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RESUMEN Las lesiones blancas de la mucosa oral son patologías relativamente frecuentes, siendo la leucoplasia oral (LO) motivo de consulta habitual en Estomatología. Existen muchas variantes de LO y la leucoplasia verrucosa proliferativa (LVP) es una de las menos frecuentes. La LVP es una enfermedad de pronóstico desfavorable, con características clínico-patológicas distintivas, de lento y progresivo crecimiento, de difícil diagnóstico temprano. La etiología permanece incierta aunque se han implicado hábitos tóxicos como el tabaquismo y agentes infecciosos como Papiloma Virus Humano, Candidaalbicans, Virus de Epstein Barr, entre otros. Suele afectar la encía y mucosa alveolar pero el compromiso puede ser de cualquier sitio de la boca. Inicialmente se observa como una placa blanquecina que se tornahiperqueratósicay genera placas irregulares con áreas rojas y zonas verrucosas, que podrían sufrir transformación maligna. Este artículo realiza una revisión bibliográfica de LVP a partir de un caso clínico.
ABSTRACT The white lesions of the oral mucosa are relatively frequent pathologies, being the oral leukoplakia (OL) reason for frequent consultation in Stomatology. There are many variants of OL and proliferative verrucous leukoplakia (PVL) is one of the least frequent. PVL is a disease with unfavorable prognosis, with distinctive clinical-pathological characteristics, of slow and progressive growth and difficult to diagnose early. The etiology remains uncertain although toxic habits have been implicated, like smoking and infectious agents such as Human Papilloma Virus, Candida albicans, Epstein Barr Virus, among others. It usually affects the gum and alveolar mucosa but any partof the mouth can be affected. Initially it is observed as a whitish plaque that becomes hyperkeratotic, generating irregular plaques with red and warty areas, which could undergo malignant transformation. This article performs a bibliographic review of PVL from a clinical case.
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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.
Subject(s)
Humans , Male , Middle Aged , Alveolar Process , Biopsy , Diagnosis , DNA , Follow-Up Studies , Genotype , Gingiva , Human papillomavirus 16 , Lasers, Semiconductor , Leukoplakia , Mouth Neoplasms , Outpatients , Polymerase Chain ReactionABSTRACT
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.
Resumo Introdução: Leucoplasia verrucosa proliferativa (LVP) é uma lesão multifocal e progressiva da mucosa oral, com etiologia desconhecida e comumente resistente a todas as tentativas terapêuticas, com recorrências frequentes. É caracterizada por uma alta taxa de transformação em carcinoma de células escamosas e carcinoma verrucoso da cavidade oral. Objetivo: Analisar os estudos sobre LVP e elaborar uma atualização resumida. Método: Foi realizada uma pesquisa na base de dados Pubmed que identificou estudos (pesquisas laboratoriais, séries de casos e revisões de literatura) que avaliaram pacientes com LVP. Resultados e discussão: Não há estudos suficientes sobre LVP na literatura. Os poucos estudos encontrados não apresentam consenso quanto aos critérios de etiologia e diagnóstico. Embora várias estratégias de tratamento tenham sido propostas, a maioria ainda apresenta alta taxa de recorrência. Conclusão: Mais pesquisas sobre LVP são necessárias para entender e tratar essa doença.
Subject(s)
Humans , Male , Female , Leukoplakia, Oral/diagnosis , Leukoplakia, Oral/etiology , Leukoplakia, Oral/pathology , Leukoplakia, Oral/therapyABSTRACT
CONTEXT: Proliferative verrucous leukoplakia (PVL) is a highly persistent and aggressive oral pre‑malignant lesion with an obscure etiopathogenesis and a malignant transformation rate of 85‑100%. AIMS: The aim of the present study is to assess the role of Ki‑67, p16, CD34, Bcl‑2, cyclooxygenase‑2 (COX‑2) in the spectrum of PVL to ascertain their role in its etiopathogenesis. SETTINGS AND DESIGN: A retrospective chart analysis was carried out on a series of seven confirmed cases of PVL, which were followed‑up for 2 years. SUBJECTS AND METHODS: Immunohistochemical appraisal of these cases was carried out by a panel of markers, related to cell proliferation, cell cycle regulation, angiogenesis, apoptosis and inflammation. The expression of these markers was correlated with patients’ clinicopathological profile. STATISTICAL ANALYSIS USED: The frequency distribution of the group data was analyzed. RESULTS: The latest labeling index of Ki‑67 in our cases ranged from 8.18 to 12.6. p16 was positive in 3/7 cases. Bcl‑2 expression was moderately positive in 2/7 cases. All cases were intensely positive for COX‑2 staining. Microvascular density assessed by CD34 staining ranged from 11 to 20/high power fields. One case which transformed into squamous cell carcinoma demonstrated increased Ki‑67, Bcl‑2, COX‑2, CD34 expression, but negative p16 and Bcl‑2 expression. CONCLUSIONS: Application of these markers in understanding the behavior of PVL suggests that an imbalance between the proliferation apoptosis dynamics of the lesion accompanied by an increase in inflammation and angiogenesis underlie the molecular pathogenesis of the PVL spectrum.
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White lesions are relatively frequent in the oral cavity with a prevalence of approximately 24.8%. Among them is oral leukoplakia with a prevalence rate of 0.2–3.6%. There were various debates about the verrucous carcinoma and PVL (proliferative verrucous leukoplakia) being different entities or a part of spectrum at different stages of the disease process. In this article we are reporting a case with coexistence of two different histological features in the form of verrucous carcinoma and PVL of oral cavity with a need to throw some light to understand the pathogenesis of premalignant lesions.
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La Leucoplasia Verrucosa Proliferativa (LVP) es una placa blanca, verrucosa, exofítica, de crecimiento lento, que no se desprende al raspado y que tiende a comprometer diversos sitios de la mucosa oral. Es resistente al tratamiento independiente de la terapia adoptada y presenta una alta tasa de recidiva posterior al tratamiento quirúrgico. Desde 1985, cuando fue descrita por primera vez por Hansen, hasta le fecha, se ha mantenido como una entidad patológica compleja. Reportamos un caso de una paciente de sexo femenino de 72 años de edad que consulta por una lesión blanca, verrucosa, asintomática, que no se desprende al raspado, en el borde y vientre lingual y piso de boca. Se realizaron 2 biopsias incisionales del borde lateral de la lengua. Al examen microscópico se observó en ambas biopsias un grueso revestimiento epitelial acantósico, con marcada hiperparaqueratosis, una membrana basal nítida y cambios displásicos mínimos. Al mes de realizadas las biopsias la lesión presentó recidiva, manteniendo las mismas características clínicas encontradas inicialmente. Considerando la evolución, comportamiento biológico y las características histopatológicas, la lesión se diagnosticó como una LVP. Hasta la fecha, no hay protocolo de tratamiento establecido para estas lesiones. En este caso en particular, tomando en cuenta la extensión de la lesión, los sitios comprometidos, las escasas atipias presentes al examen histopatológico, la edad y escaso nivel socioeconómico de la paciente, se decidió no realizar la remoción quirúrgica de la lesión y mantenerla en control clínico cada 3 meses. Después de varios controles realizados durante un periodo de 3 años, se observó que la lesión mantuvo sus características clínicas iniciales. Esto confirma que haber optado por un tratamiento conservador, en este caso en particular de LVP, fue la decisión correcta...
The proliferative verrucous leukoplakia (PVL) is a white plate, wart-like, exophytic , slow growth , which does not follow the scaling that tends to compromise various oral mucosal sites . It is resistent to independent therapy and has a high rate of recurrence after surgical treatment. Since 1985, when it was first described by Hansen, and to date it has remained a complex pathological disorder. We report a case of a 72-year-old female patient who complains of a white, verrucous and asymptomatic lesion. The lesion does not detach by scraping the edge, lingual belly or mouth floor. Two Incisional biopsies were performed on lateral border of the tongue. Upon microscopic examination of both biopsies, thick epithelial lining, with marked hyperparakeratosis, a basement membrane, and minimal dysplasia alterations were observed. One month following biopsies of the lesion were performed, lesion relapsed and maintained the same clinical features found initially. Considering the evolution, biological behavior and histopathological features, the lesion is diagnosed as an PVL. To date, there is no established treatment protocol for these injuries. In this particular case, taking into account the extent of the injury, compromised sites, the few atypia present histopathological examination, age and low socioeconomic level of the patient, it was decided not to perform surgical removal of the lesion and maintain clinical monitoring every 3 months. Following several examinations carried out over a three-year period, it was observed that the injury kept initial clinical features. This confirms that having opted for conservative treatment, in this particular case of PVL, was the right decision...
Subject(s)
Humans , Female , Aged , Mouth Diseases/diagnosis , Mouth Diseases/pathology , Leukoplakia, Oral/diagnosis , Leukoplakia, Oral/pathology , Biopsy , Precancerous ConditionsABSTRACT
Verrucous carcinoma is a highly differentiated variant of squamous cell carcinoma which tends to occur more commonly in the men in the 6-7th decade of life. There are reports to indicate the lesions arise from proliferative verrucous leukoplakia. Both the lesions have a greater tendency to occur in patients with smokeless tobacco use. Verruocus carcinoma is an innocuous lesion with a late tendency to metastasize. It responds well to surgical management. Here we report the occurrence of verrucous carcinoma from a preexisting case of proliferative verrucous leukoplakia in a 72 year old female patient.