Proliferative verrucous leukoplakia: a clinicopathological comparative study.

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.