Verrucous Leukoplakia Research Articles

Considering SOD and miRNA analysis as potential prognostic markers in white lesion malignant transformation: A report of two cases.

Predictive biomarkers can be effective in the identification of the oral leukoplakia with an increased probability of malignant transformation. A 63-year-old patient presents with persistent burning sensations throughout the oral cavity, accompanied by a white lesion on the tongue. Additionally, a 57-year-old patient with multiple white lesions in the oral cavity. Histopathological analysis of the excised tissue. Changes in the expression miRNAs (miR17, miR206, and miR23), the activity of antioxidant enzymes (superoxide dismutase, glutathione peroxidase, glutathione reductase, and glutathione-S-transferase), and concentration of reduced glutathione were detected, followed by meta-analysis of previous studies. In both patients (verrucous leukoplakia, oral squamous cell carcinoma) upregulated expression of miR-23a, miR-17, and downregulated expression of miR206 were detected when compared to healthy individuals. In the plasma of a patient diagnosed with carcinoma, higher activity of antioxidant enzymes connected to glutathione was measured in comparison to healthy individuals. The connection between miRNA expression changes, the increase in glutathione-S-transferase and especially the decrease in superoxide dismutase activities in patients with white lesion potential malignant transformation using the provided statistical analysis was confirmed.

Precancers of the oral mucosa: clinic, diagnostics

The aim of the study. Improving the efficiency of diagnosis and detailing the features of the clinic of «potentially malignant» diseases of the oral mucosa. Clinical and laboratory examination of 124 patients of the department of oral mucosa diseases aged 35 to 80 years, among whom there were 75 women and 49 men, with diseases such as erythroplakia - 12 patients, verrucous leukoplakia - 52 patients, erosive form of leukoplakia - 35 patients, cheilitis Manganotti - 25 patients. Histological and immunohistochemical methods of investigation were used as diagnostics. To assess the proliferative activity of epithelial cells, the determination of the Ki-67 index was used. The synthesis of keratin 15 (K15) in epithelial layers was determined as a diagnostic criterion for the severity of neoplasia. The expression of human papillomavirus type 16 (HPV 16) antigens and p16INK4a protein in epithelial cells was studied, as well as the expression of p53 protein. A high prevalence of p53 mutations was observed in patients with erythroplakia. In leukoplakia, the expression of the Ki-67 protein was detected in the cell nuclei in both the basal and parabasal layers of the multilayer squamous epithelium, in 77% of cases, the expression of the p16INK4a protein in the epithelial nuclei with varying degrees of dysplastic changes was noted, and a positive reaction to HPV16 was also observed in the cell nuclei and cytoplasm of epithelial cells in the basal, parabasal and spiny epithelial layers. The appearance of K15 in the cytoplasm of cells above the basal layer with abrasive precancerous cheilitis was found in 48% of cases. To diagnose early manifestations of neoplastic processes in «potentially malignant» diseases of the oral mucosa, it is necessary to use both classical histological and immunohistochemical methods of investigation with various markers.

A Five Year Retrospective Study of Oral Potentially Malignant Disorders (Opmds) and Oral Squamous Cell Carcinoma (OSCC) and their Associated Risk Factors

Background: Oral squamous cell carcinoma (OSCC) is generally converted from precancerous conditions. The conversion rates are mainly linked to various addiction habits and sometimes to sociodemographic profile of patients. The clinical spectrum of oral potentially malignant disorders (OPMDs) varies between geographical districts or from place to place within the same country. The prevalence of this particular malignancy may be reduced by prompt diagnostic and therapeutic action. Aims and Objectives: We focused on the data associated with histo-pathological types of lesion in relation to certain sociodemographic profile and addiction habits in the targeted population. Materials and Methods: We performed 5 years retrospective cross-sectional study from January 2013 to December 2017 in the oral pathology department in systematic manner. Data were collected and compiled in Microsoft Excel and were analyzed through SPSS software. Chi-square, Student’s t-test, and Pearson’s correlation tests were used to determine the significance of study parameters between groups. Results: Our study suggests a more common relationship of lichen planus with gutkha, pan, and mixed habit; leukoplakia with bidi smoking and mixed habit; verrucous leukoplakia with bidi and cigarette smoking and gutkha chewing; oral submucous fibrosis with pan and gutkha; mild and moderate dysplasia with bidi and alcohol consumption; well-differentiated OSCC and moderately differentiated OSCC with tobacco intake and/or alcohol and poorly differentiated OSCC with alcohol, pan, and bidi. Conclusion: OPMDs and OSCC are more associated with various addiction habits. Cessation of these habits along with early intervention may reduce the burden of disease.

Features of molecular genetic diagnosis of verrucous leukoplakia

To evaluate the initial molecular genetic signs of malignancy of verrucous leukoplakia (VL). The study of VL was carried out on biopsies of 21 patients with the diagnoses of verrucous hyperplasia (VH) (15 cases - 71.4%) and verrucous carcinoma (VC) (6 cases - 28.5%). Tissue antigens were determined using mouse monoclonal antibodies to the Ki-67 protein (MM1, Diagnostic Biosystems). Telomerase activity was determined using rabbit immunoglobulin (TRT, Abbiotec). The amplification of the TERC (Telomerase RNA Component) portion of the RNA of the third chromosome was studied by the FISH method. In the studied groups, high cell proliferation and significant differences between HC and VC were revealed. The amplification of TERC by the FISH method made it possible to carry out differential diagnostics between VG and VC. According to the results of the study, the amplification of the TERC gene was detected in 100% in VC and in 20% in VG. The FISH method makes it possible to detect VL malignancy at an early stage. Amplification of the TERC gene is characteristic of malignant transformation of epithelial cells in VC. In IG, as a rule, there was no amplification, which can serve as evidence of the benign nature of the pathology of COP.

Characteristics of the dual nature of the p27 protein in oral leukoplakias and cancer

Abstract Dysregulation of the cell cycle is an important factor in a potentially malignant oral disorder. There have not been many studies on the role of the cell cycle regulator p27 in oral non-homogenous leukoplakia. The aim of our study was to characterise the p27 protein in homogenous and non-homogenous oral leukoplakias (OL), in comparison with healthy mucosa and squamous cell carcinoma tissues. The current study included 25 patients with OL, 15 cases with oral squamous cell carcinoma, and 15 samples of healthy oral mucosa, both as comparison groups. Immunohistochemical p27 antigen expression was determined by a standard EnView imaging system. The expression level of p27 in nodular and verrucous leukoplakia was lower than in homogenous OL but higher than in erythroleukoplakia. There was a statistically significant difference (p < 0.05) between the expression of p27 in healthy mucosa and homogenous OL. There was a significantly lower amount of p27 positive cells in oral cancer than in OL (p < 0.0001); however, its intracytoplasmic presence was diagnosed. Our study proved the instability of p27 protein and its dual nature in non-homogenous OL and OSCC, and therefore, it can be used as a predictive marker for the clinical course of these conditions.

VERRUCOUS CARCINOMA IN DORSAL REGION OF THE TONGUE: CASE REPORT

Verrucous carcinoma (VC) is a clinical-histopathologic variant of squamous cell carcinoma. The objective of this work is to report a clinical case of a 39-year-old brown-skinned male patient with an injury 10 years ago who sought the stomatology service complaining of "white spot on the tongue." During the anamnesis, the patient reported being a smoker for 20 years. On intraoral examination, a white plaque was noted on the dorsal region of the tongue, with a white color, sharp edges, firm consistency, and warty surface, measuring 3.0 × 2.0 cm. The clinical hypothesis was verrucous leukoplakia. An incisional biopsy was performed, and histopathologic sections revealed areas of epithelial neoplasia with keratin formation that invaded the lamina propria with minimally invasive VC compatibility. The patient was referred to the oncologist. This case reinforces the importance of the stomatologist in the elucidation of cases with potential for malignancy and in the direction of treatment.

Клинический случай трансформации плоской лейкоплакии в веррукозную после перенесенной новой коронавирусной инфекции (COVID-19)

The authors describe a clinical case of the transformation of flat leukoplakia into verrucous form in a patient after a new coronavirus infection. The results of clinical and histological examination are presented. The ineffectiveness of conservative treatment suggests the need for surgical treatment. Strict observation and monitoring of patients with verrucous leukoplakia should be mandatory even after surgical treatment, since they have a high recurrence rate and malignant transformation.

The use of photodynamic therapy in patients with severe forms of leukoplakia

The aim the study is to increase the effectiveness of the treatment of severe forms of leukoplakia with the use of photodynamic therapy. 120 patients with severe forms of leukoplakia were examined. 30 patients were diagnosed with Cr and carcinoma in situ, and therefore they were excluded from the study. In 90 patients, the diagnosis was confirmed by histological and IHC studies. Before the use of photodynamic therapy, the degree of saturation of pathological foci with a photosensitizer was determined by the method of fluorescent diagnostics using the LED device «RFS-400». As a result of treatment with photodynamic therapy using a 2nd generation photosensitizer («Photoditazine» 0.5% gel penetrator), a significant improvement in the epithelization of lesion elements was observed: in 92% of patients with verrucous leukoplakia and in 83% of patients with erosive leukoplakia. The use of photodynamic therapy for the treatment of patients with complicated forms of leukoplakia is an effective method of treatment for this pathology.

Oral leukoplakia in the Sudan: clinicopathological features and risk factors

To analyse the clinical and histopathological features of oral leukoplakia (OL) in the Sudan, and to identify the risk factors associated with dysplastic and malignant changes. Records of 117 cases with the diagnosis of OL at the Department of Oral Pathology in the period from 2010 to 2017 were reviewed. Of the 117 cases included in this study, 30 cases (25.6%) showed carcinoma in the initial diagnostic biopsy. The mean age at diagnosis was 59.8years with a male/female ratio of 3.3:1. The lip (48.7%) and the gingiva (31.6%) were the predominantly affected sites. Multivariate regression analysis revealed that females were associated with 3.36-fold [95% confidence interval (CI), 1.36-10.76; P=0.012] higher risk of malignant transformation compared with males. Verrucous leukoplakia was associated with 3.38-fold (95% CI, 1.12-10.19; P=0.031) higher risk of malignant transformation compared with homogeneous leukoplakia. Exclusive Toombak dipping was the significant risk factor for the presence of dysplasia in OL (odds ratio, 9.35; 95% CI, 1.28-67.99; P=0.027). Clinical and histopathological features of OL were analysed and correlated. Toombak dipping was the significant risk factor for dysplastic changes, while female gender and verrucous leukoplakia were the factors associated with malignant transformation.

A report on the clinical-pathological correlations of 788 gingival lesion.

BackgroundThe diagnosis and treatment of a variety of non-plaque related gingival diseases have become an integrated aspect of everyday dentistry. The aim of this study was to analyse the relationship between clinical appearance and histopathological features of gingival lesions in a large Northern Italian population.Material and MethodsA retrospective study of 788 cases of gingival and alveolar mucosal biopsies was set up. Statistical analysis was performed by calculating the odds ratio and 95% confidence interval (C.I.), in order to assess the degree of association between the clinical parameters considered (primary lesions) and the single pathologies, statistically evaluated by Mantel-Haenszel tests. The correlation between clinical and histological diagnosis was classified as follow: 1) expected data (ED): provisional clinical diagnosis; 2) real data (RD): final histopathology diagnosis; 3) concordant data (CD): correspondence between the expected data and real data. The correlation was calculated as follow: CC (complete concordance) = CD x 100 / ED, this expressing the percentage in which the clinical and the histological diagnosis overlapped.ResultsThe most frequently observed and biopsied primary lesions resulted to be exophytic, followed by mucosal colour changes and finally by losses of substance. The statistically significant association between primary lesion and their manifestation in gingival pathologies was reported. Volume increases, for instance, were positively correlated to plasma cell epulis, pyogenic granuloma, fibrous reactive hyperplasia and hemangioma. Verrucous-papillary lesions were most often seen in verrucous carcinoma, verrucous leukoplakia and mild dysplasia. White lesion resulted to be related to leukoplakia or oral lichen planus. Red lesions resulted to be related only oral lichen planus. Erosive vesicle-bullous lesions were linked to disimmune pathologies. Ulcerative lesions were positively associated to oral squamous cell cancer. Finally, potentially malignant disorders have the most percentage high concordance. Among the malignant lesions, the correlation increased up to the squamous cell carcinoma and leukaemia.ConclusionsThis article presented the frequency and the clinico-pathological concordance of all primary lesions and the histopathological diagnosis of gingival lesions. For every primary lesion, it is possible to correlate a specific histopathological diagnosis in a statistical manner. This can be a valuable aid for not specialist clinicians who daily observe mucosae and have the opportunity to intercept major diseases. Key words:Gingival lesions; clinical appearance; histological analysis; clinico-pathological correlation.

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.

The Relationship Between Periodontal Disease and Neoplasms of the Oral Cavity: A Review Article

Context: Oral cavity is one of the most common sites for neoplasms with a multifactorial etiology. Tobacco and alcohol are the main risk factors. Periodontal disease is an inflammatory disease affecting periodontal tissues such as gingiva, periodontal ligament and alveolar bone. Periodontal disease is linked to many systemic diseases. Recently a link between periodontal disease and cancer is suggested. The current review article aimed to evaluate the association between periodontal disease and risk of cancer in the oral cavity and some related factors. Evidence Acquisition: Evidence suggests that oral cavity cancer is significantly more prevalent in patients with periodontal disease, poor oral hygiene or more missing teeth. Clinically, gingival squamous cell carcinoma (GSCC) usually appears as an exophytic mass with a granular, papillary or verrucous surface or presents as an ulcerative lesion. Some reported cases of GSCC mimicking periodontal disease include gingival enlargement with no bone invasion, dentoalveolar abscess, erosive erythematosus lesion with keratotic papules, root exposure and tooth mobility, verrucous leukoplakia, verruciform xanthoma and development of hyperplastic granulation tissue after tooth extraction. Greater burden of oral flora that produce carcinogenic metabolites, human papilloma virus (HPV) and other viruses that are residents of periodontal pocket, increased amount of inflammatory mediators and markers and some periodontal pathogens affecting cell cycle leading to mutation and dysplasia are considered as the rational for the relationship between malignant lesions of oral cavity and periodontal disease. Results: Cancer of the oral cavity and periodontal disease are related from different aspects. Periodontal disease and tooth loss are considered as independent risk factors for cancer. Gingival squamous cell carcinoma can also mimic periodontal disease leading to misdiagnosis and delayed commencement of appropriate treatment. Conclusions: Based on evidence, dentists and dental health care professionals should consider periodontal disease as a risk factor for the development of neoplasms in the oral cavity. It also seems a good idea to provide periodontal therapy for patients with cancer to achieve ideal therapeutic results.

Oral leukoplakia - is biopsy at the initial appointment a must?

Oral leukoplakia is a potentially malignant disorder of the oral cavity. Leukoplakias with chances of undergoing malignant transformation owing to the presence of dysplastic changes may not be clinically distinguishable from leukoplakias without dysplasia. The study was carried out to evaluate the usefulness of biopsy in assessing the clinico-pathologic correlations of oral leukoplakia at the patient's initial visit. Hospital records with clinical diagnosis of oral leukoplakia were retrospectively analysed. All these patients had undergone biopsy in their initial visit. Histopathological slides were reviewed and reported by a single pathologist. Diagnosis agreement was considered to be present if the clinical diagnosis matched the histopathological diagnosis. Misdiagnosis was considered if the clinical diagnosis did not match the histopathological diagnosis and underdiagnosis when malignancy was detected on histopathological examination. A total of 115 patients were clinically diagnosed with oral leukoplakia. According to clinical appearance of the leukoplakia patch was categorized in to three types viz homogeneous leukoplakia (n= 24 i.e. 20.87%), speckled leukoplakia (n=76 i.e. 66.08%) and verrucous leukoplakia (n=15 i.e. 13.04%). Histopathological examination confirmed clinical diagnosis in 88 cases (a diagnosis agreement of 76.52%). Histopathological examination of 19 cases revealed a different diagnosis, thus categorized as misdiagnosis (16.52%) and 8 cases had unexpected malignancy which accounted for underdiagnosis in 6.96% cases. There was dysplasia in 45 (51.13%) of the histopathologically confirmed cases of leukoplakia. The clinical appearance of suspicious white lesions does not provide a true nature of its disease status and malignant changes may be missed.

Malignant transformation of oral verrucous leukoplakia: a clinicopathologic study of 53 cases

Oral verrucous leukoplakia (VL) is one of the non-homogenous oral leukoplakias. The objective of this study was to investigate the clinicopathologic features of VL and identify the clinicopathologic risk factors that might be associated with VL malignant transformation from China. Among 1541 patients with oral leukoplakia, a total of 53 patients with clinical and histopathologic diagnosis of VL between 1996 and 2009 were reviewed retrospectively in our hospital. Of the 53 patients, 11 (20.8%) with VL were observed to develop cancer in the study period. The average age at diagnosis was 59.8 years with a male/female ratio of 1.7:1. Tongue was the predominant site (41.5%). Multivariate regression analysis revealed that the elderly patients (>65 years old) were associated with 8.36-fold [95% confidence interval (95% CI), 1.45-48.09; P = 0.017] increased risk of malignant transformation compared with the non-elderly patients. The lesion located on gingiva was associated with 20.81-fold (95% CI, 1.94-222.80; P = 0.012) increased risk of malignant transformation compared with tongue. However, the gender, smoking, alcohol intake, and epithelial dysplasia were not risk factors. Clinicopathologic features of VL in China were elucidated. The utilization of age and lesion site at diagnosis as significant factors for evaluating malignant transformation risk in patients with VL was suggested. Further studies are required to investigate the roles of the potential risk factors in the VL malignant transformation.

Analysis of risk factors for carcinogenesis of oral leukoplakia

To investigate the risk factors for malignant transformation of oral leukoplakia. A total of 409 cases with oral leukoplakia was retrospectively analyzed. Single factor test was first performed to examine the associations between oral leukoplakia's histopathological classification and each of risk factors including sex, age, systemic diseases, course of disease, clinical classification, site, size, numbers of lesion, alcohol and tobacco consumption, and symptom. Then the association of these selected factors with oral leukoplakia's histopathological classification was evaluated using multiple logistic regression analysis. Fifty-two cases of all 409 patients with oral leukoplakia (including 9 severe dysplasia) developed oral cancer. The ratio of malignant transformation was 12.7%. Sex, age, clinical type, site and symptom were chosen as risk factors incorporated into the multiple logistic regression models. The risk of mild-moderate dysplasia in female was 2.40 times as high as that in male. The risk of mild-moderate dysplasia of speckled leukoplakia was 2.81 times as high as that of homogeneous leukoplakia. The risk of mild-moderate dysplasia of dangerous site was 1. 98 times as high as that non-dangerous site. The risk of mild-moderate dysplasia with symptom was 1.84 times as high as that without symptom. The risk of severe dysplasia and oral cancer in female was 3.11 times as high as that in male. The risk of severe dysplasia and oral cancer of speckled (4.50 times), ulcerative (5.63 times), verrucous leukoplakia (4.09 times) were much higher than that of homogeneous leukoplakia. The risk of severe dysplasia and oral cancer in dangerous site was 2.79 times as high as in non-dangerous site. The risk of severe dysplasia and oral cancer in leukoplakia with symptom was 4.38 times as high as without symptom. The malignant transformation of oral leukoplakia is correlated to sex, clinical type, site and symptom.

Relationship Between Epithelial Dysplasia and the Development of Squamous Cell Carcinoma in Oral Leukoplakia

Objective: This study estimated the relationship between epithelial dysplasia and the development of squamous cell carcinoma in patients with oral leukoplakia.Patients and Methods: 199 consecutive patients (251 lesions) were followed up for more than 1 year between 1980 and 2000, with a mean follow up period of 6.3 years,Results: The occurrences of epithelial dysplasia and severe dysplasia were higher among patients with ulcerated or verrucous leukoplakias than among those with homogeneous or nodular leukoplakias (p < 0.05). The malignant transformation rate was 3.5% (7/199 patients). The mean transformation period was 3.1 years, ranging from 7 months to 13 years. There was an obvious relationship between the malignant transformation and the clinical types, especially with verrucous and ulcerated leukoplakia (p < 0.05). In addition, the malignant transformation rate was higher among patients with severe dysplasias than among those with mild or moderate dysplasias (p < 0.05).Conclusion: These results show the importance of long-term follow-up, even for patients with clinically and histopathologically innocuous leukoplakia and suggest that patients with verrucous or ulcerated leukoplakia with severe dysplasia are the most likely to develop squamous cell carcinoma from oral leukoplakia.

Scanning electron microscopy of different types of oral leukoplakia: Comparison with normal and malignant oral mucosa

The present study analysed surface architecture of normal, premalignant and malignant oral mucosa using scanning electron microscopy to evaluate its role in early diagnosis of potentially malignant oral lesions. The surface ultrastructure of the buccal mucosa in tobacco chewers showed variations from that of non-chewers. Homogenous leukoplakia demonstrated well-defined intercellular junctions and the microrugal surface pattern as seen in normal mucosa. In verrucous leukoplakia, the surface layer consisted of characteristically-shrunken desquamated hyperkeratotic cells. Erosive leukoplakia had a discontinuous superficial layer along with complete loss of intercellular ridges. Speckled leukoplakia also showed marked abnormalities such as thickened irregular protrusions and evidence of a villus-like pattern. These villus-like structures were comparatively prominent in leukoplakia showing dysplasia. Oral carcinoma showed marked altered surface ultrastructure and had a pattern similar to dysplastic lesions. The irregular swollen elongated protrusions with villous-like structures that were observed in carcinoma and dysplastic lesions can, therefore, be considered as surface markers for potentially malignant leukoplakia.

Surgical treatment of premalignant lesions of the oral mucosa

Oral premalignant lesions were treated by surgical excision in 61 patients. Criteria for inclusion in the study were epithelial dysplasia varying from slight to carcinoma in situ, or a non-dysplastic lesion located sublingually or on the tongue. The clinical diagnosis of the treated lesions were: erythroplakia 10, erythroleukoplakia 15, nodular leukoplakia 9, verrucous leukoplakia 9, homogeneous leukoplakia 13, and lichen planus 5. The surgically created defects were closed by direct approximation of the wound edges in 25 patients, transposition by a local mucosal flap in 9, covered with a free mucosal graft in 3, and by a free split skin transplant in 24 patients. The patients have been followed for an average period of 3.9 years after the operation. A recurrence rate of 20% was found, and 3 carcinomas developed in the follow-up period. The importance of using a surgical technique permitting histological examination of the entire lesion was documented by the finding of 4 superficial carcinomas in the excision specimen, undiagnosed in the preoperative biopsy.