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Proliferative verrucous leukoplakia: a clinicopathological comparative study.

U Alkan1, G Bachar1, Y Nachalon2

  • 1Department of Otorhinolaryngology, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

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|January 23, 2022
PubMed
Summary

Proliferative verrucous leukoplakia (PVL) shows aggressive behavior and a high rate of malignant transformation into oral cancer. Early recognition and long-term monitoring are crucial for managing this challenging oral lesion.

Keywords:
hyperplasialeukoplakialichen planussquamous carcinomaverrucous carcinoma

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Area of Science:

  • Oral pathology
  • Oncology
  • Dermatopathology

Background:

  • Proliferative verrucous leukoplakia (PVL) is a rare oral lesion with a high malignant potential.
  • Distinguishing PVL from other oral lesions like leukoplakia (LK), oral lichen planus (OLP)/oral lichenoid lesions (OLL), and verrucous carcinoma (VC) can be challenging due to overlapping features.

Purpose of the Study:

  • To compare the clinicopathological features and malignant transformation rates of PVL with LK, OLP/OLL, and VC.
  • To highlight the aggressive behavior and diagnostic challenges associated with PVL.

Main Methods:

  • Retrospective clinicopathological analysis of 134 oral lesions: 35 PVL, 40 LK, 48 OLP/OLL, and 11 VC.
  • Analysis included patient demographics, lesion characteristics, biopsy history, and outcomes.
  • Immunohistochemical analysis for p53, COX-2, and podoplanin was performed.

Main Results:

  • All PVL cases (N=35) developed malignancy, predominantly squamous cell carcinoma (77.1%) and verrucous carcinoma (40%).
  • Malignant transformation rates were significantly lower in LK (2.5%) and OLP/OLL (2.1%) compared to PVL.
  • No significant differences in p53, COX-2, or podoplanin expression were found between the groups.

Conclusions:

  • PVL exhibits persistent aggressive behavior and a high rate of malignant transformation, necessitating careful distinction from other oral lesions.
  • Overlapping clinical and pathological features can delay PVL recognition, emphasizing the need for precise definitions and vigilant monitoring.
  • Effective management of PVL is challenging due to its aggressive nature and high recurrence rate.