Malignant transformation of proliferative verrucous leukoplakia to. Two specific forms of squamous cancers may arise from pvl lesions. Proliferative verrucous leukoplakia and its related. It is as well to warn the clinician, therefore, that a patient developing a verrucous lesion, or indeed flatter dysplasia at more than one oral site, may possibly be at some point in the natural history of proliferative verrucous leukoplakia, and that close and prolonged followup is essential. Proliferative multifocal leukoplakia better name that. Oral leukoplakia is an oral potentially malignant disorder opmd that presents as white patches of the oral mucosa. Underdiagnosed oral precursor lesion that requires retrospective clinicopathological correlation ozgur mete 1, yaren keskin 2, gunter hafiz 3, kivanc bektas kayhan 2, meral unur 2 dermatology online journal 16 5. The aim of this study is to evaluate a cohort of pvl in a single tertiary referral clinic. A particularly aggressive form of oral leukoplakia that commences with a hyperkeratosis, spreads to become multifocal and verruciform in appearance, and later becomes malignant has been termed proliferative verrucous leukoplakia. Proliferative verrucous leukoplakia pvl is a recognized high risk subtype of nonhomogenous leukoplakia. Proliferative verrucous leukoplakia of the gingiva pvlg appears to be a subset of oral proliferative verrucous leukoplakia. Development of proliferative verrucous leukoplakia starts as a simple hyperkeratosis without epithelial dysplasia, verrucous carcinoma and then carcinoma.
The development of proliferative verrucous leukoplakia in. Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus. Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which was first described in 1985 by hansen et al. Proliferative verrucous leukoplakiapvl is rare high risk form of leukoplakia first described by hansen and. Therefore, pvl presents a high malignant transformation rate table 1. Proliferative verrucous leukoplakia pvl is a particularly aggressive form of oral leukoplakia which is characterized by multifocal and recurrent lesions which are typically exophytic with a verruciform or papillary surface pattern hansen et al. A case report with an update rakhi issrani 1, namdeo prabhu 2, vaishali keluskar 3 1 department of oral medicine and radiology, saraswati dental college, lucknow, uttar pradesh, india 2 department of oral and maxillofacial surgery, k. It should not be issued as a pathological diagnosis. Histopathology may help to distinct the stage of the disease as described before. Because there is evidence that these carcinomas evolve from leukoplakias that also exhibit a verrucoid architecture,17 they are termed proliferative verrucous leukoplakia pvl.
Proliferative verrucous leukoplakia is a rare and distinct variant of oral leukoplakia. It is characterized by a high rate of oral squamous cell carcinoma and. This article looks at leukoplakia of the head and neck hairy leukoplakia is dealt with separately. Since then, various published case series have presented pvl as a. K institute of dental sciences, belgaum, karnataka, india 3 department of oral medicine and radiology, k.
Since then, various published case series have presented pvl as a disease with aggressive biological behavior due to its high probability of recurrence and a high rate of malignant transformation, usually higher than 70%. As mentioned above, most pvl cases processed to malignancy over many years, sometimes 20 years. Oral lichen planus, proliferative verrucous oral leukoplakia, malignant oral lichen planus, multifocal verrucous oral lichen planus, proliferative verrucous oral lichen planus. Proliferative verrucous leukoplakia pvl is a rare oral leukoplakia and has four features such as chronic proliferation, multiple occurrences, refractoriness to treatment and high rate of malignant transformation. It involves multiple mucosal areas with confuent, exophytic and proliferative features. Most commonly resistant to all forms of therapy as. Schmalbach md, facs1 1department of otolaryngology head and neck surgery, wilford hall medical center, lackland afb, texas.
It can be characterized as a solitary, recurring, progressive white patch that develops a verruciform architecture and may not be associated with hpv. Proliferative verrucous leukoplakia pvl is an uncommon form of progressive multifocal leukoplakia with a high rate of malignant transformation to either squamous cell cancer or verrucous carcinoma and a high probability of recurrence. It is proliferative verrucous leukoplakia of the gingiva. Proliferative verrucous leukoplakia genetic and rare.
Among them oral leukoplakia ol is quite prevalent 0. Histopathology revealed moderately differentiated squamous cell carcinoma scc. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which was first. Papillary and verrucous lesions of the oral mucosa. Patients with this condition represent a unique clinically and pathologically progressive characteristic from conventional leukoplakia. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. Histopathologically, erythroplakia most commonly shows at least some degree of dysplasia and often even carcinoma in situ or invasive carcinoma. Verrucous histopathologic patterns characterize a subset of oral epithelial tumors. The previously reported pvl are mostly elderly patients with a longer progress. This condition is characterized by usually extensive, papillary or verrucoid keratotic plaques that tends to slowly enlarge into adjacent mucosal sites. N2 proliferative verrucous leukoplakia pvl is a particularly aggressive form of oral leukoplakia that is resistant to treatment and presents a high risk of recurrence and malignant transformation. Leukoplakia is a relatively common clinical finding in clinical medicine. There are not enough studies about proliferative verrucous leukoplakia in the. If lymph nodes are palpable, they usually present as an inflammatory reaction in large secondarily infected lesions.
Shopper, dds, med, is an associate pr ofessor in the department of or al diagnosis, oral medicine, and radiology. Proliferative verrucous leukoplakia is multifocal and progressive lesion with a high rate of malignant transformation. However, this report described a case of rapid progress, which had malignant. Ten patients with persistent multifocal verruciform white patches were investigated. Vc is a locally invading tumor and does not spread to the local lymph nodes. We present herein a case of pvl which was misdiagnosed as oral leukoplakia and progressed to oral carcinoma. Proliferative verrucous leukoplakia pvl is a rare form of oral. Histopathology, biology and markers the oral cancer. The lesion was excised figure 6 and sent for histopathological examination. It mainly involves the lining inside of the cheeks buccal mucosa and tongue. Carcinoma, proliferative verrucous leukoplakia and ebv epsteinbarr virus in oral proliferative verrucous leukoplakia and squamous cell carcinoma. According to the world health organization, the term leukoplakia should be reserved for white plaques of questionable risk, having excluded other known diseases or disorders that carry no increased risk for cancer.
Current evidence in diagnosis and treatment of proliferative. The diagnosis can only be achieved through the keen clinical observation of the temporal progression in individual patients to verrucous andor conventional squamous carcinoma. An unusual case report of an early proliferative verrucous. This is largely due to the overlapping clinical and pathologic early features with conventional multifocal leukoplakia with dysplasia. Soames and southam reported mutations of p53 in the cells from dysplastic areas of some leukoplakias who smoke and drink heavily. Proliferative verrucous leukoplakia pvl is defined as an aggressive, relentless and recalcitrant form of leukoplakia that has a high propensity for malignant transformation. Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. Each has been shown to have a considerable propensity to progress to carcinomaeither verrucous or conventional squamous cell carcinoma of. The diagnosis of this entity is predicated on a temporal constellation of clinical features and histopathologic findings. Proliferative verrucous leukoplakia pvl is a progressive, multifocal, exophytic form of leukoplakia with high rates of malignant transformation. Carcinoma, proliferative verrucous leukoplakia and ebv med oral patol oral cir bucal.
Proliferative verrucous leukoplakia of the gingiva listed as pvlg. Proliferative verrucous leukoplakia misdiagnosed as oral. To analyze the studies about proliferative verrucous leukoplakia and develop a concise update. Proliferative verrucous leukoplakia med oral patol oral cir bucal. Proliferative verrucous leukoplakia pvl is a very rare kind of leukoplakia with great risk of cancerization. Proliferative verrucous leukoplakia appears as a single or multifocal growth involving several oral sites. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia. Most commonly buccal mucosa affected in women and tongue in men. The aim of this study was to evaluate the malignant potential of pvl and determine its possible association with highrisk human papillomavirus hpv. An aggressive form of oral leukoplakia thomas p shopper, robert b brannon and william h stalker thomas p. Proliferative verrucous leukoplakia pvl is a rare type of oral leukoplakia, where white patches that have a high risk of becoming cancerous develop inside the mouth.
Proliferative verrucous leukoplakia misdiagnosed as oral leukoplakia. This article describes the clinical features and follow. Pdf white lesions both physiologic as well as pathologic are relatively frequent in the oral cavity, the most common pathology being oral. Diagnosis is usually made retrospectively on the basis of clinical and pathological features which. Proliferative verrucous leukoplakia pvl is a distinct form of oral leukoplakia characterized by a high recurrence rate and high rate of transformation into oral squamous cell carcinoma.
Proliferative verrucous oral leukoplakia is a subtype of verrucous leukoplakia according to some authors3,6. Histopathological findings may show acanthosis and hyperkeratosis with. Scitech verrucous leukoplakia a diagnostic dilemma. It is uncommon, and usually involves the buccal mucosa and the gingiva the gums. Pdf proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which. Proliferative verrucous leukoplakia pvl and verrucous hyperplasia vh are two interrelated oral mucosal lesions. Proliferative verrucous leukoplakia is multifocal and progressive lesion with a. After this study, these lesions were named oral proliferative verrucous leukoplakia opvl. Proliferative verrucous leukoplakia of the gingiva how. Verrucous hyperplasia proliferative verrucous leukoplakia. Because of the lack of defined pathologic lesions, identifying patients with the early diagnosis of pvl is challenging.
Oral leukoplakia and proliferative verrucous leukoplakia. Case report of rapidly progressive proliferative verrucous. Proliferative verrucous leukoplakia pvl is a rare, unique type of oral leukoplakia, which is enigmatic in etiology and behaves in a far more aggressive fashion than other forms of leukoplakia. The clinical and histopathological characteristics of 14 cases of olp that progress towards a plaquelike and verrucous form were indicated, with monitoring over a period of six to 24. Proliferative verrucous leukoplakia pvl is a rare oral mucosa disorder, frequently involving periodontal sites, with a high rate of progression to oral squamous cell carcinoma scc and verrucous carcinoma vc.
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