Form Of Leukoplakia Research Articles

A review of proliferative verrucous leukoplakia

Proliferative verrucous leukoplakia (PVL) is a rare, but relentless, form of leukoplakia, with a high recurrence rate and a tendency to become malignant, either as an oral squamous cell carcinoma (OSCC) or verrucous carcinoma (VC). Its aetiology is mainly unknown, and there is uncertainty around its management owing to its resistance to most treatments with a high rate of recurrence. CPD/Clinical Relevance: Understanding PVL is key to making prompt diagnosis and referral for improved outcome of treatment due to its high malignancy transformation rate.

МЕТОДЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ЛЕЙКОПЛАКИИ СЛИЗИСТОЙ ОБОЛОЧКИ РТА (ЛИТЕРАТУРНЫЙ ОБЗОР)

Subject. The high prevalence of oral mucosal leukoplakia, its often recurrent course and the possibility of malignancy makes the problem of finding effective methods of diagnosis and treatment of this pathology urgent. Many methods of acting lesions have been proposed, but individual studies cannot demonstrate evidence of the advantages of one treatment method over another.
 Objectives. On the basis of modern literature to determine effective methods of diagnosis and treatment of various forms of leukoplakia.
 Methodology. The information bases are analyzed: PubMed, Elibrary, GoogleScholar, Medline, Cyberleninka. Combinations of keywords were used for the search.
 Results. 593 articles were found according to the declared keywords. The number of articles remaining after applying the exclusion criteria is 58, after analyzing the annotations for compliance with the content of the stated review topic – 24. Analyzing the literature sources, it was determined that the diagnosis of the disease is carried out using clinical and histological studies. Elimination of the lesion with a laser occurs with a minimum of side effects, unlike traditional surgical treatment; recurrence of the disease occurs regardless of the chosen treatment method and is associated with the area of the lesion, its location and the presence of bad habits in patients; the most effective methods are argonoplasmic coagulation, erbium laser radiation and diode laser, allowing to achieve complete epithelialization in 7 days; also worthy alternative methods of treatment of oral leukoplakia are cryosurgery and photodynamic therapy.
 Conclusions. In order to diagnose of oral mucosal leukoplakia, a clinical study with histological verification of the diagnosis is used. Conservative methods of treatment of oral leukoplakia are not always effective, especially with erosive and verrucose forms. In such a situation, a dentist is forced to resort to surgical excision of foci to prevent further development of the disease and transformation into a malignant neoplasm. Traditional methods of surgical treatment are gradually being replaced by more modern effective methods that allow obtaining an aesthetic result with a favorable course of the postoperative period.

The results of the frequency of detection of galvanic couple of metal structures in of the oral mucosal diseases

The study is devoted to identifying the frequency of detection of galvanic couple of metal structures in various of the oral mucosal diseases. A high difference in the electrochemical potentials of metal structures in the mouth, exceeding 50 mV, was observed in 33% of patients with glossalgia, while in precancerous diseases, such as erosive and ulcerative form of lichen planus, verrucous form of leukoplakia, limited hyperkeratosis of the mucous membrane, galvanic couple with a high difference in electrochemical potentials were found in 78–87% of cases. Due to the high frequency of detection of metal structures with a high difference of electrochemical potentials in patients with oral mucosal diseases, the study to detect galvanic couples of metal structures should be introduced in the list of mandatory measures in the examination.

ORAL PROLIFERATIVE VERRUCOUS LEUKOPLAKIA: A LONG-TERM CLINICAL, CYTOPATHOLOGIC, AND HISTOPATHOLOGIC FOLLOW-UP

Proliferative verrucous leukoplakia (PVL) is an aggressive form of leukoplakia, which affects multiple oral sites, with high probability of recurrence and a high rate of malignant transformation. Clinically it may present as a homogeneous white plaque or leukoeritroplakia, with an exophytic or verrucous surface. We report a case with 8 years of follow-up of an 85-year-old woman with white plaques on the left buccal mucosa, inferior alveolar mucosa, floor of the mouth, and lateral border of the tongue. Combined cytopathologic and histopathologic examination was performed over 6 years, showing initially mild dysplasia and keratosis, which progressed to moderate and severe dysplasia. After 6 years of follow-up evaluation, an upper alveolar mucosa lesion was diagnosed as an in situ carcinoma. The patient was referred for treatment, and a surgical resection was performed. The patient is currently being monitored and evaluated with periodic cytopathologic exams.

A cytological study of leukoplakia in oral cavity at Patliputra Medical College and Hospital, Dhanbad

Objectives: To assess the role of cytology in leukoplakia and its etiology in patients attending outpatient department at Patliputra Medical College and Hospital (PMCH), Dhanbad, Jharkhand, India. Materials and Methods: The diagnosis of leukoplakia was based on clinical examination and cytological smear. Results: The total number of patients affected by leukoplakia in this time duration was 268. Of these, 238 (86%) were male, whereas 30 were female (14%). Greatest proportion of patients with leukoplakia had a habit of consuming khaini and tobacco in other forms. Mild form of leukoplakia was commonly seen. Conclusion: This study reveals that the incidence rate of leukoplakia in patients visiting PMCH, Dhanbad, was 1%. Males were more affected than females. Use of cytology in mass screening programs helped in identifying leukoplakias with parakeratotic patterns and leading to those cases, which need careful long-term follow-up.

Disorders of bladder microcirculation and morphologic changes in women with leukoplakia of the bladder

This study consists of 145 women with morphologically confirmed diagnosis of leukoplakia of the bladder. Patients were divided into 3 groups. Group n. 1 consisted of 32 (22.1%) women who morphologically had the simple form of leukoplakia. Group n. 2 consisted of 71 (48.9%) women with verrucous leukoplakia and the third group consisted of 42 (29%) patients with keratinization type of leukoplakia.The control group consisted of 32 healthy women. Blood flow in the bladder was evaluated by intravesical high frequency Doppler ultrasound. The relationship between the character of morphological changes in the severity of leukoplakia and microcirculation disorders in the bladder was detected. The most severe microcirculatory disorders observed in patients treated with a special morphological type of leukoplakia – keratinization leukoplakia.

Clinicopathologic diagnostic criteria of an enigmatic entity: Proliferative verrucous leukoplakia

Proliferative verrucous leukoplakia (PVL) is a rare, unique type of oral leukoplakia, which is enigmatic in etiology and behaves in a far more aggressive fashion than other forms of leukoplakia. Diagnosis is often late with the disease in an advanced stage when it is especially refractory to treatment. There are no definite criteria that dictate how extensive the leukoplakic changes should be, how many or which oral subsites should be involved, or how many recurrences should have occurred, in order to qualify for the diagnosis of PVL. The lack of definitive diagnostic criteria is the prime reason for PVL not being treated appropriately and in a timely fashion, thereby leading to the very concept of PVL being questioned. This article discusses the various clinicopathologic diagnostic criteria for this enigmatic entity and also reports a case of PVL in a 73-year-old female.

Carcinoma Espinocelular da Língua – Factores de Risco e Importância do Reconhecimento de Lesões Pré-Malignas

ObjectiveTo discuss the risk factors of squamous cell carcinoma of the tongue as well as emphasize the importance of systematic monitoring for early diagnosis of premalignant lesions. TopicsSquamous cell carcinoma of the tongue as other oral malignancy is more common among males aged over 45 years-old; however, this gender rate tends to be less pronounced and more documented in young adults. The tongue presents itself as the preferentially place affected by this type of cancer, representing about 50% of oral carcinomas. Squamous cell carcinoma can be presented in different clinical aspect, like exophytic, endophytic, leukoplakia, erytroplakia or erytroleucoplakia. Patients should avoid exposure to major risk factors: tobacco and alcohol, but other factors may promote the emergence of potentially malignant lesions: viral infections, oral lichen planus, iron deficiency, immunosuppression, food ingestion in extreme temperatures and traumatic agents. Squamous cell carcinoma is often preceded by pre-malignant lesions, but mostly clinically detectable symptoms. These lesions appear to be in the form of leukoplakia, erytroplakia or eytroleucoplakia and whenever they are identified, a conventional biopsy should be performed to obtain a definitive histopathological diagnosis. Developed workSearch based on several primary and secondary databases a Medline/Pubmed database, B-Online, Scielo and Scopus

Prognostic value of cyclin D1, p27, and p63 in oral leukoplakia

Studies on the expression of genes regulating cell proliferation and apoptosis are essential to help better understand the severity and possible malignant transformation of oral leukoplakia. The characteristics of cyclin D1, p27, and p63 were investigated in this microscopic study, complementing our previous results with Ki67, p53, and the apoptosis index. Clinical and histologic as well as immunohistochemical studies were carried out on oral leukoplakia of 18 patients. Homogenous, or non-homogenous (nodular or speckled) and erythroleukoplakia were determined clinically. Pathologic classification was performed according to the degree of dysplasia. Immunoperoxidase reaction for cyclin D1, p27, and p63 was carried out on the biopsy specimens and the positivity of the reactions was calculated for 1000 epithelial cells. The expression of cyclin D1 increased in parallel with the severity of leukoplakia. The p27 index was 14-16% in homogenous and nodular leukoplakias but it was substantially lower to 1-2% in erythroleukoplakia. The p63 index was 10% in homogenous, 5% in nodular or speckled, but nearly 20% in erythroleukoplakia, on the average. These results suggest that the characteristic expression of cyclin D1, p27, and p63 in various forms of leukoplakia may be of prognostic value.

Prognostic significance of cyclin D1, p27 and p63 expression in oral leukoplakia

Studies on the expression of genes regulating cell proliferation and apoptosis is of importance in relation to understanding the severity of the process and the possibility of malignant transformation. In the present study immunohistochemical demonstration of cyclin D1, p27 and p63 has been added to our previous investigations on Ki-67, p53 and apoptosis index. Clinical and pathological immunohistochemical studies on oral leukoplakias of 18 patients were performed. Clinically homogenous, non-homogenous or nodular, and erythroleukoplakia were distinguished. Pathologically the grading was made according to the degree of dysplasia. Immunoperoxidase reactions for cyclin D1, p27 and p63 were carried out, and the positivity was expressed in per cent, considering 1000 epithelial cells. Expression of cyclin D1 increased in parallel with the severity of leukoplakia. p27 expression was 14-16% in homogenous and nodular leukoplakias, whereas in erythroleukoplakia it decreased to 1-2%. p63 expression was 10% in average in homogenous, and 5% in nodular leukoplakias. While in erythroleukoplakias it increased to 20 per cent. The characteristic cyclin D1, p27 and p63 phenotype in various forms of leukoplakia may be considered as prognostic factors.

Oral proliferative verrucous leukoplakia (PVL); open trial of surgery compared with combined therapy using surgery and methisoprinol in papillomavirus-related PVL

Abstract.Proliferative verrucous leukoplakia (PVL) is a unique oral white lesion in which human papillomavirus (HPV) may play a role. PVL behaves far more aggressively than other forms of leukoplakia with a high rate of recurrence after surgical excision, and relentless progression to verrucous hyperplasia and to verrucous or squamous cell carcinomas. The treatment of PVL is usually by surgery, but there is often early recurrence.This study was an open trial of surgery in 25 patients with oral HPV-positive PVL, compared with combined therapy using surgery and methisoprinol in another group of 25 patients with oral PVL. Six months postoperatively there was a significant difference, with 18 recurrences in the patients treated by surgery alone compared to only two recurrences in the patients treated also with methisoprinol (isoprinosine or inosine pranobex), a synthetic agent with immunomodulatory properties and some antiviral activity against HPV. Eighteen months postoperatively there were no further recurrences in the patients treated by surgery alone but another two recurrences in the patients treated with methisoprinol. Overall, by 18 months follow-up, there were 18 recurrences in the group treated by surgery alone, compared with four in those also receiving methisoprinol.The use of this antiviral agent appeared to offer a significant enhancement to the surgical management of PVL.

Proliferative verrucous leukoplakia and its related lesions.

Proliferative verrucous leukoplakia (PVL) is a unique type of clinical oral leukoplakia. Enigmatic in etiology, PVL behaves in a far more aggressive fashion than other forms of leukoplakia. Its aggressiveness relates not only to a high recurrence rate, but more so to a very high level of and relentless progression from a localized simple keratosis to extensive oral disease and squamous carcinomas of verrucous, or conventional squamous cell type. Diagnosis is often late in the protracted course of PVL with the disease in an advanced stage when it is especially refractory to treatment. Within the histologic spectrum that is seen in PVL, usually as a function of time, are: (1) verrucous hyperplasia (VH), a histologically defined lesion; (2) varying degrees of dysplasia; and (3) three forms of squamous cell carcinoma: verrucous, conventional and, according to some, papillary squamous cell carcinoma. Each of these are discussed both within and outside the context of PVL. VH is a forerunner of verrucous carcinoma and the transition is so consistent that the hyperplasia, once diagnosed, should be treated like verrucous carcinoma. VH is not only an oral lesion; it can occur in the upper airway (sinonasal tract and larynx) where it is not usually found within a maternal soil of PVL. Papillary squamous cell carcinoma has been a loosely defined neoplasm, more often considered a verrucal type of malignancy. It nonetheless is a distinct clinicopathologic entity, separate from verrucous carcinoma and without a predilection for the oral cavity or an association with PVL.

悪性化したＰｒｏｌｉｆｅｒａｔｉｖｅ ｖｅｒｒｕｃｏｕｓ ｌｅｕｋｏｐｌａｋｉａの組織学的観察を行った１例

Proliferative verrucous leukoplakia (PVL) is a particular form of leukoplakia with a very high risk of malignant transformation. Therefore, this lesion may provide clues to understanding malignant transformation of the precancerous lesion “leukoplakia”.To define the process of the malignant transformation of PVL, serial sections of a rare case of tongue PVL were examined pathologically, ultrastructurally, and immunohistochemically with the use of nuclear protein “Ki-67”, a widely accepted marker of cell proliferation.The patient was a 55-year-old man. The lesion was white and verrucous. The tissue showed various pathologic characteristics, such as those of simple hyperplasia, severe dysplasia, verrucous hyperplasia, and squamous cell carcinoma. Ki-67 positive nuclei increased parallel to the degree of malignancy. Ultrastructurally, the tumor cells extended cytoplasmic processes to stromal tissue, indicating a highly invasive nature.The data are presented in detail here. Moreover, based on this case, methods for treatment are discussed. We concluded that cases of PVL, such as the presented one, that were suspected clinically should be treated similarly to malignant tumors.

Proliferative verrucous leukoplakia: A long-term study of thirty patients

Up to 6% of oral leukoplakia, a relatively common mucosal disease, can be expected to become malignant. This report describes a long-term study of 30 patients in whom a particular form of leukoplakia was identified and labeled proliferative verrucous leukoplakia (PVL), a disease of unknown origin, which exhibits a strong tendency to develop areas of carcinoma. PVL begins as a simple hyperkeratosis but tends to spread and become multifocal. PVL is slow-growing, persistent, and irreversible, and in time areas become exophytic, wartlike, and apparently resistant to all forms of therapy as recurrence is the rule. The disease was most commonly seen in elderly women and had been present for many years. Patients were followed for 1 to 20 years. Thirteen died of or with their disease, 14 were alive with PVL, and 3 were alive without PVL at last contact. PVL rarely regressed despite therapy. All patients who died had persistent or recurrent disease. PVL appears to constitute a continuum of hyperkeratotic disease, ranging from a simple hyperkeratosis at one end to invasive squamous cell carcinoma at the other. Microscopic findings are dependent upon the stage of the disease's development and the location and adequacy of the biopsy.

Orale Candida-Besiedlung bei Leukoplakien und Karzinomen der Mundhöhle*

The incidence of Candida albicans and other candida species were examined by mycological culture and histologically in 193 patients with various forms of oral leukoplakia and 14 patients with carcinoma of the oral mucosa, the results being compared with a control group of 137 subjects with a normal mucosa. Comparing the leukoplakia groups one with the other and with the control group revealed definite, usually statistically significant, differences in the incidence of fungi: 46.4% of patients, 29.2% among controls. The incidence of oral fungi was 35.4% among those with noxigenic leukoplakia, 50% in precancerous leukoplakia, 71.5% in mucosal carcinoma, and 49% in nosogenic leukoplakia (mainly lichen planus mucosae). The fungal elements could be demonstrated histologically much less frequently than by culture, but the difference of demonstration was statistically more significant between the different forms of leukoplakia. It is probable that chronic candidiasis in leukoplakia is not carcinogenic as such but is the microbiological and indicator of a local or systemic disorder of the cellular immune system.

Patterns of keratinization in oral leukoplakia.

LEUKOPLAKIA is the most commonly observed oral keratotic lesion. There are essentially two main types that can be differentiated microscopically. The majority of cases are characterized histologically by varying degrees of hyperkeratosis, parakeratosis, or a combination of both types of keratinization.^1,2This form of leukoplakia is referred to as the simple hyperkeratotic variety or benign leukoplakia.³In about 10% of the cases of oral leukoplakia, there is the additional histologic feature of dysplasia or atypia.^4,5This variety of leukoplakia is referred to as the dysplastic, premalignant, or malignant form, and is comparable to the so called precancerous dermatoses, such as Bowen's disease. The benign form of oral leukoplakia represents a simple hyperkeratotic response to irritation. The dysplastic form of oral leukoplakia represents a premalignant lesion and may be regarded as a carcinoma in situ. The essential alteration from normal to malignant has already occurred and these lesions

Tumors of the Oral Mucous Membrane

Except for epithelial tumors arising from aberrant salivary glands and for growths involving epithelial remnants concerned in the development of the teeth, practically all of the benign and malignant oral-epithelial tumors are derived from the lining cells of the mucous membrane and are epidermoid in character. The benign epithelial growths usually arise in areas of irritation and take the form of a thickening of the mucous membrane, leukoplakia, or of papilloma appearing in such a thickened area, so-called verrucous leukoplakia. Either form of leukoplakia may be followed by the appearance of ulceration and carcinoma. One-fifth of all cases of oral carcinoma will show one or more areas of leukoplakia in the region of the tumor or elsewhere in the mouth. Ulceration without clinical evidence of overgrowth is also a frequent starting point for oral cancer. In some instances the ulceration is syphilitic rather than traumatic.

V.—MONILIA CANDIDA INFECTION OF THE MOUTH

J. B., aged 53, a heavy-set laborer, well nourished, entered the Barnard Free Skin and Cancer Hospital, Jan. 22, 1916, complaining of a sore mouth. He stated that the condition had existed for seven years. He did not know how the trouble began, but stated that he was a constant tobacco chewer. About four or five months before his entrance to the hospital he was injured in some way, and the cheek was nearly cut through. He presented over the entire left side of the buccal mucous membrane, invading somewhat the right side, a thickened mat of whitish filiform projections which was sharply defined against the healthy mucous membrane. The appearance of the entire lesion was peculiar, looking at first glance like a form of leukoplakia. It mounted to the hard palate, sweeping over it and throwing out a peninsular extension to the right side and extended backward to the