Rate Of Malignant Transformation Research Articles

Clinical efficacy of photodynamic therapy of oral potentially malignant disorder

ObjectiveTo investigate the clinical efficacy of aminovalerate hydrochloride photodynamic therapy (PDT) for oral potentially malignant disorder (OPMD),oral leukoplakia (OLK), along with identifying the influencing factors.Additionally, the study aims to detect the rates of recurrence and malignancy after PDT. Method60 patients with OPMD who received PDT at our hospital from 2006 to 2021 were included in this study. Relevant patient medical data were collected and analyzed using SAS 9.4 software.The Mann-Whitney U test was used to retrospectively analyze the factors influencing clinical efficacy, as well as recurrence rate and malignant transformation rate (MTR) after treatment. ResultAmong the 60 OPMD patients receiving PDT, complete remission in 13 (21.67 %), partial remission in 39 (65.00 %), and no remission in eight (13.33 %), resulting in an overall effective rate of 86.67 %.Fifteen patients experienced relapse, leading to a recurrence rate of 25.00 %. Among these relapses,11 patients occurred within one year after treatment, corresponding to an 18.33 % recurrence rate during that period. Moreover, nine patients developed malignant transformation (MT), resulting in an MTR of 15.00 %. Out of these patients, six individuals developed MT within one year after treatment, resulting in a one-year MTR of 10.00 %. ConclusionThe study findings indicate that PDT shows promising clinical efficacy in the treatment of OPMD, with relatively limited and tolerable postoperative adverse reactions. However, there remains a certain rate of recurrence and malignancy after treatment. Therefore, close attention should be paid to postoperative monitoring, regular follow-up, and further expansion of the sample size to observe its long-term efficacy.

Gastro Intestinal Stromal Tumor -Supra Pubic Region

Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract and mesentery. They are usually found in the stomach or small intestine but can occur anywhere along the GIT and rarely have extra GI involvement. They are associated with high rates of malignant transformation. Most GISTs present asymptomatically but also present with bleeding, abdominal pain, and rarely gastric outlet obstruction. There have been many risk stratification classifications systems which are calculated based on tumour size, mitotic rate, location, and perforation. They are best identified by computed tomography (CT) scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. The approaches to treating GISTs are to resect primary low-risk tumours, high-risk tumours and further treated with imatinib therapy and unresectable tumours treated with neoadjuvant imatinib 400 mg daily followed by surgical resection and regular follow up by abdominal CT scan.

Clinical evaluation of photodynamic therapy for oral leukoplakia: a retrospective study of 50 patients

BackgroundTopical photodynamic therapy (PDT) has demonstrated encouraging results in the treatment of oral leukoplakia (OLK). However, data on the clinical efficacy of PDT in Chinese patients with OLK are still limited.MethodsFifty patients diagnosed with OLK were enrolled, including patients with various dysplastic tissues. All patients received topical PDT with 5-aminolevulinic acid (5-ALA) as a photosensitizer. Clinical efficacy was evaluated 4 weeks after treatment. Follow-up was performed every 3 months during the first year and every 6 months during the second year.ResultsThe overall response rate was 68% (34/50): 12% (n = 6) complete and 56% (n = 28) partial responses. Aneuploidy was reduced in the patients with dysplastic lesions. Oral pain and local ulcers developed in 52% of the patients (n = 26). Patients with a long history of OLK including hyperplasia and dysplastic lesions, as well as those with non-homogenous lesions, were more likely to develop pain and ulcer. During follow-up, the recurrence rate of hyperplasia and dysplastic lesions was 32% (n = 16) and the malignant transformation rate of dysplastic lesions was 4% (n = 2). Lesions on the buccal mucosa were associated with recurrence (P = 0.044; OR: 0.108, 95% CI: 0.013–0.915).ConclusionTopical 5-ALA-mediated PDT is an effective treatment for OLK, particularly for homogenous leukoplakia, with few side effects. The buccal mucosa may be a protective factor that can reduce recurrence.

Malignant transformation rate of erosive oral lichen planus: a retrospective study

Oral lichen planus (OLP) is a chronic inflammatory oral condition previously known to have a rate of malignant transformation of around 1%. Additionally, erosive lichen planus, a subtype of lichen planus, which is a known risk factor for malignant transformation, has previously been unquantified in a large cohort of patients. In a single unit observation between 2005 and 2021 we retrospectively assessed 1,920 patients who underwent histological analysis for suspected oral lichen planus, and followed the progression of their disease to assess the rate of malignant transformation. In total, 1.39% of OLP transformed to oral squamous cell carcinoma over an average of 5.8 years. However, we found that the transformation rate of erosive OLP into malignancy was 5.98% with an aggressive clinical pathway. To our knowledge the incidence of erosive OLP has not previously been quantified in a large cohort of patients. This retrospective study sheds light on, and raises warning signs about, the seriousness of this condition.

Unexpected submucosal lesion with malignant potential.

The inverted hyperplastic polyp (IHP) is known as hyperplastic gastric mucosa growth into submucosa and endoscopically presented as sessile or pedunculated submucosa lesion. It occurs in between 3.1% to 20.1% of cases, while its malignant transformation rate is just 0.02%. A male underwent esophagogastroduodenoscopy (EGD) and discovered a submucosal lesion with a pinhole-like orifice in the fundus. And endoscopic ultrasound (EUS) showed it was a heterogenous hypoechoic lesion located in the submucosa. After endoscopic resection, the pathological findings and immunohistochemical staining revealed it was inverted hyperplastic polyp (IHP) with adenocarcinoma. The measurement of the cancerous IHP depth of invasion is controversial. Thus, how to define the depth of lesion invasion in this patient needs to be seriously considered. To manage IHP with adenocarcinoma better, the depth of lesion invasion cancerous IHP needs to be seriously considered.

Importance of nasal leukoplakia

Nasal leukoplakia is a type of precancerous lesion. The rate of malignant transformation of nasal leukoplakia can be reduced by its early detection, diagnosis, treatment, and prevention. The nasal mucosa (including the nasal septum; upper, middle, and in- ferior turbinate; upper, middle, and inferior meatus; nasopharynx, and nasal sinuses) develop leukoplakia. Studies have reported that the development of leukoplakia in the oral and laryngeal mucosa is high; in contrast, nasal leukoplakia is rare.

An update on central nervous system tumors in germline replication-repair deficiency syndromes.

DNA replication-repair deficiency (RRD) arises from pathogenic variants in the mismatch repair and/or polymerase-proofreading genes. Multiple germline cancer predisposition syndromes in children and young adults, including constitutional mismatch repair deficiency (CMMRD), Lynch, polymerase-proofreading deficiency, and rare digenic syndromes can lead to RRD cancers. The most frequent brain tumors in these children are high-grade gliomas. Embryonal tumors like medulloblastoma have also been described. Lower-grade tumors are reported from cancer surveillance initiatives. The latter has an extremely high rate of malignant transformation. Novel functional assays quantifying the genomic microsatellite indel load have been demonstrated to be highly sensitive and specific for the diagnosis of RRD cancers and children with germline CMMRD. Importantly, RRD brain tumors uniformly harbor high mutation and microsatellite burden. High T-cell infiltration makes these aggressive cancers amenable to immune checkpoint inhibition, irrespective of their germline genetic background. Synergistic combinations are reported to be successful in patients failing checkpoint inhibitor monotherapy. Future directions include the development of innovative approaches to improve immune surveillance for RRD brain cancers. Additionally, the use of novel tools including circulating tumor DNA and quantifying microsatellite indel load over time can be useful to monitor disease burden and treatment responses in patients.

Malignant Transformation of Actinic Cheilitis: A Decade-long Retrospective Study in Southern Brazil.

Actinic cheilitis (AC), an oral potentially malignant oral disorder (OPMD), predominantly affects fair-skinned individuals, particularly males, with a higher prevalence in their sixth and seventh decades. In the Southeast region of Brazil, oral cancer ranks as the fourth most common tumor among males, with squamous cell carcinoma (SCC) constituting 90% to 95% of lip tumor cases, primarily impacting the lower lip. This retrospective study aims to evaluate the malignant transformation rate in previously diagnosed AC patients between 2008 and 2018, utilizing biopsy records. We retrospectively reviewed medical records of lip lesion patients at the Department of Oral and Maxillofacial Surgery (DOMS) during the stated period, collecting demographic and medical data for analysis. Among the 224 analyzed AC cases, 67.8% were male, with an average age of 65 years. Approximately 87.6% of patients reported occupational exposure to AC-associated risk factors. Malignant transformations occurred in 27 patients (12.05%). Our study underscores the possible effect of early intervention and preventive measures in stabilizing AC lesions and averting their progression to malignancy. These findings underscore the significance of prompt AC diagnosis and management to mitigate the risk of malignant transformation. Key words:Actinic cheilitis, oral squamous cell carcinoma, malignant transformation.

Prevalence Of Different Stages Of Oral Submucous Fibrosis In India: A Cross Sectional Study

Background: Oral Submucous Fibrosis (OSMF) is a persistent and gradually developing disorder that impacts the mouth and occasionally the throat. It is marked by an inflammatory response just beneath the epithelium and alterations in the fibroelastic components of the lamina propria. These changes result in stiffness of the oral mucosa, limited mouth opening (trismus), and challenges with eating. OSMF is distinguished by its significantly elevated potential to progress into malignancy, compared to other oral lesions with a risk of malignancy, predominantly affecting those of Indian and Southeast Asian descent. The global prevalence rate stands at 2.28% - 8.62%, with a notable gender disparity in occurrence and a malignant transformation rate of 4.2%. Aim: The objective of this research is to evaluate the prevalence and distribution by gender of OSMF stages within a private dental institution, with a particular emphasis on examining the relationship between the frequency of the disease and the occurrence of its stages. Materials and Methods: Over a period of 32 months, a cross-sectional analysis was carried out in the outpatient section of the Department of Oral Medicine and Radiology. After receiving approval from the ethics committee, 337 individuals diagnosed with OSMF were selected for inclusion in the study, with information categorized according to gender and age. Results: The study found a significant male predominance (94%) among the patients, with a mean age of 31-50 years. Stage 2 OSMF was more prevalent among both genders, followed by stage 3 and 1, indicating a specific pattern of disease progression. Discussion: Consistent with previous studies, our research confirmed a male predominance in OSMF occurrence. The age and stage distribution aligns partially with existing literature, suggesting a predominant affliction of individuals in their mid-life. Contrary to Anuna Liala Mathew et al.'s findings, our study observed a higher prevalence of stage 2 OSMF, underscoring potential variations in disease progression or detection practices. Conclusion: OSMF presents a significant public health challenge due to its high malignant transformation potential and association with arecanut and tobacco use. This study highlights the urgent need for public education on the adverse effects of these substances and calls for enhanced awareness and management strategies for OSMF, particularly considering its prevalence and severity among males in the studied population.

Biological biomarkers of oral cancer

AbstractThe oral squamous cell carcinoma (OSCC) 5 year survival rate of 41% has marginally improved in the last few years, with less than a 1% improvement per year from 2005 to 2017, with higher survival rates when detected at early stages. Based on histopathological grading of oral dysplasia, it is estimated that severe dysplasia has a malignant transformation rate of 7%–50%. Despite these numbers, oral dysplasia grading does not reliably predict its clinical behavior. Thus, more accurate markers predicting oral dysplasia progression to cancer would enable better targeting of these lesions for closer follow‐up, especially in the early stages of the disease. In this context, molecular biomarkers derived from genetics, proteins, and metabolites play key roles in clinical oncology. These molecular signatures can help predict the likelihood of OSCC development and/or progression and have the potential to detect the disease at an early stage and, support treatment decision‐making and predict treatment responsiveness. Also, identifying reliable biomarkers for OSCC detection that can be obtained non‐invasively would enhance management of OSCC. This review will discuss biomarkers for OSCC that have emerged from different biological areas, including genomics, transcriptomics, proteomics, metabolomics, immunomics, and microbiomics.

Correlation Between Clinical and Histopathological Stagings of Oral Submucous Fibrosis: A Clinicopathological Cognizance of 238 Cases From South India.

Background This paper aims to descriptively present the clinico-demographic and pathological profile of 238 cases of oral submucous fibrosis (OSMF) with emphasis on the correlation between clinical and histopathological classification systems and the incidence of malignant transformation. Methods A total of 7098 oral biopsies were retrospectively retrieved over a period of 13 years, out of which 238 cases of OSMF were included in the present study. Data were analyzed for age, gender, habits, clinical symptoms, functional staging, histological staging, type and nature of epithelium, signet-ring cell changes, presence/absence of dysplasia or transformation squamous cell carcinoma, and treatment. Results Clinically and histologically, most cases were moderately advanced. Men outnumbered women. The prevalence of dysplasia was found to be 23.94% and the malignant transformation rate was estimated to be 13.8%. There was a significant correlation between clinical staging with age and histological grading. No correlation was found between histological staging and the age of the patients. Conclusions OSMF is a habit-related progressive chronic oral condition with a high malignant transformation rate. Multimodal treatment with auxiliary physiotherapy helps in the improvement of the clinical symptoms.

Fluoride as a potential contributory factor in pathogenesis of oral submucous fibrosis: A novel hypothesis

Oral submucous fibrosis (OSMF) is a chronic premalignant condition of the oral cavity characterized by progressive submucosal fibrosis and high malignant transformation risk. Areca nut chewing is an established aetiological factor, but OSMF's sporadic incidence in nut users indicates other contributing cofactors. This paper propose a novel hypothesis on the potential role of fluoride exposure in OSMF pathogenesis. Evidence in the literature demonstrates fluoride readily accumulates in oral tissues upon topical exposure and can elicit oxidative stress, chronic inflammation, collagen changes, and muscle degeneration through various mechanisms. We hypothesize chronic topical fluoride exposure from gutkha, areca nut or other smokeless tobacco products, along with other aetiologic factors, may induce an aberrant microenvironment in the oral mucosa, initiating and propagating submucosal fibrosis. Resultant repetitive injury coupled with fluoride's interference in collagen metabolism and wound healing may culminate in OSMF pathogenesis. We further speculate that chronic ingestion of dietary fluoride especially from drinking water and food may predispose individuals to OSMF when it interacts synergistically with direct contact of gutkha or other smokeless products. In addition, it is also speculated that the cellular effects of fluoride in a dose-dependent manner, could contribute to dysplastic changes and malignant transformation in severe OSMF cases. Further research should systematically investigate fluoride levels in OSMF cohorts and correlate with disease severity and malignant transformation rates. Confirming the aetiopathologic role of fluoride as a promoting factor would highlight public health efforts to limit its topical exposure from oral habits and diet to combat this oral potentially malignant disorder.

Malignant Transformation in Oral Lichen Planus and Lichenoid Reactions in Southern Thai Population

Objectives: This study aimed to determine the prevalence of malignant transformation (MT) and the incidence rate of oral squamous cell carcinoma (OSCC) in oral lichen planus (OLP) and oral lichenoid reaction (OLR) patients from southern Thailand. Methods: This hospital-based retrospective cohort study comprised OLP/OLR patients who were treated between January 2016 and December 2022. Data on the general characteristics, clinical manifestations and laboratory investigations were obtained from the hospital records and analyzed. Descriptive and analytical statistics were performed to assess the demographic data, clinical profiles of the patients and the prevalence and incidence rate of MT. Results: A total of 117 patients were included in the study; 103 (88%) were diagnosed with OLP, and 14 (12%) were diagnosed with OLR. The median follow-up time was 15.6 months (interquartile range; 6.1-46.0). The overall prevalence of MT in OLP/OLR was 1.71% (2/117 patients); specifically, MT in OLP was 1.94% (2/103 patients). The overall annual incidence rate of MT into OSCC was 0.0060 (95% confidence interval, 0.0015-0.0240). Conclusions: These findings suggest that OLP is a potentially malignant disorder with an MT incidence of 1.94% in the southern Thai population. OLP patients must be regularly followed-up and advised about the risk of MT.

The Potential of Nano-Based Photodynamic Treatment as a Therapy against Oral Leukoplakia: A Narrative Review.

Oral leukoplakia is a predominantly white lesion of the oral mucosa that cannot be classified as any other definable lesion with the risk of progressing into malignancy. Despite the advancements in conventional therapy, the rates of malignant transformation remain notably high, affecting 4.11% of adults, due to the difficulty of accurate diagnosis and indistinct treatment. Photodynamic therapy (PDT), being a minimally invasive surgical intervention, employs a variety of factors, including light, nano-photosensitizers (PSs) and oxygen in the management of precancerous lesions. PDT faces limitations in administering photosensitizers (PSs) because of their low water solubility. However, these challenges could be effectively resolved through the incorporation of PSs in nanostructured drug delivery systems, such as gold nanoparticles, micelles, liposomes, metal nanoparticles, dendrimers and quantum dots. This review will give an overview of the different innovative PS approaches in the management of premalignant lesions, highlighting the most recent advancements. From a clinical perspective, it is expected that nanotechnology will overcome barriers faced by traditional therapeutics and will address critical gaps in clinical cancer care.

Iatrogenic cushing’s syndrome post intralesional triamcinolone acetonide in oral submucous fibrosis: 2 case reports

BackgroundOral Submucous Fibrosis (OFMF) is an oral potentially malignant disorder (OPMDs), strongly linked to betel quid chewing. It exhibits a significantly higher rate of malignant transformation compared to other OPMDs. The use of Intralesional Triamcinolone Acetonide Injection has emerged as a highly effective treatment option and has become the cornerstone of managing this condition.Case PresentationA 44-year-old female and a 40-year-old male presented with burning sensation and limited mouth opening, leading to diagnosis of OSMF. Both patients were treated with Triamcinolone Acetonide (TAC) Intralesional injections. Following a few months of treatment, a significant improvement in mouth opening was observed. However, both patients began experiencing symptoms such as facial rounding (mooning of the face), a buffalo hump, uneven hair growth, and swelling in the lower extremities. Upon recognizing these symptoms as indicative of Cushing’s Syndrome, the administration of TAC injection was discontinued. Both patients were referred to a higher-level medical facility for confirmatory tests, which revealed elevated cortisol levels in both morning (Cortisol A.M) and evening (Cortisol P.M).ConclusionTAC injection has been established as an effective treatment for OSMF. However, it is crucial to closely monitor patients for any adverse effects resulting from the treatment, which may arise from high dosage or increased frequency.

Evaluating photodynamic therapy for oral precancerous lesions: Highlighting outcome measure of malignant transformation

The main outcome measure assessed in previous studies on photodynamic therapy (PDT) for oral precancerous lesions (OPL) is clinical response based on the alteration in lesion size after treatment. However, the primary and secondary outcome measures of the interventions for OPL should be malignant transformation and recurrence. Thus, the objective of this short communication is to summarize the evidence on PDT in preventing the recurrence and malignant transformation of OPL. There were 16 eligible studies which addressed the issue of OPL patients who received PDT with recurrence outcome, and the pooled recurrence rate (95% confidence interval) was analyzed to be 20.1% (16.2–24.6%). Notably, only 1 study reported that 7.5% of malignant transformation rate for OPL received PDT. These should be interpreted with caution due to low-level evidence, such as differences in study design, clinical and pathological features of patients enrolled, limited sample size, short follow-up time. Given few evaluated the effect of PDT on malignant transformation, we highlight that this primary outcome measure of OPL needs to be investigated in further well-designed longitudinal studies with adequate follow-up periods.

Proliferative Verrucous Leukoplakia: An Update

Objectives: Proliferative verrucous leukoplakia was first described by Hansen et al. in 1985. It is a rare form of oral leukoplakia with a high risk of malignant transformation. A review of the scientific literature indicates that there is no consensus on the management and follow-up of proliferative verrucous leukoplakia. This article aims to provide an update on the epidemiological, clinical, histological and immunohistochemical, diagnostic, treatment and follow-up data on the disease. Materials and Methods: We performed a narrative review by searching the Pubmed and Google Scholar databases using keywords. Results: 93 out of 446 selected articles were selected for analysis. The majority of affected patients are women. The lesions are multifocal and usually occur on the gingiva and alveolar mucosa. The aetiology is idiopathic. The diagnosis is retrospective and based on the history of the disease. Apart from mapping the lesions using repeated biopsies to detect a malignant area progression, there is no recommended treatment to cure the disease. Conclusion: The current understanding of this entity is based on the analysis of retrospective studies with weak scientific evidence. Expert recommendations regarding follow-up and management would facilitate better control of recurrence and malignant transformation rates.

Clinical outcomes of oral epithelial dysplasia managed by observation versus excision.

Oral potentially malignant disorders, including oral epithelial dysplasia (OED), are a group of conditions with an increased risk of progression to oral cancer. Clinical management of OED is challenging and usually involves monitoring with repeated incisional biopsies or complete surgical excision. To determine if complete surgical excision of OED impacts malignant transformation or improves survival outcomes in lesions that progress to malignancy. A retrospective review of all patients diagnosed with OED between 2009 and 2016 was completed, and patients were followed until January 2022 for disease course and outcomes. Hundred and fifty-five cases of OED met the inclusion criteria. Among the 61 lesions managed by observation, 15 progressed to cancer. Among the 94 lesions managed by surgical excision, 27 progressed to cancer. The overall malignant transformation rate was 27%, with an annual rate of 6.4%. Surgical excision with or without histologically negative margins did not decrease malignant transformation but was associated with lower oncologic staging at the time of diagnosis and improved survival. Surgical excision of OED with or without negative margins did not reduce the rate of transformation to oral cancer but resulted in lower oncologic staging at diagnosis, leading to improved patient outcomes. Our results support the implementation of more extensive tissue sampling to improve cancer diagnosis and patient outcomes.

Evaluation of Platelet Parameters in Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma in a Background of Oral Submucous Fibrosis.

The role of platelet parameters as markers of inflammation in various diseases is now in limelight. The interaction between cancer cells and platelets is a well-established phenomenon. Oral submucous fibrosis (OSMF) is a premalignant disorder with a malignant transformation rate of 2-8%. This study aimed to evaluate platelet parameters in OSMF and oral squamous cell carcinoma (OSCC) in the background of OSMF. This cross-sectional study was performed using secondary data retrieved between January 2019 and December 2019 in the Department of Oral Pathology and the Hematology Laboratory. The data retrieved included 44 histopathologically proven OSCC in a background of OSMF (group III) and 36 OSMF (group II). The haematological parameters of these selected cases were retrieved from the Sysmex XN-1000 automated hematology analyser database. A control group (group I) comprises 50 subjects with normal (negative/unflagged) haematological parameters. All data were statistically analysed using SPSS 20.0. The significance level of tests was set at 5%. The mean platelet volume (MPV) (9.60 [±0.95] P < 0.001), platelet distribution width (PDW) (10.45 [±1.9], P < 0.001), platelet large cell ratio (PLCR) (21.70 [±7.98], P < 0.001), and the ratio of mean platelet volume to total platelet count (MPV/PLT) (0.03 [0.01], P < 0.001) were lower in group III when compared to the other two groups. Platelet parameters may be used as indices in the OSCC in the background of OSMF. However, large-scale prospective studies are necessary to evaluate the utility of these parameters during the malignant transformation of OSMF, thereby encouraging prompt treatment to prevent morbidity and mortality.

Evaluation of Iron Deficiency in OSMF patients: A Cross-sectional Study

Oral submucous fibrosis is a type of chronic oral pathological ailment, which is having insidious onset. It possesses high rate of malignant transformation, which gets accentuated by pernicious oral habits like chewing of areca nut in betel. OSMF predisposes to marked hematological abnormalities, leading to anemia and reduction in levels of serum iron and proteins. The aim of this study was to measure the hemoglobin, serum iron and protein levels among OSMF patients and also to compare these parameters with healthy controls.In the hospital-based study, among 100 study subjects, 45 OSMF patients were selected as cases, whereas 55 apparently healthy individuals were chosen as controls. The hemoglobin, serum iron and protein levels were estimated using hematological and biochemical autoanalyzers. Significantly lower levels of hemoglobin, serum iron, and protein levels were observed in OSMF patients in comparison with apparently healthy subjects.Findings of this study focus on the necessity and rationale of assessing hemoglobin, serum iron and protein amongst OSMF patients. These biochemical assessments in the precancerous condition of OSMF may help in early diagnosis and prognosis. Besides that, iron therapy should be initiated at the earliest with the initial diagnosis, which can be helpful to check further deterioration of the aforesaid premalignant condition. Further extensive studies are required for fine delineation of hematological alterations in OSMF patients.