Proliferative verrucous leukoplakia: diagnosis, management and current advances / Leucoplasia verrucosa proliferativa: diagnóstico, conduta e avanços atuais

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.

Proliferative Veruccous Leukoplakia: An Extensive Red and White Lesion.

Proliferative verrucous leukoplakia (PVL) is a rare form of leukoplakia, which was first described by Hansen et al. in the year 1985. PVL is a disease with aggressive behavior due to its high rate of recurrence and a high rate of malignant transformation, usually more than 70%. This is a long-term progressive condition, which is observed more frequently in females over the age of 60 years. In the course of time, PVL tends to become multifocal with progressive deterioration of the lesions, making it more and more difficult to control. Unlike other cases of leukoplakia, tobacco use does not seem to have a significant influence on the appearance and progression of PVL. As this condition is seen in non-smokers, the etiology of PVL remains unclear making the management and diagnosis difficult. The aim of this article is to present a case which is diagnosed based on the diagnostic criteria proposed by Cerero-Lapiadra et al.

Cryosurgery in the Management of Potentially Malignant Lesions: A Report of Two Cases.

Cryosurgery is a therapeutical approach that uses freezing to obtain a tissue inflammatory or destructive response. It has been successfully used for both cutaneous and oral conditions. The characteristics of oral mucosa like humidity and smoothness makes it an ideal site for this approach. Oral submucous fibrosis is a potentially malignant disorder of the oral mucosa, with areca nut chewing being the primary causative agent. Leukoplakia is a potentially malignant lesion associated with excessive consumption of alcohol and tobacco. Although there are no specific treatment modalities to prevent recurrence, abandoning habits can decrease the chance of recurrence, as well as the transfiguration into malignant tumors of these disorders. However, with the advent of cryosurgery, oral surgeons are provided with a new modality for treating oral potentially malignant disorders. This case report highlights the pioneering effect of nitrous oxide cryosurgery in treating two cases of oral submucous fibrosis with leukoplakia and oral leukoplakia respectively showing promising results during follow-up.

Leukoplakia removal by carbon dioxide laser [CO[2]] laser

Definitive treatment of oral leukoplakia is very important because of its recurrences and malignant transformation depending on the location, clinical feature, degree of dysplasia and etiological factors. There are different kinds of treatment for this lesion, but using high power laser has some advantages like less pain, swelling, prevention of metastasis, edema, less bleeding [dry surgery] and infection. A 53 year old man with leukoplakia lesion with moderate dysplasia on the left side of the ventral surface of the tongue was selected for treatment with CO[2] laser. The average power is set on 6.2 W with frequency of 20 Hz. The irradiation mode was non-contact. The entire lesion evaporated by the laser with a 2 mm safety margin. In this case, 80% of lesion had disappeared after 5 weeks and the 20% residual was evaporated again with the same parameters than the first time. No significant clinical differences were seen between the normal and laser-treated tissue. Using laser in the treatment of oral lesions has many advantages like selective removal of the affected tissues and minimal damage to surrounding tissue, leading to excellent wound healing with no or minimal scar and good functional results

Leucoplasia oral en un paciente pediátrico con deficiencia primaria de linfocitos T / Oral leukoplasia in a pediatric patient with primary deficiency of T lymphocytes

La presencia de infecciones recurrentes causadas por gérmenes no habituales con la aparición de complicaciones frecuentes y asociadas con manifestaciones alérgicas y autoinmunes o tumorales o ambas, son características de las inmunodeficiencias primarias. Se presenta el caso de un niño varón de 12 años de edad, de color de la piel blanca, con antecedentes de infecciones virales, bacterianas y parasitarias, recurrentes y severas desde los primeros meses de nacido, con el diagnóstico actual de leucoplasia oral no homogénea de la lengua, corroborada por histopatología. Los estudios virológicos mostraron la presencia de anticuerpos específicos contra la cápside viral y del antígeno nuclear del virus de Epstein-Barr. Los estudios inmunológicos demostraron la presencia de una inmunodeficiencia primaria de los linfocitos T. No se encontraron alteraciones en las concentraciones séricas de las inmunoglobulinas, el complemento y la función fagocítica. La extirpación quirúrgica de la lesión y el uso de inmunomoduladores, contribuyeron a la evolución favorable del enfermo.

Presence off recurrent infections caused by uncommon germs related to appearance of frequent complications and associated with allergic and autoimmune and/or tumor manifestations, are characteristic of primary immunodeficiencies. Authors present the case of a white male child aged 12, with backgrounds of viral, bacterial and parasitic, recurrent and severe infections, from the first months of life, with a diagnosis of non-homogenous oral leukoplasia of tongue, supported by histopathology. Viral study showed the presence of antibodies specific to viral capsid and of nuclear antigen of Epstein-Barr virus. Immunologic studies showed the presence of a primary immunodeficiency of T lymphocytes. There were not alterations in serum concentrations of immunoglobulins, the complement and the phagocytic function. Surgical removal of lesion and the use of immunomodulation contributed to a favorable course of patient.

Diagnóstico diferencial e manejo da leucoplasia bucal- caso clínico: acompanhamento de 4 anos / Oral leukoplakia differential diagnosis and management- case report: accompaniment of 4 years

A leucoplasia é a lesão cancerizável mais prevalente na cavidade bucal. Seu diagnóstico é eminentemente clínico e baseia-se na exclusão de outras lesões brancas. Devido ao potencial de transformação maligna, os pacientes devem ser orientados quanto à importância da remoção dos fatores de risco e à necessidade de acompanhamento constante. A coloração com o azul de toluidina é um instrumento complementar para o acompanhamento de lesões cancerizáveis, auxiliando na escolha do melhor momento para a realização da biópsia e sitio onde deve ser realizada. Neste artigo, descreve-se um caso de leucoplasia bucal com acompanhamento de quatro anos ressaltando a importância do diagnóstico diferencial, utilização da coloração com o azul de toluidina e proservação do caso.

Citología exfoliativa en el diagnóstico precoz de lesiones oncológicas bucales / Exfoliative citology in early diagnosis of oral oncological lesions

Con el objetivo de demostrar mediante de pruebas estadísticas la importancia de la citología exfoliativa en el diagnóstico precoz de lesiones oncológicas bucales, se realizó un estudio observacional analítico transversal en el Hospital Provincial Docente "Manuel Ascunce Domenech" de Camagüey, de enero a diciembre del 2000. Se realizo examen de PDCB a 248 pacientes remitidos, se seleccionaron 41 por presentar lesiones que por su aspecto parecían malignas o sospechosas; todas fueron sometidas a examen citológico y biopsia. Dadas las características del estudio constituyeron a la vez la muestra y el control en dependencia del proceder aplicado. La efectividad de los métodos se comprobó mediante el sistema estadístico de Galen y Gambino. Los resultados citológicos fueron positivos en 30 pacientes, 6 negativos, cero sospechosos y 5 no útiles; en cuanto a las biopsias: 29 carcinomas epidermoides, 10 leucoplasias y 2 descriptivas. Al ser comparadas, la citología demostró poseer 100 por ciento de sensibilidad, 28 por ciento de especificidad, valor predictivo y negativo de 91 por ciento y 100 por ciento, respectivamente, con el 96 por ciento de eficiencia global de la prueba. Se demuestra su importancia como método diagnóstico no invasivo(AU)

With the objective of statistically proving the importance of exfoliative citology in the early diagnosis of oral oncological lesions, a crosswise, analytical and observational study was carried out at "Manuel Ascunce" Provincial Teaching Hospital in Camaguey from January to December, 2000. PDCB test was performed on 248 referred patients of whom 41 were selected because they presented with lesions that seemed to be malignant or suspected of malignancy. All these lesions were applied cytological tests and biopsies. Given the characteristics of the study, they were as samples or controls depending on the applied procedures. The effectiveness of the methods is confirmed by Galen and Gambino's statistical system. Cytological results were positive in 30 patients, negative in 6, 0 suspected and 5 were useless. Biopsies showed 29 epidermoid carcinomas, 10 leukoplasias and 2 descriptive. When compared, cytology showed 100 percent sensitivity, 28 percent specificity, predictive and negative value of 81 percent and 100 percent and the global efficiency of the test was 96 percent. This paper proved the importance of exfoliative cytology as non-invasive diagnostic method(AU)

Crioterapia em lesöes leucoplásticas da boca: estudo clínico em humanos / Cryotherapy in leukoplakia lesions on bucal mucosa: clinic study in human

Este estudo tem como objetivo avaliar clinicamente o efeito terapêutico e sintomático da crioterapia com nitrogênio líquido em lesöes leucoplásticas da mucosa bucal. Para a realizaçäo deste trabalho foram selecionados 24 pacientes, triados no Centro de Oncologia Bucal, que apresentavam lesäo com características clínicas de leucoplasia. A idade, o sexo e a raça näo foram levados em consideraçäo e todos foram tratados com o nitrogênio líquido na forma spray. O aparelho utilizado para a aplicaçäo foi uma garrafa térmica e um cano de cobre com uma agulha de uso veterinário. As avaliaçöes foram feitas aos 3, 7, 15, 30, 40 e 60 dias pós-operatórios. Com base neste estudo, concluiu-se que o criospray é um método assintomático e eficaz para este tratamento

Alteraçöes dos tecidos moles da boca. Parte 2: lesöes brancas e vermelho-azuis / Alterations of bucal soft tissues. Part 2: white and red-blue lesions

Os autores dao continuidade ao desenvolvimento do tema Alteraçoes dos tecidos moles da boca, fornecendo informaçoes sobre as principais lesoes brancas e vermelho-azuis.

Criocirugía en lesiones de boca / Cryosurgery in mouth lesions

La criocirugía es un procedimiento de tratamiento hipotérmico de lesiones benignas propiamente dichas, lesiones benignas con posibilidades de transformación neoplásicas y de lesiones malignas de boca. Se comunican 158 casos analizándose las técnicas utilizadas y los resultados en las distintas patologías. Este método sólo o asociado a la cirugía o radiofrecuencia permitió la extirpación de lesiones bucales benignas o malignas sin pérdida de sustancia o sea con la conservación anatómica y funcional de la zona tratada. Tiene como ventaja que no daña al hueso ni a las piezas dentarias aunque la lesión esté adherida a estos elementos anatómicos.

Validity of cryosurgery in the treatment of lichen planus and leukoplakia

Cryosurgery offers a means of destroying tissue by subjecting it to extreme cold. The effectiveness and advantages of cryotherapy in the treatment of various oral mucosal lesions is well accepted, in spite of the mechanism by which cells are die as yet poorly understood. The treatment of oral lichen planus and leukoplakia using cryosurgery was discussed. An overview of the clinical and histological changes occuring after this treatment also was presented

Prevalência de leucoplasia bucal em pacientes portadores de hanseníase virchowiana: estudo clínico e histopatológico de 170 pacientes / Prevalence of oral leukoplakia in patients with virchowian leprosy: clinical and histopathological study of 170 patients

Em 170 pacientes portadores de hanseníase virchowiana, internados no Hospital "Lauro de Souza Lima", foi realizada uma avaliaçäo no sentido de detecçäo de lesöes leucoplásicas bucais. Os pacientes foram submetidos a exame clínico-dermatológico, estomatológico, biópsia da lesäo representativa e estudo histopatológico, baciloscópico e pesquisa de fungos das peças excisadas. A prevalência geral de leucoplasias foi de 16,4 por cento, isto é, 28 pacientes com idade mediana de 54,5 anos demonstraram lesöes leucoplásicas do ponto de vista clínico. A maioria dessas lesöes tinha pequenas dimensöes e o exame histológico revelou um predomínio de hiperplasia epitelial simples sem hiperqueratose. Foram detectadas atipias celulares de grau leve (4 casos), moderada (1 caso) e intensa (1 caso), num total de 6 casos...