dedicated sections, reflecting that the oral cavity is the most common location in the head and neck for both these entities which have distinct clinical and histologic features from conventional squamous cell carcinoma. This review summarizes the changes in Chapter 5 with special reference to new additions, deletions, and sections that reflect current clinical, histological, and molecular advances.

Fog Computing Employed Computer Aided Cancer Classification System Using Deep Neural Network in Internet of Things Based Healthcare System

Computer assisted automatic smart pattern analysis of cancer affected pixel structure takes critical role in pre-interventional decision making for oral cancer treatment. Internet of Things (IoT) in healthcare systems is now emerging solution for modern e-healthcare system to provide high quality medical care. In this research work, we proposed a novel method which utilizes a modified vesselness measurement and a Deep Convolutional Neural Network (DCNN) to identify the oral cancer region structure in IoT based smart healthcare system. The robust vesselness filtering scheme handles noise while reserving small structures, while the CNN framework considerably improves classification accuracy by deblurring focused region of interest (ROI) through integrating with multi-dimensional information from feature vector selection step. The marked feature vector points are extracted from each connected component in the region and used as input for training the CNN. During classification, each connected part is individually analysed using the trained DCNN by considering the feature vector values that belong to its region. For a training of 1500 image dataset, an accuracy of 96.8% and sensitivity of 92% is obtained. Hence, the results of this work validate that the proposed algorithm is effective and accurate in terms of classification of oral cancer region in accurate decision making. The developed system can be used in IoT based diagnosis in health care systems, where accuracy and real time diagnosis are essential.

Historical Evolution of the Polymorphous Adenocarcinoma

The 2017 World Health Organization Classification of Head and Neck Tumors introduced for the first time the diagnostic terminology "cribriform variant of polymorphous adenocarcinoma". This nomenclature attempts to reconciliate the ongoing taxonomical controversy related to cribriform adenocarcinoma of tongue. In order to better understand this classification conundrum, it is imperative for pathologist to comprehend the historical evolution of polymorphous adenocarcinoma formerly known as polymorphous "low grade" adenocarcinoma. This review highlights our understanding of these tumors since their origins.

What does the 4th edition of the World Health Organization Classification of Head and Neck Tumors (2017) bring new about mucosal melanomas?

The recently published 4th Edition of the World Health Organization Classification of Head and Neck Tumors addresses the most relevant and updated aspects of tumor biology, including clinical presentation, histopathology, immunohistochemistry, and prognosis of head and neck tumors. The objective of the present study is to compare these updates to the 3rd edition of that book with regard to mucosal melanomas and to highlight the potential factors that differ those tumors from cutaneous melanomas. We observed progress in the understanding of oral and sinonasal mucosal melanomas, which also present themselves, in the molecular scope, differently form cutaneous melanomas.

Evolution of oral neoplasm in an andalusian population (Spain)

BACKGROUND

Head and neck cancer are one of the most common neoplasm pathologies in humans. The aim of this study was to analyze the type, characteristics, treatment and evolution of oral neoplasm or precancerous lesion in a sample of Andalusian population (Spain) derived from the Oncology Rehabilitation Hospital Unit during a period of 20 years.

MATERIAL AND METHODS

A retrospective descriptive study was carried out during the years 1991 and 2011 analyzing the type, characteristics, treatment and follow-up of oral neoplasm in the Oral and Maxillofacial Surgery Unit of the Universitary Hospital Virgen del Rocio. The inclusion criteria were patients whose underlying pathology was any type of benign or malignant neoplasm or presence of precancerous lesion that, after treatment, had been referred to the Prosthetic Rehabilitation Unit.

RESULTS

Of the initial analyzed sample of 60 patients, only 45 patients met the inclusion criteria. Of the final sample analyzed, 31 subjects were men (68.9%) and 14 women (31.1%) (p = 0.0169). The mean age of the sample was 57 years ± 13.83, been more frequently in older people with more than 50 years (73.3%) (p = 0.0169). The most common type of neoplasm was epidermoid carcinoma (64.4%). The site most frequently found in squamous cell carcinoma was the floor of the mouth (31%). The most frequent treatment modality was surgery with postoperative radiotherapy (42.2%). All patients had a minimum follow-up of 5 years, and a recurrence in this period was identified in 11.1% of the sample. Multivariate logistic regression showed a statistically significant association for the variables age (p = 0.0063) and smoking (p = 0.0434).

CONCLUSIONS

Epidermoid carcinoma is the most frequent tumor in the oral cavity, where increase age and smoking are confirmed as associated risk factors.

Squamous cell carcinoma of the oral cavity: clinical and pathological aspects

Oral cavity cancer is a public health problem as the sixth leading cause of cancer worldwide. Most tumor lesions are detected in stage III and IV, leading to a poor prognosis, five-year survival rate ranging between 10% and 40%. Oral cancer etiology is multifactorial, known still incomplete. The main etiopathogenic factors are exposure to cigarette smoke and alcohol consumption. We conducted a retrospective study of oral cavity tumors hospitalized in 2008-2012 in Oral and Maxillofacial Surgery Clinic of the Emergency County Hospital of Craiova, Romania. Of 143 tumors of the oral cavity, 125 were malignant, and of these, 115 (92%) were represented by squamous cell carcinoma. Tumor lesions were more common in males (69%), patients from rural areas (64%) and those over 50-year-old (87.71%).

Incidence of oral cancer among South Asians and those of other ethnic groups by sex in West Yorkshire and England, 2001-2006

In 2008 there were 11682 cases of oral cancer in the United Kingdom; this is 16.41/100000 population, and 3.7% of all cancers. Ethnic coding of these data is poor, and so databases were combined to report rates for the incidence of oral cancer in South Asians compared with those among other ethnic groups in West Yorkshire, 2001-2006. A total of 2157 patients with oral cancer were identified in West Yorkshire, 138 of whom were South Asian (6.4%). We analysed them by ethnicity, sex, area in which they lived, and site of cancer. Oral cancer was significantly more common among South Asian women than those from other ethnic groups in England and West Yorkshire, and in England alone it was significantly more common in men of other ethnic groups than those from South Asia. Patients from South Asia were at higher risk of being diagnosed with oral cancer than those of other ethnic groups within West Yorkshire, when data were adjusted for age at diagnosis and sex. In England and in West Yorkshire there was a significantly higher rate of oral cancer among Southern Asian women than among those of other ethnic groups, and men in other ethnic groups had a higher incidence than those from South Asia (England only). The excess of oral cancers gives further weight to the association between smokeless tobacco, smoking, alcohol, and dietary intake by ethnic group. This information is particularly pertinent in areas such as West Yorkshire where there are large groups of Asian people.

Brownian motion curve-based textural classification and its application in cancer diagnosis

OBJECTIVE

To develop an automated diagnostic methodology based on textural features of the oral mucosal epithelium to discriminate normal and oral submucous fibrosis (OSF).

STUDY DESIGN

A total of 83 normal and 29 OSF images from histopathologic sections of the oral mucosa are considered. The proposed diagnostic mechanism consists of two parts: feature extraction using Brownian motion curve (BMC) and design ofa suitable classifier. The discrimination ability of the features has been substantiated by statistical tests. An error back-propagation neural network (BPNN) is used to classify OSF vs. normal.

RESULTS

In development of an automated oral cancer diagnostic module, BMC has played an important role in characterizing textural features of the oral images. Fisher's linear discriminant analysis yields 100% sensitivity and 85% specificity, whereas BPNN leads to 92.31% sensitivity and 100% specificity, respectively.

CONCLUSION

In addition to intensity and morphology-based features, textural features are also very important, especially in histopathologic diagnosis of oral cancer. In view of this, a set of textural features are extracted using the BMC for the diagnosis of OSF. Finally, a textural classifier is designed using BPNN, which leads to a diagnostic performance with 96.43% accuracy. (Anal Quant

The immunohistochemical profile of oral inflammatory myofibroblastic tumors

OBJECTIVE

The aim of this study was to demonstrate the immunohistochemical profile of oral inflammatory myofibroblastic tumors (IMTs) along with morphologic analysis.

STUDY DESIGN

Three cases diagnosed as oral IMTs were selected to compile an immunohistochemical panel constituted by calponin, caldesmon, Bcl-2, desmin, fibronectin, CD68, Ki-67, S100, anaplastic lymphoma kinase (ALK), α-smooth muscle actin, cytokeratins AE1/AE3, muscle-specific actin, CD34, and vimentin. An oral squamous cell carcinoma with a focal area of desmoplastic stroma was used as control for the stained myofibroblastic cells.

RESULTS

All oral IMTs were positive for calponin, revealing a strong and diffuse expression in the spindle-shaped cells. The lesions were also positive for vimentin (3/3), fibronectin (3/3), α-smooth muscle actin (3/3), and muscle-specific actin (1/3) and negative for h-caldesmon, Bcl-2, desmin, CD68, Ki-67, S100, ALK, cytokeratins AE1/AE3, and CD34.

CONCLUSIONS

Within the results encountered, the present panel should be of great assistance in the diagnosis of oral IMTs.

Oral premalignant lesions: from the pathological viewpoint

Under the widely used World Health Organization (WHO) classification for the pathological diagnosis of oral premalignant lesions, dysplasia, which is graded as mild, moderate or severe, and carcinoma in situ (CIS), which is a non-invasive carcinoma, are classified as precursor lesions of oral squamous cell carcinoma. Since the first edition (Wahi et al. International histological classification of tumours no. 4, WHO, Geneva, 1971), the criterion for CIS--that all epithelial layers are replaced by atypical cells--has remained unchanged. However, this dysplasia-carcinoma sequence theory was introduced from the viewpoint of pathological changes in the uterine cervix: in contrast, almost all premalignant lesions and CIS of the oral mucosa show superficial maturation and differentiation. Based on this recognition, the squamous intraepithelial neoplasia (SIN) classification and Ljubljana classification were included in WHO's latest edition published in 2005. Although the WHO classification is commonly used in Japan, recent developments in oral oncology have promoted modifications of the classification used in this country. In 2005, the Working Group of the Japan Society for Oral Tumours advocated iodine staining and proposed a modified SIN system, and in 2007, the Working Committee of the Japanese Society for Oral Pathology (JSOP) reported a new CIS (JSOP) definition that included differentiated-type CIS. In 2010, based on these studies, a new entity--oral intraepithelial neoplasia (OIN)--was included in the first edition of General Rules for Clinical and Pathological Studies on Oral Cancer. In this review, we focus on the OIN/CIS (JSOP) new classification of premalignant lesions in oral mucosa, which further advances the concept of SIN.

[Odontogenic tumours in the dog and cat]

OBJECTIVE

Odontogenic tumours in the dog and cat, as well as in other domestic animals and in man occur rarely and can be difficult to diagnose. In the present study a great number of canine and feline odontogenic tumours were investigated histopathologically and classified to provide an appropriate basis for the evaluation of these tumours.

MATERIAL AND METHODS

In a retrospective study of a total of 1390 canine and 317 feline oral tumours from the years 1977 to 2007, the tumours of odontogenic origin were selected, characterized histopathologically and classified according to the current human WHO-classification of odontogenic tumours (2005) and the current veterinary WHO-classification of odontogenic tumours (2003).

RESULTS

18% (n=250) of the canine and 3.2% (n=10) of the feline oral tumours proved to be of odontogenic origin. They could be divided into benign (epithelial, epithelial and ectomesenchymal, ectomesenchymal) and malignant (carcinomas and sarcomas) odontogenic tumours with a total of 12 different entities. The odontogenic fibroma was the most common canine (n=167) and feline (n=4) odontogenic tumour. The second most common odontogenic tumour for canines was ameloblastoma (n=74) and that for felines was ameloblastic fibroma (n=2). Four of the 12 entities could be classified according to both WHO-classifications of odontogenic tumours. Seven and two of the 12 entities could only be classified according to the current human WHO-classification and veterinary WHO-classification, respectively.

CONCLUSION AND CLINICAL RELEVANCE

The prognostic evaluation of tumours is of the greatest clinical relevance and calls for an absolutely certain diagnosis. Particularly in the case of the rare and histomorphologically complex odontogenic tumours the current veterinary WHO-classification does not meet this requirement and needs to be revised and extended. The human WHO-classification proved to be more efficient when compared to the veterinary one.

[Peculiarities of protein Ki-67 expression in cases of leukoplakia and epidermoid cancer of oral mucous membrane]

There were presented results of the study directed to disclosure of malignant cell changes criterion in cases of oral mucous membrane leukoplakia with different degrees of neoplastic transformation according to WHO-2005 classification of squamous intraepithelial neoplasia (SIN). With the help of immunohistochemical method proliferation in different layers of oral mucous membrane epithelium was evaluated. It was established that most important for diagnostics was the correspondence of proliferating cells in parabasal and basal epithelium layers. Figure less than 1 was corresponding to normal epithelium and SIN1, between 1 and 2 was corresponding to SIN2, 2 and more was characteristic itoSIN3.

Supervised classification of array CGH data with HMM-based feature selection

MOTIVATION

For different tumour types, extended knowledge about the molecular mechanisms involved in tumorigenesis is lacking. Looking for copy number variations (CNV) by Comparative Genomic Hybridization (CGH) can help however to determine key elements in this tumorigenesis. As genome-wide array CGH gives the opportunity to evaluate CNV at high resolution, this leads to huge amount of data, necessitating adequate mathematical methods to carefully select and interpret these data.

RESULTS

Two groups of patients differing in cancer subtype were defined in two publicly available array CGH data sets as well as in our own data set on ovarian cancer. Chromosomal regions characterizing each group of patients were gathered using recurrent hidden Markov Models (HMM). The differential regions were reduced to a subset of features for classification by integrating different univariate feature selection methods. Weighted Least Squares Support Vector Machines (LS-SVM), a supervised classification method which takes unbalancedness of data sets into account, resulted in leave-one-out or 10-fold cross-validation accuracies ranging from 88 to 95.5%.

CONCLUSION

The combination of recurrent HMMs for the detection of copy number alterations with LS-SVM classifiers offers a novel methodological approach for classification based on copy number alterations. Additionally, this approach limits the chromosomal regions that are necessary to classify patients according to cancer subtype.

Prognostic significance of the anatomical location and TNM clinical classification in oral squamous cell carcinoma

OBJECTIVES

The aim of this study was to investigate the existence of correlation between the TNM clinical classification, anatomical location and prognosis of oral squamous cell carcinoma.

STUDY DESIGN

A total of 130 oral squamous cell carcinomas were selected from the files of the Dr. Luiz Antonio Hospital (Natal, Rio Grande do Norte, Brazil). Data concerning TNM clinical classification, anatomical location and prognosis were obtained. Pearsons correlation test was applied for the statistical analysis of data.

RESULTS

It revealed a statistically significant correlation (p = 0.01) between TNM clinical classification and prognosis. It also revealed correlation between TNM classification and the anatomical location of oral squamous cell carcinomas (p = 0.01).

CONCLUSIONS

We concluded that TNM classification presented correlation with prognosis and with the different anatomical locations of oral squamous cell carcinomas.

Oral undifferentiated high-grade pleomorphic sarcoma: report of a case

The current World Health Organization classification considers the existence of an undifferentiated unclassifiable category of pleomorphic sarcomas, defined as a group of pleomorphic high-grade sarcomas. Undifferentiated high-grade pleomorphic sarcoma represents about 5% of all soft tissue sarcomas in adults and occurs more commonly in the extremities. In the oral cavity, undifferentiated pleomorphic sarcoma is extremely rare. We report a case of undifferentiated high-grade pleomorphic sarcoma located in the floor of the mouth in a man 56 years old. Microscopically, spindle-shaped cells with accented pleomorphism arranged in a storiform pattern, several bizarre giant cells, and frequent atypical mitoses were observed. The tumor cells were positive only for vimentin, with focal positivity for CD68. The patient was treated by surgery and postoperative radiation therapy, and after 25 months, no recurrence was observed.

[Cavernous hemangiomas of the skin of the face and neck and the oral soft tissues]

The structure, clinical manifestations, behavior of cavernous hemangomas of the skin of the face and neck, and the oral soft tissues were studied, by using biopsy specimens from 229 patients. Three types of cavernous hemagiomas of these areas were identified. Their preferred treatments were defined and pathogenetically warranted.

Oral non-Hodgkin's lymphoma: review of the literature and World Health Organization classification with reference to 40 cases

Forty cases of oral cavity non-Hodgkin's lymphoma (NHL) were evaluated for sex, age, location, clinical presentation, and World Health Organization (WHO) histological subtype. Fifty-three percent were female and the mean age was 71. The upper jaw (maxilla or palatal bone), mandible, palatal soft tissue, and vestibule and gingivae (maxillary or mandibular soft tissue involvement only) were, respectively, the most common locations. Swelling, ulceration, and radiographic destruction of bone were the most frequent signs. Most of the lymphomas were of B cell lineage (98%), and the majority of these B cell lymphomas (58%) were histologically subtyped as diffuse large B cell lymphoma, which is considered to have an aggressive clinical course. An immunohistochemical panel was used in the majority of cases to confirm the lineage and to help characterize the subtype. B and T cell specific markers were used to show lineage of the neoplastic cells. Additional markers were used to help confirm specific subtypes that characteristically show specific positivity to some of these antibodies. Molecular studies to detect monoclonal immunoglobulin heavy chain (IgH) gene rearrangements and Bcl-1 and Bcl-2 gene translocations were performed in cases in which the diagnosis was in question. The current WHO classification is also reviewed in detail.

Histologic subtypes of oral squamous cell carcinoma: prognostic relevance

Squamous cell carcinoma (SCC) is the most prevalent malignant neoplasm of the oral cavity. The conventional tumour and several histologic subtypes of SCC present morphologic features and specific behaviour when they occur in the oral mucosa. For example, basaloid SCC is an aggressive tumour and verrucous carcinoma has the lowest invasive and metastatic potential; however, the clinical and biologic course of these oral SCC variants has not been completely established. Furthermore, although numerous clinical and histologic features associated with oral SCC have been identified, none shows unequivocal prognostic significance. The purpose of this article is to review the various subtypes of oral SCC, emphasizing problems in their histologic diagnosis and prognosis.

Odontogenic Tumors in Sri Lanka: Analysis of 226 Cases

PURPOSE

The purpose of this study was to analyze the relative prevalence of odontogenic tumors in Sri Lanka and compare it with prevalences reported for other countries.

PATIENTS AND METHODS

A total of 226 cases of odontogenic tumors reported by the Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya between 1996 and 2002, were analyzed.

RESULTS

The most prevalent tumor was ameloblastoma (69.8%); odontoma was the fourth most prevalent (4.5%). No gender predilection was seen, but the tumors occurred most frequently in the second to fifth decades of life (77.4%) and most commonly in the mandible (79.6%).

CONCLUSIONS

The comparative data with statistically significant differences suggest a geographical difference in the relative prevalence of ameloblastoma among various continents. It is suggested that ameloblastoma most frequently occurs in the mandible (the posterior region) in all Asian, African, and South American countries.

Gene expression signatures that can discriminate oral leukoplakia subtypes and squamous cell carcinoma

The purpose of this study is to generate a classifier for oral squamous cell carcinoma (OSCC) and leukoplakias (LPs), and evaluate its diagnostic potential. In order to identify marker gene candidates, differential gene expression between LPs and OSCCs were examined by cDNA microarray. The expression of 118 marker gene candidates was further evaluated by quantitative reverse transcription-PCR (QRT-PCR) analyses of 27 OSCC and 19 LP tissues. We identified 12 up-regulated and 15 down-regulated marker genes in OSCCs compared to LPs. Using Fisher's linear discriminant analysis (LDA), we demonstrated that 11-gene predictors among this novel marker set could best distinguish OSCCs from LPs (>97% accuracy), whereas a further seven of these gene predictors could be utilized to distinguish higher grade (higher than moderate) from lower grade (lower than mild) dysplasias (>95% accuracy). These predictor gene sets provide multigene classifiers for the diagnosis of pre-cancerous to cancerous transition of oral malignancy.

Macroscopic classification of superficial neoplastic lesions of the oral mucosa: a preliminary study

BACKGROUND

Careful endoscopic classification of macroscopic appearance of superficial neoplasias of the gastrointestinal tract is essential in the early detection and appropriate treatment of cancer. It has contributed to introduce minimally invasive endoscopic surgery and has significantly improved survival of patients with colon and gastric cancers. Squamous cell carcinoma of the oral cavity has been characterized, in past and present times, by poor prognosis and lack of progress in treatment outcome. Failure in diagnosing oral malignancy at an early stage is a major culprit, and the lack of a worldwide adopted classification of its macroscopic appearance, similar to that of gastrointestinal neoplasias, may have contributed to it.

AIM

To test the hypothesis that is possible to extend the diagnostic benefit of a classification based upon the macroscopic appearance of superficial tumours of the digestive tract to superficial carcinoma of the oral mucosa.

METHODS

We retrospectively examined a group of patients who developed multiple intraepithelial and early invasive malignant oral neoplasias, applying a modified version of the Paris classification of superficial GI neoplastic lesions.

RESULTS

One hundred and ten out of 116 (94.9%) of the study lesions had morphological features that accorded with the prepared classification.

CONCLUSIONS

These preliminary data suggest that most superficial early neoplastic lesions of the oral cavity can be easily detected using a well-defined classification system similar to that employed in the diagnosis of early gastrointestinal malignancy.

Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian population

Hemangioma, vascular malformation and varix are benign vascular lesions, common in the head and neck regions. Studies about the prevalence of these lesions in the oral cavity are scarce. The aim of this study was to estimate the prevalence of and to obtain clinical data on oral hemangioma, vascular malformation and varix in a Brazilian population. Clinical data on those lesions were retrieved from the clinical forms from the files of the Oral Diagnosis Service, School of Dentistry, Federal University of Minas Gerais, Brazil, from 1992 to 2002. Descriptive analysis was performed. A total of 2,419 clinical forms in the 10-year period were evaluated, of which 154 (6.4%) cases were categorized as oral hemangioma, oral vascular malformation or oral varix. Oral varix was the most frequent lesion (65.6%). Females had more oral hemangioma and oral varix than males. Oral vascular malformation and oral varix were more prevalent in the 7th and 6th decades, respectively. Oral hemangioma and oral varix were more prevalent in the ventral surface of the tongue and oral vascular malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5%), and vascular malformation was managed with sclerotherapy and surgery (19.4% each). The data of this study suggests that benign vascular lesions are unusual alterations on the oral mucosa and jaws.

Increased CK19 expression correlated with pathologic differentiation grade and prognosis in oral squamous cell carcinoma patients

OBJECTIVE

To investigate cytokeratin 19 (CK19) expression in oral squamous cell carcinoma (OSCC) tissue as well as its correlation with pathologic differentiation grade and prognosis.

STUDY DESIGN

Cancerous and distant tissues from 33 primary OSCC patients were collected during surgery. Each sample was divided into 2 parts, one for CK19 protein detection using immunohistochemistry, and the other for CK19 mRNA-level detection of relative quantification using fluorescent real-time reverse transcriptase polymerase chain reaction (RT-PCR).

RESULTS

The CK19 positive rate in cancerous tissue was 90.9% (30 out of 33) detected using immunohistochemistry, which was significantly higher than that in distant tissue (15.2%, 5 out of 33) by chi-square test (P < .001). The CK19 positive score in cancerous tissue was also significantly higher than that in the corresponding distant tissue by paired samples t test (P < .001). Patients with positive CK19 expression in distant tissue had higher tumor recurrence rate (P = .008) and lower survival rate (P = .015) than those with negative CK19 expression in distant tissue. Using fluorescent real-time RT-PCR, CK19 mRNA level in cancerous tissue was 2.21-fold higher than that in distant tissue (P = .020). The CK19 expression correlated significantly with pathologic differentiation grade, which was detected not only using immunohistochemistry (P = .002) but also using fluorescent real-time RT-PCR (P = .025), poorer differentiated indicating higher CK19 positive score and CK19 mRNA level.

CONCLUSIONS

Increased CK19 protein expression and gene transcription in OSCC tissue correlate significantly with pathologic differentiation grade. Positive CK19 expression in distant tissue suggests a higher tumor recurrence rate and a lower survival rate.

Correlation of proliferative markers (Ki-67 and PCNA) with survival and lymph node metastasis in oral squamous cell carcinoma: a clinical and histopathological analysis of 113 patients

The purposes of this study were to examine the correlations between proliferation markers and survival rate in oral squamous cell carcinoma (OSCC) patients, and to evaluate the efficacy of proliferation markers in predicting lymph node metastasis. The patients' age, gender, T score, clinical stage, PCNA and Ki-67 index were analysed. Univariate analysis showed that T score had a significant influence on survival, and stage 4 group had a significantly lower survival rate. Lymph node metastasis was also a significant predictor of survival. Using a cut-off point of 25%, those patients with lower Ki-67 scores had survival advantage over those with higher Ki-67 scores. PCNA did not show any differences in survival with a cut-off point of 50%. Ki-67 and PCNA were significantly higher in the primary tumours associated with lymph node metastasis (pN+) than in those without lymph node metastasis (pN0). Multivariate analysis showed that clinical stage and Ki-67 were independent prognostic factors for survival in OSCC patients. From this result, it can be postulated that the cancer staging based on the TNM stage was a powerful prognostic variable and Ki-67 had a significant effect on the cumulative survival rate.

Carcinoma of tongue and the buccal mucosa represent different biological subentities of the oral carcinoma

PURPOSE

Clinico-epidemiological studies show that the behaviour of the tongue cancer is different from the cancer originating at other sites of the oral cavity. However, studies identifying the reason for such difference are lacking in the literature.

METHODS

In the present study, we have attempted to see whether any difference existed in the cell cycle regulatory mechanism of these tumours by comparing immunohistochemically the expression of major cell cycle regulatory proteins in 147 buccal and 94 tongue carcinoma (anterior two-third of tongue) prospectively.

RESULTS

On comparison of buccal and tongue carcinoma, expression of p16 and p21 showed significant difference. In combined analysis, simultaneous down regulation of p16 and p21 was seen in 47% of tongue cancer cases as against 28% in buccal carcinoma (P=0.004). In univariate analysis, none of the clinico-biological variables studied showed significant association with survival in tongue carcinoma, whereas, some of the clinico-biological variables associated with survival in buccal carcinoma. Among the biological markers, the overexpression of cyclin D1 (P=0.007) and p53, detected using both the clones of antibodies-DO7 (P=0.008) and PAb240 (P=0.014) and the down regulation of p16 (0.033), showed significant association with shorter disease free survival (DFS) in these cases. Whereas in the case of overall survival (OS), overexpression of p53 [DO7 (P=0.031) and PAb240 (P=0.017)] and cyclin D1 (P=0.001) associated with poor survival. In multivariate analysis, the expression pattern of p53 and p16 protein influences the DFS whereas cyclin D1 expression showed independent association with the OS in buccal carcinoma.

CONCLUSIONS

Thus, tongue and buccal cancers represent different biological subentities, and such differences should be considered in oral cancer management.

Aktuelle Klassifikation der Präkursorläsionen des oralen Plattenepithelkarzinoms

The WHO classification of oral tumours summarizes the precancerous squamous cell lesions under the term epithelial precursor lesions. For the first time three classification schemas that histologically categorize oral epithelial precursor lesions are used analogously. According to the WHO suggestion of 2005 the traditional schema of grading dysplasia as mild dysplasia, moderate dysplasia, severe dysplasia and carcinoma in situ continues to be used. In addition the concept of intraepithelial neoplasia is introduced as squamous intraepithelial neoplasia I-III. Squamous intraepithelial neoplasia III (SIN III) combines severe dysplasia and carcinoma in situ. The Ljubljana classification of squamous intraepithelial lesions was originally established to grade laryngeal epithelial precancerous lesions. The clear and succinct nomenclature and the simple clinical utility of the Ljubljana classification have also proven to be useful for oral epithelial precursor lesions: squamous cell (simple) hyperplasia; basal/parabasal cell hyperplasia (analogous to mild dysplasia and to SIN I); atypical hyperplasia (analogous to moderate-severe dysplasia and to SIN I-III and is also called risky epithelium); carcinoma in situ (analogous to WHO carcinoma in situ and to SIN III). Atypical hyperplasia (risky epithelium) and carcinoma in situ are defined as lesions requiring either total excision or close clinical monitoring.

[Histological charakteristics of tongue and floor of the mouth neoplasms and their clinical prognostic value]

INTRODUCTION

The number of histological classifications has been introduced to asses the squamous cell carcinoma in head and neck. The Jakobsson histological system employs 8 different morphological characteristics. Four of them concerning tumor cell population and another four describe relation to the adjacent tissues.

MATERIAL AND METHODS

The material comprised tissue specimens from 80 patients with squamous cell carcinoma of the tongue and floor of the mouth who underwent the primary surgery. All the data concerning Jakobsson classification, histological differentiation G, TNM classification, and recurrence and survival rates were recorded and analyzed.

RESULTS

Any significant correlation has been found between Jakobsson classification and histological differentiation. Nevertheless statistically significant correlation between Jakobsson classification and T of the tumor, nodal metastases and local and nodal relapse has been recorded.

CONCLUSIONS

The Jakobsson classification constitute the important supplement of the routine histological assessment and may significantly contribute to the choice of therapy.

Oral cancer detection using diffuse reflectance spectral ratio R540/R575 of oxygenated hemoglobin bands

A low-cost, fast, and noninvasive method for early diagnosis of malignant lesions of oral mucosa based on diffuse reflectance spectral signatures is presented. In this technique, output of a tungsten halogen lamp is guided to the tissue through the central fiber of a reflection probe whose surrounding six fibers collects tissue reflectance. Ex vivo diffuse reflectance spectra in the 400 to 600-nm region is measured from surgically removed oral cavity lesions using a miniature fiber optic spectrometer connected to a computer. Reflectance spectral intensity is higher in malignant tissues and shows dips at 542 and 577 nm owing to absorption from oxygenated hemoglobin (HbO2). Measurements carried out, within an hour of surgical excision, on malignant lesion and adjoining uninvolved mucosa show that these absorption features are more prominent in neoplastic tissues owing to increased microvasculature and blood content. It is observed that reflectance intensity ratio of hemoglobin bands, R540/R575, from malignant sites are always lower than that from normal sites and vary according to the histological grade of malignancy. The diffuse reflectance intensity ratio R540/R575 of the hemoglobin bands appears to be a useful tool to discriminate between malignant lesions and normal mucosa of the oral cavity in a clinical setting.

Principal component analysis and artificial neural network analysis of oral tissue fluorescence spectra: Classification of normal premalignant and malignant pathological conditions

Pulsed laser-induced autofluorescence spectroscopic studies of pathologically certified normal, premalignant, and malignant oral tissues were carried out at 325 nm excitation. The spectral analysis and classification for discrimination among normal, premalignant, and malignant conditions were performed using principal component analysis (PCA) and artificial neural network (ANN) separately on the same set of spectral data. In case of PCA, spectral residuals, Mahalanobis distance, and scores of factors were used for discrimination among normal, premalignant, and malignant cases. In ANN, parameters like mean, spectral residual, standard deviation, and total energy were used to train the network. The ANN used in this study is a classical multiplayer feed-forward type with a back-propagation algorithm for the training of the network. The specificity and sensitivity were determined in both classification schemes. In the case of PCA, they are 100 and 92.9%, respectively, whereas for ANN they are 100 and 96.5% for the data set considered.

Intra-oral findings and general health conditions among institutionalized and non-institutionalized elderly in Greece

BACKGROUND

The aim of the study was to record the findings from intra-oral examination and the general health conditions encountered in a group of Greek individuals 65 years of age or older.

PATIENTS AND METHODS

The study subjects were derived from the elderly attending 12 randomly selected community centres located in Athens and neighbouring municipalities, consisting the non-institutionalized study group and from the elderly living in three ecclesiastical nursing homes, consisting the institutionalized study group. The research data comprised information from the subjects' interviews, self-defined health status, medical records and intra-oral examination on the following variables: sex, age, general health condition, dentate or not, use of dentures and oral conditions. Fisher's exact two-sided test was used for statistical analysis.

RESULTS

Overall, 316 patients were examined; 120 male (38%), 196 female (62%), mean age 78 years (range: 65-99). Of those, 150 were non-institutionalized (59 male, 91 female) and 166 institutionalized (61 male and 105 female). The vast majority (90%) of the patients had at least one general health problem, for which they were taking daily medication. Twenty-three different medical conditions were recorded. The most frequent medical problems were hypertension (56%), cardiovascular problems (41%), depression/anxiety (39%), arthritis (18.5%) and visual problems (16%). The vast majority of the study patients (79%) were edentulous, while 33% were not wearing or using their dentures. Almost half of them (47%) had at least one oral condition. Twenty-seven different oral conditions were recorded. The most frequent oral findings were denture-induced stomatitis (17.2%), dry mouth (14.6%), atrophy of tongue papillae (10.5%), fissured tongue (9.8%) and haemangioma (6.8%). No cases of malignant lesions were observed.

CONCLUSIONS

The present study confirms that in this particular age group, general health problems are frequent, variable, coexistent, necessitating the daily administration of multiple medications, while oral examination by a specialist is an essential part of the multidisciplinary medical care in this group of individuals.

Older adults--implications for private dental practitioners

Currently, 35 million people are over the age of 65 in the United States. This number is expected to double to 70 million by 2030 (Figure 1). In California, 3.7 million people are over the age of 65, and this number is expected to increase to 6.4 million in the next 20 years or within the practice lifetime of students presently enrolled in California's dental hygiene and dental schools. The oldest old, those over age 85, are the fastest-growing segment of the United States and California's population. California's aging population will reflect the diversity of the state in general. Table 1 lists California's 65-plus population by age and ethnic/racial categories. By 2030, one in five Americans and Californians will be 65 years or older. Women who reach age 65 can expect to live an additional 19 years of life, while men can expect to live an additional 16 years. The gap in life expectancy between men and women is narrowing due to improvements in medical care, preventive health services, and healthier lifestyles. Figures 2-4 show the improvements in life expectancy at birth, age 65, and age 75 for the U.S. population. In the United States, there are an estimated 1.8 million nursing home beds used by 80 percent of the residents over age 65. A report by the U.S. General Accounting Office estimated that 43 percent of all Americans over age 65 will reside in a nursing home at some time in their life. California currently has approximately 100,000 residents living in one of the 1503 nursing home facilities throughout the state. Nursing home care in California accounts for 5.6 billion dollars. In 1998, the U.S. General Accounting Office reported that one in three California nursing homes was cited for serious or potentially life-threatening care problems. With an aging imperative in California, this paper will discuss the implications of an aging society on maintaining oral health throughout one's life, and the ability of dental professionals to meet the oral health needs of this population.

Characteristics of 40 primary extranodal non-Hodgkin lymphomas of the oral cavity in perspective of the new WHO classification and the International Prognostic Index

Non-Hodgkin lymphomas (NHLs) are often present outside the lymph nodes. Although primary extranodal NHLs (PE-NHL) form a substantial part of all NHLs, reports on oral PE-NHLs are rare. Forty patients with PE-NHL of the oral cavity have been studied for the distribution of gender, age, oral subsite and presenting complaint, histological subtype according to the WHO classification, clinical stage, treatment, and follow-up. The data are reviewed against the background of the literature. Furthermore, the International Prognostic Index has been taken into consideration. All patients had a lymphoma of B-cell lineage. Two-thirds of patients presented with locoregional disease. Mean survival time was 38 months, with a mean recurrence-free survival time of 31 months. There was no statistically significant difference in survival time between patients with bone versus soft tissue localisation of the PE-NHL. In view of the rarity of PE-NHL involving the oral region multicenter studies are needed for evaluation of the usefulness of the International Prognostic Index for non-Hodgkin lymphoma in this particular part of the body.

Correlation between TNM classification and malignancy histological feature of oral squamous cell carcinoma

Histological staging of deep invasive margin of oral squamous cell carcinoma has a significant influence on survival of patients since the tumor cells are more poorly differentiated in this area and have high prognostic value.

Aim

the purpose of the present study is to correlate TNM clinical classification with histopathologic characteristics (degree of keratinization, nuclear pleomorphism, invasion pattern and lymphoplasmocytic infiltrate) and histologic malignancy scores in 38 cases of oral epidermoid carcinoma in the lesion's deepest areas.

Study Form

Retrospective clinical study.

Material and Method

This is a retrospective study based on histological review of 38 cases of oral squamous cell carcinoma selected from the medical files of Hospital Dr. Luis Antonio, Natal - Rio Grande do Norte, Brazil. TNM clinical classification data were obtained from the analysis of the medical records. Two pathologists performed histological malignancy staging on routine 3 µm-thick sections of invasive tumor areas stained with hematoxylin and eosin. For statistical analysis, parametric (ANOVA) and non-parametric tests (Tukey; Pearson; Chi²) were employed.

Results

We found significant correlation between TNM clinical staging and malignancy mean score (p = 0.001) and histopathologic parameters, such as nuclear pleomorphism (p = 0.016) and degree of keratinization (p = 0.025). Furthermore, there were also statistically significant correlations between lymphocytic infiltration (p = 0.016) and nuclear pleomorphism (p = 0.004) with TNM classification when grouped in two series: TNM I/II and III/IV.

Conclusion

TNM classification, as well as malignancy mean score, had statistically significant correlation with degree of keratinization, nuclear pleomorphism and lymphocytic infiltration. These highly significant results indicated that histologically invasive areas may be primarily responsible for the clinical behavior of the tumor, and this may be important for the therapy of choice for oral squamous cell carcinoma.

Chemoembolization Using Cisplatin Crystals as Neoadjuvant Treatment of Oral Cancer

Chemoembolization for cancer of the head and neck has been used very rarely in the past owing to local characteristics and risks. By combining the antineoplastic activity and embolizing effect in the same drug, a more routine use seems possible. A cisplatin suspension in normal saline (5 mg in 1 mL) with precipitation of microembolizing cisplatin crystals and without additional drugs was prepared. The cisplatin dosage was 150 mg/m2, the maximum absolute dose 300 mg, and the maximum amount of fluid 60 mL. One hundred and three consecutive patients with previously untreated squamous cell carcinomas of the oral cavity and the anterior oropharynx were treated in a neoadjuvant setting with superselective chemoembolization using the cisplatin suspension. Acceptance by the patients has been excellent with no refusal. Overall response after one intervention has been 73%, with 18.5% showing pathological complete remissions. The highest response rates could be seen in T1-3 tumors and tumors of the oral tongue and floor of the mouth. Measurable acute systemic toxicity has been low. Postembolization syndrome, especially swelling, had to be observed carefully. There have been 3.5% interventional and 10% local complications, which could be significantly reduced by the use of this procedure only in cancers of the oral tongue, floor of the mouth, and mandibular alveolar ridge. Chemoembolization of cancer in the head and neck area can be carried out regularly and safely using this method, and it is highly effective. It could be used as an induction before definitive surgery or radiotherapy. Further investigation is mandatory to assess the potential of chemoembolization for the improvement of local control and survival.

Intra-oral squamous cell carcinoma in Nigerians under 40 years of age: a clinicopathological review of eight cases

Intra-oral squamous cell carcinoma (SCC) is a disease commonly seen in patients aged 50 and above. A recent report on intra-oral SCC in the Nigerian population placed the mean age of occurrence for the disease at 50.7 years for male and 49.6 years for females. Age is recognized to be an important factor in the onset and outcome of diseases like cancer. The focus of this study was to conduct a clinicopathological review on the incidence, pattern of presentation, management and outcome of the disease in patients aged 40 years and below seen at the University College Hospital Ibadan, between 1980-1995. During the period under review the total number of cases of SCC was 104, out of which 8 (7.7%) occurred in patients aged 40 years and below. The figure is higher than that of 1-3% obtained in Caucasian studies. The 5 year survival rate of our patients was nil.

Oral carcinoma associated with betel nut chewing in the Pacific: an impending crisis?

In Western populations, tobacco and alcohol use are the major etiologic factors associated with oral cavity cancers. In developing countries of Asia and the South Pacific, however, oral cancer is increasingly associated with the chewing of betel nut. As the population of Asia and the South Pacific immigrates, Head and Neck surgeons in North America are likely to see more patients with oral carcinoma induced by betel nut chewing. Tumor Registry records from 1977-2003 from a tertiary care, referral medical center were reviewed. All patient charts (27) demonstrating betel quid use of greater than 20 years and carcinoma of the upper aerodigestive tract were entered into the study. Five-year disease-free rates by stage were as follows: Stage 1: 100% (2/2); Stage 11: 50% (2/4); Stage III: 36% (4/9): Stage IV: 25% (3/12). Despite the prevalent misperception in the Pacific region that betel nut chewing is a harmless habit, betel nut-induced oral carcinomas are aggressive malignancies requiring aggressive treatment and long-term follow-up.

Clinical study for classification of benign, dysplastic, and malignant oral lesions using autofluorescence spectroscopy

Autofluorescence spectroscopy shows promising results for detection and staging of oral (pre-)malignancies. To improve staging reliability, we develop and compare algorithms for lesion classification. Furthermore, we examine the potential for detecting invisible tissue alterations. Autofluorescence spectra are recorded at six excitation wavelengths from 172 benign, dysplastic, and cancerous lesions and from 97 healthy volunteers. We apply principal components analysis (PCA), artificial neural networks, and red/green intensity ratio's to separate benign from (pre-)malignant lesions, using four normalization techniques. To assess the potential for detecting invisible tissue alterations, we compare PC scores of healthy mucosa and surroundings/contralateral positions of lesions. The spectra show large variations in shape and intensity within each lesion group. Intensities and PC score distributions demonstrate large overlap between benign and (pre-)malignant lesions. The receiver-operator characteristic areas under the curve (ROC-AUCs) for distinguishing cancerous from healthy tissue are excellent (0.90 to 0.97). However, the ROC-AUCs are too low for classification of benign versus (pre-)malignant mucosa for all methods (0.50 to 0.70). Some statistically significant differences between surrounding/contralateral tissues of benign and healthy tissue and of (pre-)malignant lesions are observed. We can successfully separate healthy mucosa from cancers (ROC-AUC>0.9). However, autofluorescence spectroscopy is not able to distinguish benign from visible (pre-)malignant lesions using our methods (ROC-AUC<0.65). The observed significant differences between healthy tissue and surroundings/contralateral positions of lesions might be useful for invisible tissue alteration detection.

Molecular classification of oral cancer by cDNA microarrays identifies overexpressed genes correlated with nodal metastasis

Our purpose was to classify OSCCs based on their gene expression profiles, to identify differentially expressed genes in these cancers and to correlate genetic deregulation with clinical and histopathologic data and patient outcome. After conducting proof-of-principle experiments utilizing 6 HNSCC cell lines, the gene expression profiles of 20 OSCCs were determined using cDNA microarrays containing 19,200 sequences and the BTSVQ method of data analysis. We identified 2 sample clusters that correlated with the T3-T4 category of disease (p = 0.035) and nodal metastasis (p = 0.035). BTSVQ analysis identified a subset of 23 differentially expressed genes with the lowest QE scores in the cluster containing more advanced-stage tumors. Expression of 6 of these differentially expressed genes was validated by quantitative real-time RT-PCR. Statistical analysis of quantitative real-time RT-PCR data was performed and, after Bonferroni correction, CLDN1 overexpression was significantly correlated with the cluster containing more advanced-stage tumors (p = 0.007). Despite the clinical heterogeneity of OSCC, molecular subtyping by cDNA microarray analysis identified distinct patterns of gene expression associated with relevant clinical parameters. Application of this methodology represents an advance in the classification of oral cavity tumors and may ultimately aid in the development of more tailored therapies for oral carcinoma.

Diffuse Large B-cell Lymphomas With Plasmablastic Differentiation Represent a Heterogeneous Group of Disease Entities

Plasmablastic lymphoma was initially described as a variant of diffuse large B-cell lymphoma (DLBCL) involving the oral cavity of HIV+ patients and characterized by immunoblastic morphology and a plasma cell phenotype. However, other lymphomas may exhibit similar morphologic and immunophenotypic features. To determine the significance of plasmablastic differentiation in DLBCL and examine the heterogeneity of lymphomas with these characteristics, we examined 50 DLBCLs with low/absent CD20/CD79a and an immunophenotype indicative of terminal B-cell differentiation (MUM1/CD38/CD138/EMA-positive). We were able to define several distinct subgroups. Twenty-three tumors were classified as plasmablastic lymphoma of the oral mucosa type and showed a monomorphic population of immunoblasts with no or minimal plasmacytic differentiation. Most patients were HIV+ and EBV was positive in 74%. Eleven (48%) cases presented in the oral mucosa, but the remaining presented in other extranodal (39%) or nodal (13%) sites. Sixteen cases were classified as plasmablastic lymphoma with plasmacytic differentiation. These were composed predominantly of immunoblasts and plasmablasts, but in addition exhibited more differentiation to mature plasma cells. Only 33% were HIV+, EBV was detected in 62%, and 44% had nodal presentation. Nine cases, morphologically indistinguishable from the previous group, were secondary extramedullary plasmablastic tumors occurring in patients with prior or synchronous plasma cell neoplasms, classified as multiple myeloma in 7 of the 9. Two additional neoplasms were an HHV-8+ extracavitary variant of primary effusion lymphoma and an ALK+ DLBCL. HHV-8 was examined in 39 additional cases, and was negative in all. In conclusion, DLBCLs with plasmablastic differentiation are a heterogeneous group of neoplasms with different clinicopathological characteristics that may correspond to different entities.

Periapical cemental (fibrous) dysplasia. Clinical, radiographic and pathologic aspects in 7 reported cases

AIM

Periapical cemental dysplasia (PCD) is a relatively common, well-defined pathology. Because of the structural similarities existing in the group of the so-called "fibro-(cemento)-osseus lesions" of the jaws, to which PCD belongs, clinical and radiographic findings are probably more diagnostic than histology. The aim of the present paper is to analyse some new cases of PCD and to compare their clinical, radiographic and histologic features to those reported by the international literature.

METHODS

Seven new cases of PCD are presented here; they were observed in a 12-year period of time. All the patients are white women and 6 lesions exceeded 1 cm in diameter. Only 2 patients were surgically treated, but all of them are still today clinically and radiographically followed.

RESULTS

Clinical, radiographic and histologic data of our cases are generally in agreement with those provided by the international literature.

CONCLUSION

Finally, stress is laid on the existing difficulty, at present as well as in the past, of establishing definitive classification criteria for all fibro-cemento-osseous lesions of the jaws.

PLS-ANN based classification model for oral submucous fibrosis and oral carcinogenesis

BACKGROUND AND OBJECTIVES

For effective management of oral neoplasia, autofluorescence spectroscopy was conducted on patients with different characteristics of oral lesions in vivo. This study tested the possibility of using a multivariate statistical algorithm to differentiate human oral premalignant and malignant lesions from benign lesions or normal oral mucosa.

STUDY DESIGN/MATERIALS AND METHODS

A fiber optics-based fluorospectrometer was used to measure the autofluorescence spectra from healthy volunteers (NOM) and patients with oral lesions of submucous fibrosis (OSF), epithelial hyperkeratosis (EH), epithelial dysplasia (ED), and squamous cell carcinoma (SCC). A partial least-squares and artificial neural network (PLS-ANN) classification algorithm was used to characterize these oral lesions to discriminate premalignant (ED) and malignant (SCC) tissues from "benign" (NOM, OSF, and EH) tissues.

RESULTS

The normalized and centerized spectra of the different kinds of samples showed similar but divergent patterns. Our PLS-ANN classification algorithm could differentiate "premalignant and malignant" tissues from "benign" tissues with a sensitivity of 81%, a specificity of 96%, and a positive predictive value of 88%.

CONCLUSIONS

We conclude that the PLS-ANN classification algorithm based on autofluorescence spectroscopy at 330-nm excitation is useful for in vivo diagnosis of OSF as well as oral premalignant and malignant lesions.

Sugarcane farming, occupational solvent exposures, and the risk of oral cancer in Puerto Rico

The work history information from a population-based case-control study conducted in Puerto Rico was analyzed using a job exposure matrix to investigate the relationship between occupational exposures and cancers of the oral cavity or pharynx. After adjustment for age, alcohol, smoking, and residence in a logistic model, the risk for cancer of the oral cavity, but not the pharynx, was significantly elevated among farm workers in the sugarcane industry (OR = 4.4, 95% CI = 1.4-13.6). An exposure-response trend was seen for cumulative exposure to solvents, with an OR = 3.2 (95% CI = 0.8-12.6) in the highest exposure category. The overall contribution to the risk of cancer of the oral cavity or pharynx associated with occupational exposures in Puerto Rico appears to be small, however, the elevated risks were seen among sugarcane farmers and subjects with high cumulative exposure to solvents.

Aggressive, multifocal oral verrucous leukoplakia: proliferative verrucous leukoplakia or not?

BACKGROUND

Some oral verrucal lesions may constitute parts of the clinicopathological spectrum of proliferative verrucous leukoplakia (PVL). Because of its idiopathic yet sinister nature, it is possible that PVL may exist in other populations. The aim of this study was to review the clinicopathological features of persistent, multifocal, oral verrucal lesions in Malaysian population.

METHODS

Patients with multifocal oral verrucal lesions were selected from surgical and histopathological records.

RESULTS

Nine patients of diverse ethnicity with 43 biopsies were reviewed. The mean age at the presentation was 62 years. The most frequent sites affected were gum, sulci, cheek and tongue. Indulgence in risk habits was reported in about 70% of patients. Four cases developed multifocal carcinoma from multifocal leukoplakia.

CONCLUSIONS

In retrospect, none of the cases fulfilled the original PVL criteria, although three cases were suggestive of PVL. Nevertheless, these findings do not necessarily preclude the existence of PVL as a clinicopathological entity in Malaysian population.