Rate Of Malignant Transformation Research Articles

Adhesive lipophilic gels delivering rapamycin prevent oral leukoplakia from malignant transformation

Oral leukoplakia (OLK) is the most emblematic oral potentially malignant disorder that may precede the diagnosis of oral squamous cell carcinoma (OSCC) and has an overall malignant transformation rate of 9.8 %. Early intervention is crucial to reduce the malignant transformation rate from OLK to OSCC but the lack of effective local pharmaceutical preparations poses a challenge to clinical management. Rapamycin is speculated to prevent OLK from carcinogenesis and its inherent lipophilicity facilitates its penetration into stratum corneum. Nevertheless, hydrophilic hydrogels frequently encounter challenges when attempting to deliver lipophilic drugs. Furthermore, the oral cavity presents a complex environment defined by oral motor functions, saliva secretion cycles, dynamic fluctuations, and protective barriers comprising mucus and lipid layers. Consequently, addressing issues of muco-penetration and muco-adhesion is imperative for developing an effective drug delivery system aiming at delivering rapamycin to target oral potentially malignant disorders.Here, a dual-function hydrogel drug delivery system integrating adhesion and lipophilicity was successfully developed based on polyvinyl alcohol (PVA) and dioleoyl phosphatidylglycerol (DOPG) via dynamic boronic ester bonds. Rheological experiments based on orthogonal design revealed that PVA-DOPG hydrogels exhibited ideal adhesive strength (around 6 kPa) and could adhere to various surfaces in both dry and wet conditions. PVA-DOPG hydrogels also significantly promoted lipophilic molecules’ penetration into stratum corneum (integrated fluorescence density of 6.95 ± 0.52 × 106 and mean fluorescence depth of 0.96 ± 0.07 mm) of ex-vivo porcine buccal mucosa (p < 0.001). Furthermore, PVA-DOPG hydrogels incorporating rapamycin inhibited malignant transformation of OLK mouse model induced by 4-Nitroquinoline N-oxide (4-NQO), distinct improvements in survival (the neoplasm incidence density at the 40th day is 0.0091) (p < 0.05), decrease in neoplasm incidence density of 36.36 % and inhibition rate in neoplasm volume of 75.04 ± 33.67 % have been demonstrated, suggesting the hydrogels were valuable candidates for potential applications in the management of OLK.

"Navigating the complexities of low-Grade glioma treatment: insights into SBT I-125 and novel assessment tools".

Central nervous system tumors, classified by the WHO into four grades based on their aggressiveness, present significant challenges in treatment, particularly low-grade gliomas (LGGs) which, despite their slower growth, can progress to high-grade gliomas. Lucca B. Palavani and colleagues evaluated the efficacy and safety of SBT I-125 brachytherapy for LGMs in a systematic review and meta-analysis of 20 studies involving 988 patients. The analysis revealed an overall complication rate of 10%, with headaches and cyst formation being the most frequent issues. The five-year progression-free survival (PFS) rate was 66%, while the ten-year PFS rate was 30%, and the rate of malignant transformation was 26%. The mortality rate was 33%. Despite these findings, significant limitations were noted, including data insufficiencies, study heterogeneity, lack of randomized controlled trials, and potential publication bias. Inconsistencies in follow-up durations further hindered the evaluation of long-term efficacy and safety. Recent advancements in automated tumor assessment, such as Cheng et al.'s deep learning-based pipeline, are revolutionizing glioma management by enhancing the accuracy and consistency of tumor volume and RANO measurements. These innovations facilitate improved glioma grading, genetic mutation prediction, surgical planning, real-time intraoperative guidance, and histopathological analysis. Integrating such advanced tools into clinical practice can significantly enhance the precision and efficiency of glioma management. In conclusion, while SBT I-125 brachytherapy shows promise, concerns regarding safety and efficacy underscore the need for further research with standardized methodologies. Incorporating advanced automated assessment tools could improve treatment evaluation and patient outcomes.

Gingival Proliferative Verrucous Leukoplakia and Cancer: A Systematic Review With Meta-Analysis.

Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder. Forms that affect only one tissue are poorly studied, especially the exclusively gingival PVL (gPVL), which may have a more increased malignant transformation potential. The aim of the present study was to characterise the gPVL and its risk of malignant transformation to better raise awareness of this specific disorder. The systematic review was performed on PubMed, Scopus, Web of Science and Google Scholar. Only articles reporting primary studies, case reports and case series were included. The meta-analysis was performed for the cancer prevalence, proportion of smokers, age and sex ratio, recurrences of gPVL and mortality. A total of 1298 studies were assessed for eligibility by reading titles and abstracts. Fourteen original articles were included with a total of 58 patients. The malignant transformation rate of gPVL was 47.75%. The mortality was 5.84%. The mean follow-up duration before malignant transformation was 3 years. gPVL seems to have a faster malignant transformation rate than the other forms of PVL. Finding anatomo-pathological or genetic markers could be a line of research to predict gPVL malignant transformation and improve its diagnosis and treatment.

Expression of Programmed Death Ligand 1 and Indoleamine 2,3-Dioxygenase in Oral Lichen Planus and Oral Lichenoid Lesions.

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are inflammatory T-cell mediated disorders of the oral mucosa (OM). Both are associated with an increased risk of oral squamous cell carcinoma, with OLL possibly having a higher rate of malignant transformation than OLP. Programmed death ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase (IDO) are immunosuppressive molecules possessing inhibitory effect on T-cells and have been implicated in carcinogenesis. The aim of this study was to examine the expression of PD-L1 and IDO in OLP and OLL. Sixty-eight formalin-fixed, paraffin-embedded tissue samples diagnosed as OLP, compatible with OLP, or OLL were divided into OLP (n = 39) or OLL (n = 29) groups based on both clinical and histopathological diagnostic criteria. Samples of healthy OM (n = 9) served as controls. Samples were immunohistochemically stained for PD-L1 and IDO, and staining distribution and intensity were evaluated. Immunohistochemical expression of PD-L1 was increased in the basal and intermediate layers of epithelium in OLP and in lamina propria in both OLP and OLL compared to controls. OLP and OLL showed increased expression of IDO in epithelium and lamina propria compared to controls. PD-L1 staining intensity in the basal epithelial layer, and IDO staining intensity in lamina propria were increased in OLP compared to OLL. The results indicate that the expression of PD-L1 and IDO increases in OLP and OLL, suggesting that these molecules may play a role in the pathogenesis of both disorders.

Management of Oral Leukoplakia – A Systematic Umbrella Review of Global Evidence

Objective: To summarize the global evidence related to various interventions for treating Oral Leukoplakia. Introduction: Oral leukoplakia is a common oral potentially malignant lesion that precedes the development of oral cancer. The main aim of any treatment is to prevent the malignant transformation. This umbrella review updates the global evidence of different medicinal treatment available for Oral Leukoplakia. Methods: The databases searched were Cochrane database of systematic reviews, JBI Evidence Synthesis, MEDLINE, Web of Science, Scopus. The key terms used were leukoplakia, oral leukoplakias, Proliferative verrucous leukoplakia, interventions, management, chemoprevention, laser, photodynamic, topical agents. JBI Sumari software was used to screen and appraise the articles along with data extraction and data synthesis. Results: A total of 670 citations were identified through the electronic search. Out of which 61 systematic reviews were recognized. Following removal of duplicates, 47 records were retrieved. The full texts of 13 papers were retrieved for further examination with 9 systematic reviews meeting the inclusion criteria and therefore included in this umbrella review. Study overlap calculation was conducted and pooled results showed that the treatments available for oral leukoplakia has little effect on clinical response and malignant transformation rate. Conclusions: Currently we do not have evidence of a treatment that is preventing oral leukoplakia from converting to oral cancer. Treatments such as vitamin A and beta carotene may be effective in reducing clinical size of oral lesions. More long-term studies are required for surgical management, lasers and photodynamic therapy.

Beyond surgical resection: evaluating stereotactic brachytherapy iodine-125 for low-grade gliomas: a systematic review and meta-analysis.

Stereotactic Brachytherapy Iodine-125 (SBT I-125) has been investigated by some studies for the treatment of lowgrade gliomas. We performed a meta-analysis to assess the efficacy and safety of SBT I-125 Brachytherapy for treatment of patients with Low-Grade Gliomas. PubMed, Cochrane, Web of Science, and EMBASE databases were searched for randomized and observational studies. This systematic review and meta-analysis was conducted according to the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. We used relative risk (RR) with 95% confidence intervals and random effects model to compare the effects of I-125 SBT treatment on the interest outcomes. We evaluated heterogeneity using I2 statistics; we considered heterogeneity to be significant if the p-value was less than 0.05 and I2 was higher than 35%. We performed statistical analysis using the software R (version 4.2.3). A total of 20 studies with a cohort of 988 patients with low grade gliomas who received SBT I-125 as a treatment option. The pooled analysis evidenced: (1) Complication rate of 10% (95% CI: 7-12%; I² = 60%); (2) 5-year PFS of 66% (99% CI: 45-86%; I²= 98%); (3) 10-year PFS was 66% (99% CI: 45-86%; I²= 98%); (4) Malignant transformation rate of 26% (95% CI: 8-45%; I²=0); (5) Mortality of 33% (95% CI: 15-51%; I² = 0%). Our systematic review and meta-analysis of SBT I-125 for low-grade gliomas have revealed significant concerns regarding its safety and efficacy. Despite a proportion of patients remaining progression-free, elevated rates of complications and mortality cast doubt on the intervention's reliability. Future research should prioritize long-term follow-up studies, standardized protocols, and comparative effectiveness research.

Malignant Recurrence of Benign Odontogenic Tumors (A Single Center Cross-Sectional Study)

BackgroundDespite their rarity, malignant odontogenic tumors (MOT) represent an important group of oral lesions characterized by their variable clinical presentations and sometimes unexpected biological behavior.ObjectivesThe purpose of this retrospective cross-sectional study was to evaluate the number, types, and frequency of MOT and to investigate the relative rate of malignant transformation in recurrent odontogenic tumors (OT).MethodologyThe records of patients diagnosed with OT in the hospital of the Faculty of Dentistry, Cairo University, were reviewed over 10 years (2013-2022). The OT were investigated for frequency, age, gender, site, and recurrence. The data were recorded and then analyzed using SPSS software version 25.ResultsAmong 5543 oral excisions, 357 cases of them were OT, including 336 benign (94.1%) and 21 malignant neoplasms (5.9%). Among the odontogenic malignancies, 18 lesions (85.7%) appeared de novo, and 3 lesions (14.3%) developed as recurrent of previously classified benign tumors. A high incidence was observed in the middle and old age groups (90.4%) with a median age being 42. Slight male predilection (1.3:1) was noticed. The mandible was the highly affected site but all recurrent cases were diagnosed in the maxilla as ghost cell odontogenic carcinoma (n = 2, 66.6%) and primary intraosseous carcinoma (n = 1, 33.3%).ConclusionRetrospective analysis of the relative frequency of MOT and the documentation of the unusual recurrence of benign OT as a malignancy enhances our understanding of OT behavior and the need for appropriate therapy and clinical follow-up.

Prognostic nomogram for proliferative verrucous leukoplakia

BackgroundProliferative verrucous leukoplakia (PVL) is a special type of leukoplakia characterized by high rate of malignant transformation into oral squamous cell carcinoma (OSCC). This study aimed to analyze the canceration risk and prognostic factors of PVL and establish effective diagnostic and prognostic predictive models. Materials and methodsA total of 467 patients were enrolled, including 170 cases of PVL. The independent risk and prognostic factors of PVL were analyzed by univariable and multivariable logistic regression. Nomogram models were constructed to predict the canceration risk and prognosis of PVL. The predictive power was evaluated by Hosmer–Lemeshow test, receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis. ResultsMultivariable logistic regression analyses identified that canceration risk factors of PVL included sex, lesion sites, clinical presentation, non-smoker and oral epithelial dysplasia (OED). The independent prognostic factors of PVL were sex, clinical presentation, local irritants and OED. Diagnosis and prognostic nomogram models were constructed. The areas under the ROC curve were 0.945 and 0.893, respectively. The calibration plots showed strong agreement between the prediction and observation. Decision curve analysis indicated that the models provided significant clinical benefits for patients. ConclusionOur study established and validated the diagnosis and prognostic predictive nomogram models, which were accurate to predict the canceration risk and prognostic factors of PVL, providing individualized clinical decisions for clinical work.

A Bibliometric and Visualised Analysis of Proliferative Verrucous Leucoplakia From 2003 to 2023

BackgroundProliferative verrucous leucoplakia (PVL) is a rare but slow-growing, aggressive leucoplakia lesion associated with the highest malignant transformation rate in oral potentially malignant disorders (OPMDs). With increasing attention paid to PVL, it is urgent for us to analyse and summarise the publications globally using comprehensive bibliometric studies to help researchers propose possible future research directions and guide them to further conduct relevant studies in the domain. ObjectivesThe purpose of the study was to evaluate global academic productivity, impact, and collaboration of potentially malignant oral disorder PVL utilising bibliometrics based on annual number of publications, countries and regions, institution, authors, journals, citations and co-occurrences of author keywords over the last 20 years. MethodsThis study searched publications pertaining to proliferative verrucous leucoplakia in the Web of Science Core Collection, spanning from 2003 to 2023. Utilizing VOSviewer, R software, Bibliometric online analysis platform, CiteSpace software, and Microsoft Excel, we conducted a bibliometric and visualised analysis of PVL. ResultsThe quantity of pertinent publications in this research domain displays a fluctuating but overall upward trend. In aggregate, there are 148 articles and 61 reviews, encompassing research contributions from 44 countries, 45 institutions, and involving 831 authors. Among these publications, the USA, Spain, and UK emerged as the predominant contributing nations. Predominantly, articles found their publication venue in “Pathology Research and Practice.” Notably, the author with the highest number of publications and most influence is Warnakulasuriya S. The top 3 keywords include “Proliferative Verrucous Leucoplakia,” “Squamous-Cell Carcinoma,” “Oral Leucoplakia,” and “Potentially Malignant Disorders.” ConclusionIn this investigation, statistical analysis and network visualisation were conducted to reveal the research progress, trends, and trending topics on PVL via a thorough bibliometric analysis. We found that current publications comprise mainly case reports, there is a significant research need to explore the molecular mechanisms, specific diagnostic criteria, and effective management options for PVL. Our work should serve as a key reference and a directional guide for future research in this domain.

METB-07. FREQUENCY AND OUTCOMES OF CDKN2A/B LOSS IN PEDIATRIC GLIOMA

Abstract BACKGROUND Chromosome 9p21 deletions involving the tumor-suppressor genes cyclin-dependent kinase 2A and 2B (CDKN2A/B) have been identified as a poor prognostic factor in various cancer types, including adult low-grade gliomas. The frequency and influence of CDKN2A/B hemi- and homozygous deletions in pediatric glioma are less well defined. Herein, we report a single-institution evaluation of the frequency and clinical outcomes of CDKN2A/B loss in pediatric gliomas. METHOD We performed a retrospective, IRB-approved single institutional study, utilizing an existing institutional data registry to identify pediatric patients (age &amp;lt; 21) diagnosed with a glioma who had undergone targeted DNA next generation panel sequencing (Oncopanel) between 2013-2023. IDH1/2-mutant gliomas were excluded. Clinical features, treatment details and outcome data were collected and analyzed. RESULTS Oncopanel was performed on 510 pediatric gliomas. Of these, 372 (72.9%) had low-grade and 138 (27%) had high-grade gliomas. Sixty-six (12.9%) gliomas harbored CDKN2A/B hemi-/homozygous loss; this included 26/372 (7%) low-grade and 40/138 (29%) high-grade gliomas. Homozygous loss was seen in 13/372 (3.5%) low-grade and 26/138 (18.8%) high-grade gliomas. The most common co-alteration with CDKN2A/B loss was BRAFV600E (28/66, 42%), followed by TP53 (8/66, 12%). Median follow-up time of the entire cohort was 3.2 years (range:0.1-36). The 10-year overall survival for pLGGs with CDKN2A/B wildtype and CDKN2A/B homozygous deletion were 95% and 85%, respectively (p=0.03). There was no significant difference in survival of pLGGs with CDKN2A/B wildtype and CDKN2A/B hemizygous deletion. For pHGGs, there was no difference in survival outcomes based on CDKN2A/B status. Further univariate and multivariable analyses are underway. Central pathology review and methylation subtyping to confirm rates of malignant transformation are also ongoing. CONCLUSION CDKN2A/B loss is identified in a subset of both pediatric low- and high-grade gliomas. Our data suggest that homozygous CDKN2A/B loss in pLGG is associated with poorer long-term survival.

Identification of the differentially expressed activated memory CD4+ T-cells-related genes and ceRNAs in oral lichen planus

BackgroundOral lichen planus (OLP) is a common chronic oral mucosal disease with 1.4 % malignant transformation rate, and its etiology especially immune pathogenesis remains unclear. This study was aimed at investigating the immune cells related molecular underlying the pathophysiology of OLP through bioinformatics analysis. MethodsThe dataset GSE52130 obtained from the Gene Expression Omnibus (GEO) database was conducted a comprehensive analysis in this study. The CIBERSORTx was used for investigating immune cells infiltration. The gene set enrichment analysis (GSEA) and gene ontology (GO) enrichment were performed for exploring the biological functions and gene annotation. The protein-protein interactions (PPI) were constructed by STRING database and visualized by Cytoscape software. The cytohubba plugin was utilized for screening hub genes. The receiver operating characteristic (ROC) was performed for evaluating diagnostic value of hub genes. The miRNAs, lncRNAs and drugs were respectively predicted by NetworkAnalyst, miRTarbase, ENCORI, and DGIdb database. ResultsThis study identified 595 differentially expressed genes (DEGs). The GSEA indicated keratinization, innate immune system and biological oxidation were involved in OLP. GO analysis showed extracellular matrix and keratinocyte were mainly enriched. And we found the activated memory CD4+ T cells were lowly infiltrated in OLP. We identified 101 activated memory CD4+ T-cells-related DEGs. Three hub genes (APP, IL1B, TF) were selected. APP and IL1B were significantly up-regulated, whereas TF was down-regulated in OLP. The three hub genes show high diagnostic value in OLP. Additionally, they were involved in MAPK signal, NF-kappaB signal and iron metabolism in OLP. What's more, NEAT1/XIST - miR - 15a - 5p/miR - 155–5p - APP/IL1B signal axis was focused in competing endogenous RNA (ceRNA) network. In addition, 35 drugs were predicted for OLP. ConclusionThree activated memory CD4+ T-cells-related DEGs were identified by integrative analysis. It may provide novel insight into the pathogenesis of OLP and suggest potential therapeutic targets for OLP.

Intralesional nivolumab in oral potentially malignant disorders: A phase 1 pilot study on safety, tolerability, and preliminary efficacy.

6016 Background: Oral Potentially Malignant Disorders (OPMD) encompass a diverse group of oral mucosal diseases, including the prevalent oral leukoplakia (OL), serving as precursors to invasive oral squamous cell carcinoma. OPMD exhibits an annual malignant transformation rate up to 36%. Despite the breadth of research on OPMD the standard-of-care remains surgery or observation. We aim to evaluate the safety and tolerability of intralesional injections of Nivolumab in patients with OPMD. Secondary objectives include assessing objective response rate and pathologic complete response rate. We describe the results of an immune prevention trial designed to avoid systemic toxicities of immunotherapy in patient with pre-malignancy by administrating aPD1 intralesionaly. Methods: Phase 1, single-arm, open-label, dose-escalation pilot study that involves intralesional injections of Nivolumab (index lesion) in patients with high-risk OPMD lesions every 3 weeks (total of 4 doses, 12 weeks). Non-index, non-injected, oral lesion(s) were also documented and monitored. The study includes two dose cohorts (10 mg and 20 mg) to assess maximally tolerated dose with a 3 + 6 dose-escalation design. Adverse events were reported according to NCI CTCAE Version 5.0. Serial biopsies at baseline and up to 8 weeks after treatment were taken to assess efficacy using a composite score (i.e., size and degree of dysplasia) in index lesion. Major response was defined as &gt;80% decrease in score; partial response as 40%-80% decrease. Freshly frozen tumors were subjected to RNA sequencing and gene pathway analysis to identify biomarkers of response or progression. Results: At the time of data analysis, 13 patients have completed treatment (61.5% males), both dose levels were well tolerated. The adverse event grades ranged from grade 1 (i.e. diarrhea, elevated LFT and skin rash) constituting the majority at 80.5% of reported adverse events, grade 2 (i.e. skin rash, cellulitis) at 13.9%, and grade 3 (i.e. hypertension) at 5.6%. Ten patients had multifocal disease. Major response was observed in 22.5% and partial response in 50% of the patients. One patient progressed to invasive SCC in a non-index lesion. RNA sequencing based immune phenotyping revealed increased infiltration of CD8 cytotoxic T cells in index lesions after treatment. Pathway analysis revealed significant alterations in immune pathways including Th1 and Th2 pathways, Natural killer and immunoregulatory pathways. Spatial transcriptome analysis and pharmacokinetics data are pending. Conclusions: Intralesional nivolumab is well tolerated in OPMD with suggested potential biological and clinical activity. A randomized phase II trial to assess cancer free survival is recommended to determine the efficacy in preventing cancer progression. We recommend dose of 20mg for phase II as it was well tolerated. Clinical trial information: NCT05327270 .

Clinical, histopathological characteristics and malignant transformation of proliferative verrucous leukoplakia with 36 patients: a retrospective longitudinal study

BackgroundProliferative verrucous leukoplakia (PVL), distinguished by its malignant transformation rate of 43.87% to 65.8%, stands as the oral potentially malignant disorder with the highest propensity for malignancy. PVL is marked by distinctive heterogeneity regarding the clinical or histopathological characteristics as well as prognostic factors pertinent to this condition. The purpose of this study is to compile and assess the clinicopathological features, malignant transformation, and associated risk factors in patients diagnosed with PVL.MethodsThis study is a hospital-based retrospective longitudinal study of 36 patients diagnosed with PVL from 2013 to 2023. We conducted complete clinical and histopathological evaluations of the patients.ResultsThe cohort comprised 16 males and 20 females, yielding a male-to-female ratio of 1:1.25. The follow-up period ranged from 8 to 125 months, with an average of 47.50 months. The most common clinical type of lesion was the verrucous form (58.33%), and the gingiva was the most common site (44.44%). Each patient had between 2 to 7 lesions, averaging 3.36 per patient. During the follow-up period, twelve patients (33.3%) developed oral cancer, with an average time to malignant transformation of 35.75 months. Kaplan–Meier survival analysis indicated that patients with complaints of pain, roughness, or a rough sensation, with diabetes, and the presence of cytologic atypia histologically showed a higher risk of malignant transformation (p < 0.05). In this study, the rate of malignant transformation in the treatment group (5/23) was lower than that in the untreated group (7/13), however, no statistically significant difference (p = 0.05).ConclusionThe main complaints of pain, roughness, or foreign body sensation, coupled with cytologic atypia histologically are indicative of an increased risk of malignant transformation in PVL. Further research is needed to elucidate the influence of these clinicopathological parameters on the malignant progression of PVL.

Atypical Endometriosis: A Comprehensive Systematic Review of Pathological Patterns and Diagnostic Challenges.

Endometriosis is a benign condition affecting women of reproductive age. A potential association with ovarian cancer has been documented. Atypical endometriosis (AE) is characterized by deviations from the typical microscopic appearance of endometriosis, including cytologic and architectural atypia. AE has been recognized as a potential precursor to endometriosis-associated ovarian cancers (EAOC), particularly endometrioid and clear cell subtypes. AE presents challenges in diagnosis due to its diverse clinical and pathological features, often requiring careful histological evaluation for accurate identification. Architectural AE, defined by localized proliferation of crowded glands with atypical epithelium resembling endometrial neoplasia, and cytologic AE, characterized by nuclear atypia within the epithelial lining of endometriotic cysts, are key subtypes. Immunohistochemical and molecular studies have revealed aberrant expression of markers such as Ki67, COX-2, BAF250a, p53, estrogen receptor, progesterone receptor, and IMP-3. Long-term follow-up studies suggest relatively low recurrence and malignant transformation rates among patients with AE, but uncertainties persist regarding its exact malignancy potential and optimal management strategies. Integration of artificial intelligence and shared molecular aberrations between AE and EAOC may enhance diagnostic accuracy. Continuous interdisciplinary collaboration and ongoing research efforts are crucial for a deeper understanding of the relationship between endometriosis and carcinogenesis, ultimately improving patient care and surveillance.

Benign extra skeletal chondroma of the tongue in a 16-year-old female

Chondromas are tumors that result from chondroid differentiation most frequently occurring in areas where chondrocytes are present. Rarely, they can present in soft tissues, such as the tongue. This case report will review the extra skeletal chondroma found on the posterior tongue of an asymptomatic 16-year-old female. Discussed within this case report will include the importance of histopathological analysis in distinguishing enchondroma versus chondrosarcoma and review the malignant transformation rate. Additionally, it will compare the trends of chondromas found in the oral cavity that have been previously published. This case will highlight the importance of recognizing chondromas in unusual places, such as the origin of soft tissues, and emphasize the importance of early diagnosis, surgical intervention and providing optimal outcomes for young patients.

Malignant Transformation of Dysplastic Vocal Fold Lesions

The reported rates of malignant transformation of dysplastic laryngeal lesions are highly variable, as is time to malignant degeneration. To evaluate the rate of and time to malignant transformation of dysplastic laryngeal lesions based on the World Health Organization (WHO) dysplasia classification system. PubMed, MEDLINE, Embase, CINAHL, CENTRAL, and Cochrane Reviews were searched from the date of database inception to June 8, 2023. English-language articles assessing the rate of malignant transformation using the 2005 WHO dysplasia classification system were included in this systematic review and meta-analysis. The study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was performed by 2 independent investigators. Study quality was assessed using a validated quality tool. When possible, data were pooled using random-effects meta-analysis. The primary outcome measure was the malignant transformation rate in each laryngeal dysplasia category. Secondary outcome measure was the time interval over which malignant transformation had occurred. A total of 5585 records were screened, 61 full texts were assessed, and 18 retrospective cohort studies with 3243 participants were included in the final review. The weighted pooled mean malignant transformation rates of mildly, moderately, and severely dysplastic lesions were 10.9%, 23.3%, and 30.5%, respectively. Malignant transformation rate of nondysplastic laryngeal lesions was 4.5%. Moderately and severely dysplastic lesions had significantly higher odds of malignant transformation compared with mildly dysplastic lesions (moderate: odds ratio [OR], 2.90 [95% CI, 2.06-4.09]; I2 = 0%; severe: OR, 3.42 [95% CI, 2.11-5.52]; I2 = 40%). Lesions without dysplasia had a significantly lower odds of malignant transformation compared with lesions with mild dysplasia (OR, 0.48; 95% CI, 0.28-0.81; I2 = 0%). The overall mean time to malignant transformation was 28.8 months (range, 22.0-35.6 months) for all dysplasia grades. This systematic review and meta-analysis found that the rate of malignant transformation increased with the grade of laryngeal dysplasia. Moderately dysplastic lesions were more likely to undergo malignant degeneration compared with mildly dysplastic lesions.

Role of Antioxidant Vitamins in Oral Submucous Fibrosis: A Narrative Review.

Oral submucous fibrosis (OSMF) has a high rate of malignant transformation and is an insidious chronic inflammatory disease. Though this disorder seems to be multifactorial in origin, betel quid chewing appears to be the main etiologic factor. Various treatment strategies have been attempted but none proven to cure the disorder because of its multimodal pathogenesis. Reactive oxygen species (ROS) appear to have a role in cancer formation. As OSMF is an oral premalignant disorder and found to be associated with carcinogens like areca nut and tobacco, it is believed to have some relationship with ROS. Tissue damage due to ROS along with other mechanisms may result in the complex pathophysiology of OSMF. The antioxidant system in the body helps to prevent damage caused by highly reactive ROS and helps in the repair of tissues. To study the levels of oxidative stress and antioxidant vitamins in OSMF condition, the present review was done. We carried out a thorough literature search to identify original reports and studies determining the status of oxidative stress and antioxidant vitamins in OSMF condition using several databases including Google Scholar, PubMed, and Scopus. Our review observed that the oxidative stress increased in the condition of OSMF as shown by an increase in malonaldehyde (MDA) and a decrease in antioxidant vitamins like vitamin A, vitamin C, and vitamin E. Also, after the intake of antioxidant vitamins, there was symptomatic improvement in OSMF patients. With the help of identifying oxidative stress and antioxidant status, we can assess the clinical stage of OSMF and can develop a comprehensive treatment plan.

Dermoid cyst management and outcomes: a review of over 1000 cases at a single institution

BackgroundMature cystic teratomas represent nearly 60% of benign ovarian neoplasms across all age groups. We aim to update existing descriptive studies of ovarian teratomas including the epidemiology, rate of torsion/malignancy, and treatment modalities in a large modern cohort of patients. Study DesignThis is a retrospective cross-sectional study of all pathology-confirmed cases of ovarian teratoma who underwent surgery at one tertiary care institution from 2004–2015. Patient demographics, ovarian cyst characteristics, surgical approach and timing, rate of spillage, and surgical complications were examined. Results1,054 cases of ovarian teratoma were identified during the study period. There were 113 cases of bilateral teratoma (10.7%). Mean age at diagnosis was 38 years. Average cyst size was 6.26cm. The overall rate of torsion was 5.6%, with a higher rate of torsion with increasing cyst size. Over 70% of cases were treated with minimally invasive surgery, which was associated with decreased perioperative complications but an increased risk of cyst spillage. Among 394 patients with cyst spillage, only one developed chemical peritonitis. The malignant transformation rate of mature cystic teratoma in this cohort was 1.1%. This cohort included 100 pregnant women with mature teratoma. Pregnant patients were more likely to have minimally invasive surgery in the 1st trimester and more likely to undergo laparotomy in the 2nd or 3rd trimester. ConclusionsIn this large modern cohort, we found similar rates of bilaterality, torsion, malignant transformation, and struma ovarii in ovarian teratomas when compared to previous literature. Most cases of ovarian teratoma can be managed laparoscopically, which is associated with a lower surgical complication rate. Despite increased risk of cyst spillage with a minimally invasive approach, chemical peritonitis is a rare complication.

Prevalence and Malignant Transformation Rate of Oral Erythroplakia Worldwide - A Systematic Review.

To determine the characteristics of oral erythroplakia (OE) on a global scale, it is important to analyse and evaluate findings from various studies conducted across multiple geographical locations. This review was conducted to determine the prevalence and malignant transformation rate (MTR) of OE. A systematic search was performed to identify studies reporting the prevalence and MTR of OE across various databases - PubMed, Web of Science, Google Scholar, Elsevier and ScienceDirect without any restriction for the time of publication. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, and the protocol was registered in the PROSPERO database (ID: CD42023395215). The prevalence rate of OE reported across the studies ranged from 0.04% to 1.14% with a mean of 0.25 + 0.002%. The MTRs reported across the studies included ranged from 2.6% to 65% with a mean of 30 ± 0.2%. Based on the findings from the present review, it can be concluded that while the range of MTRs of OE varies widely across different geographical locations, the average rate can be considered 30%. The review also identified a need for conducting more studies on the prevalence rates as well as longitudinal studies assessing the MTR across different regions.

Recurrence and malignant transformation of laryngeal leukoplakia treated with CO2 laser: A systematic review and meta-analysis.

Laryngeal leukoplakia (LL) is a white lesion with high potential of recurrence and malignant transformation. Currently, CO2 laser has become the primary surgical treatment for LL, and the recurrence and malignant transformation rates after treatment vary widely. We performed a systematic review and meta-analysis dedicated to evaluating the rates of recurrence and malignant transformation of LL lesions treated with CO2 laser and exploring relevant risk factors for recurrence or malignant transformation. Literature searches were conducted on ProQuest, PubMed, Web of Science, Ovid Medline, Embase, and Cochrane databases. Some articles identified through hand searching were included. A total of 14 articles and 1462 patients were included in this review. Pooled results showed that the overall recurrence rate was 15%, and the malignant transformation rate was 3%. Subgroup analysis showed that the dysplasia grade was not a significant risk factor for the recurrence and malignant transformation of LL (P > .05). The results of this systematic review and meta-analysis suggest that the CO2 laser is a safe and effective surgical instrument for the excision of LL, which yields low rates of recurrence and malignant transformation. The risk factors relevant to recurrence or malignant transformation remain unclear and require further investigation.