Proliferative verrucous leukoplakia: recognition and differentiation from conventional leukoplakia and mimics.

The majority of conventional leukoplakia remains constant and only a subset progress to high-grade dysplasia or invasive carcinoma. A less recognized form known as proliferative verrucous leukoplakia (PVL) represents a unique progressive and elusive variant. Identifying patients with this form can only be achieved through the keen clinical observation of the temporal gross and histologic progression in individual patients with squamous cell carcinoma. The difficulty in the early diagnosis of PVL stems from the overlapping clinical and pathologic features with conventional multifocal leukoplakia with dysplasia. We present the current view on the clinicopathologic and biological characteristics of PVL and discuss their diagnosis, differential diagnosis, and management.

Liquen escleroso y carcinoma escamoso / Lichen Sclerosus and Squamous Cell Carcinoma

El liquen escleroso (LE) es una enfermedad inflamatoria crónica con un potencial maligno conocido. En la literatura se recogen datos de su asociación tanto con el carcinoma epidermoide (CE) como con el carcinoma verrucoso de localización anogenital. Recientemente se han descrito dos modalidades de neoplasias intraepiteliales de vulva y pene, el Vulva Intraepithelial Neoplasia (Neoplasia Intraepitelial Vulvar, [VIN]) y el Penile Intraepithelial Neoplasia (Neoplasia Intraepitelial de Pene, [PIN]) diferenciados, relacionadas con el CE genital. Ambas son entidades altamente ligadas al LE genital e independientes de la infección por el virus del papiloma humano (VPH). Además, se han demostrado alteraciones moleculares oncogénicas independientes de la infección por VPH que podrían explicar el potencial maligno del LE por sí mismo. La posible relación entre el VPH y el LE genital sigue siendo un tema controvertido en el momento actual, y se desconoce la implicación pronóstica cuando coexisten ambas entidades. En el presente artículo revisaremos la relación del LE con el carcinoma epidermoide y el carcinoma verrucoso, los mecanismos oncogénicos implicados, así como su posible asociación con el VPH (AU)

Lichen sclerosus is a chronic inflammatory disease that can progress to malignancy. The literature indicates an association with anogenital squamous cell carcinoma and verrucous carcinoma. Two pathogenic pathways, differentiated vulvar and penile intraepithelial neoplasias, which have recently been described in relation to squamous cell carcinoma, are both highly associated with genital lichen sclerosus independently of human papilloma virus (HPV) infection. Furthermore, tumor-promoting molecular changes unrelated to HPV infection have been demonstrated and may explain the malignant potential of lichen sclerosus. The possible relationship between HPV and genital lichen sclerosus currently remains open to discussion, and the prognostic importance of the overlapping of these 2 diseases is still unclear. This review considers the relationship between lichen sclerosus and squamous cell and verrucous carcinomas, the possible oncogenic mechanisms involved, and their possible association with HPV infection (AU)

Carcinoma verrugoso de vagina. Presentación de un caso / Verrucous carcinoma of the vagina. A case report

Los carcinomas verrugosos de vagina son neoplasias poco frecuentes, con un crecimiento lento, localmente invasivo, que no suelen metastatizar y con unas características macro y microscópicas específicas. Describimos un caso de carcinoma verrugoso de cúpula vaginal en paciente postmenopáusica histerectomizada 4 años antes por prolapso uterino grado IV, discutiéndose su diagnóstico diferencial y tratamiento. El carcinoma verrugoso de vagina es un tumor poco frecuente que plantea el diagnóstico diferencial con el condiloma acuminado, el carcinoma escamoso clásico y el condilomatoso, siendo el tratamiento de elección la exéresis quirúrgica completa (AU)

Verrucous carcinoma of the vagina is a rare neoplasm. This entity is a slow-growing, locally invasive but generally nonmetastasizing neoplasm, with a characteristic gross and microscopic appearance.We report a case of verrucous carcinoma of the vagina in a postmenopausal woman diagnosed 4 years after transvaginal hysterectomy for grade 4 uterine prolapse. We also discuss the differential diagnosis and treatment.Verrucous carcinoma of the vagina is a rare neoplasm. The differential diagnosis includes typical squamous cell carcinoma, warty carcinoma, and condyloma acuminatum. Surgery remains the most effective treatment (AU)

Condiloma acuminado gigante (tumor de Buschke-Löwenstein) / Giant condyloma acuminata (Buschke-Löwenstein tumour)

Los condilomas o verrugas genitales son producidos por el virus del papiloma humano. La infección típicamente ocurre cuando las células basales del huésped se exponen a la infección viral a través de una barrera epitelial dañada, como sucede durante el acto sexual o como producto de otras abrasiones dérmicas menores. Se necesita la presencia de otros factores asociados para producir la enfermedad, como son: promiscuidad sexual, mala nutrición, tabaquismo, multiparidad, depresión del sistema inmunológico y uso prolongado de anticonceptivos orales. Los condilomas acuminados constituyen una de las enfermedades de transmisión sexual más frecuentes y se vinculan, por lo general, con los tipos de cepas 6 y 11. En pocas ocasiones pueden evolucionar como un tumor invasivo con malignidad local, aunque sin metástasis, equivalente a un carcinoma verrucoso: es el síndrome de Buschke-Löwenstein (AU)

Condylomata or genital warts are produced by the human papilloma virus (HPV). The infection occurs typically when the basal cells of the host are exposed to the viral infection due to a damaged epithelial barrier, as happens during the sexual act or in minor skin abrasions. Other associating factors are required to produce the disease, such as: inappropriate sexual behaviour, smoking, malnutrition, multiparity, immune system depression and prolonged use of oral anticonceptives. Condyloma acuminatum is one of the most frequent sexual transmitted diseases and is generally associated with types HPV 6 and 11. On some occasions, it can progress to a local invasive tumor but without metastases, similar to a verrucous carcinoma: it is the Buschke-Löwenstein syndrome (AU)

Endoscopic laser treatment in pre-malignant and malignant vocal fold epithelial lesions.

Endoscopic laser treatment was performed in 43 patients with pre-malignant or malignant vocal fold epithelial lesions, 10 were treated with endoscopic laser surgery for dysplasia, 12 for carcinoma in situ (CIS), five for verrucous carcinoma and 16 patients for squamous cell carcinoma (SCC). Thirty-two patients received laser therapy as their first therapy, whereas 11 patients had had previous radiation therapy for laryngeal carcinoma (n = 9) or CIS (n = 2). Recurrence after initial laser therapy necessitating re-treatment (a second laser treatment or radiotherapy) occurred in nine out of 32 patients (28 per cent), thus 23 (72 per cent) were maintained free of disease during the follow-up period. Besides the 32 patients without previous therapy, patients who had already undergone radiation therapy were also included in this study. In this group there were nine patients with SCC, one patient with CIS and one with dysplasia. They all underwent laser therapy. Four were free of disease during follow-up (36 per cent) and seven developed recurrences. Six (58 per cent of all patients with previous radiation therapy) underwent total laryngectomy.