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Verrucous lichen planus in hard palate and left upper buccal sulcus in the same patient after eigth years from initial diagnosis.
Source publication
Background:
Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus.
Material and methods:
The clinical and histopathological characteristics of 14 cases of OLP that progress towards a plaque-like and verrucous form were indicated, with monitoring over a period of six to 24.3 years.
Result...
Context in source publication
Context 1
... each patient are detailed in table 1. The patients did not show adverse haematological reactions. During the follow-up of patients, nine of them acquired clinical forms different from the initial (Fig. 2). Since the time of diagnosis, the mean time for developing plaque-like and multifocal verrucous lesions as the pre- dominant lesion was 4 years (Fig. 3). Hyperkeratosis (parakeratin and or orthokeratin) was present in part of all specimens, acanthosis and papi- llomatous squamous proliferation partly in ten cases, and verrucous hyperplasia in nine cases. Four patients (28.5%) went on to become malignant, three cases of squamous cell carcinoma (SCC) were well-differentia- ted, and one ...
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Citations
... The field of "lichenoid proliferative verrucous leukoplakia" has gained much attention recently following reports describing lichenoid biology progressing into a proliferative state (154,(157)(158)(159). OLP white striations might progress and display verrucous plaque with or without dysplasia, and likewise proliferative verrucous leukoplakia might have episodes with biopsy verified OLP inflammation (154,159). ...
Chronic Graft-versus-Host Disease (cGVHD) is a major long-term complication, associated with morbidity and mortality in patients following allogenic hematopoietic cell transplantation (HCT) for immune hematopoietic disorders. The mouth is one of the most frequently affected organs after HCT (45-83%) and oral cGVHD, which may appear as the first visible sign. Manifestations present with mucosal lichenoid lesions, salivary gland dysfunction and limited oral aperture. Diagnosis of oral cGVHD severity is based on mucosal lesions with symptoms of sensitivity and pain and reduced oral intake. However, diagnostic difficulties arise due to subjective definitions and low specificity to cover the spectrum of oral cGVHD. In recent years there have been significant improvements in our understanding of the underlying oral cGVHD disease mechanisms. Drawing upon the current knowledge on the pathophysiology and biological phases of oral cGVHD, we address oral mucosa lichenoid and Sjogren’s Syndrome-like sicca syndromes. We consider the response of alloreactive T-cells and macrophages to recipient tissues to drive the pathophysiological reactions and biological phases of acute inflammation (phase 1), chronic inflammation and dysregulated immunity (phase 2), and subsequent aberrant fibrotic healing (phase 3), which in time may be associated with an increased malignant transformation rate. When formulating treatment strategies, the pathophysiological spectrum of cGVHD is patient dependent and not every patient may progress chronologically through the biological stages. As such there remains a need to address and clarify personalized diagnostics and management to improve treatment descriptions. Within this review, we highlight the current state of the art knowledge on oral cGVHD pathophysiology and biological phases. We address knowledge gaps of oral cGVHD, with a view to facilitate clinical management and improve research quality on lichenoid biology and morbid forms of oral cGVHD.
... El médico reemplazó el medicamento antihipertensivo y no hubo cambios en sus lesiones, por lo que se descartó el diagnóstico de RL (21). Luego de 4 años del seguimiento, hubo un cambio en el escenario clínico y se formuló la hipótesis de LVP, ya que presenta una epidemiología similar a la descrita para LPO (15,16 (11,26,35). La transformación maligna del LPO es un tema ampliamente debatido y se presenta en el 1,4% de los casos (9). ...
... Nuestra paciente ha estado en seguimiento durante 48 meses sin signos de transformación maligna. En nuestra revisión de la literatura, el tiempo de transición de LPO a LVP fue similar a los hallazgos de García-Pola et al.(26), quienes informaron que 4 años era el tiempo promedio para el desarrollo de lesiones verrugosas multifocales. En algunos casos, también se observó una transformación maligna durante el período de seguimiento ...
This report presents the clinical, microscopic and immunohistochemical aspects of a case of proliferative verrucous leukoplakia (PVL) mimicking oral lichen planus (OLP) in a 66-year-old woman. We also review the literature reporting cases of PVL mimicking OLP, where we found a higher prevalence in women who do not consume tobacco or alcohol. The initial manifestation of lichenoid areas was around the age of 59, with the diagnosis of PVL being established on average 6 years later, while malignant transformation occurred in 8 of the 22 cases at an average of 3.7 years after the final diagnosis of PVL. We emphasize the need for a close follow-up of any patient presenting white lesions of the oral mucosa. Lesions that are clinically and microscopically compatible with lichenoid reactions or OLP must be investigated and differentiated from PVL, which has a worse prognosis.
... not by atrophic, erosive, and/or plaque-type areas. Bearing in mind this last subtype (i.e., OLP or OLLs showing plaque-type areas), some authors have described the development of multiple widespread leukoplakias in patients previously diagnosed simply as pathologies inside the lichenoid spectrum.32 Chainani et al.33 described the same progression to OL in a cohort of patients initially diagnosed as OLP.Prompted by discussed literature, Gilligan et al.25 hypothesized that a subset of PVL cases could be presented as the evolution of OLP or OLLs but also could be a continuum of the same precancerous condition in the context of field cancerization. ...
Background:
Proliferative verrucous leukoplakia (PVL) is considered an uncommon oral potentially malignant disorder with a high malignant transformation (MT) rate. The objective of this paper was to define its cancer incidence and related risk factors.
Methods:
A retrospective audit of 34 patients diagnosed with PVL from a university-based unit, during the period from 1995 to 2019 was performed. The mean number of visits was 23 ± 18.6. The follow-up was divided into 4-time intervals to evaluate the clinical presentation, number of lesions, dysplasia grade and MT rate.
Results:
The majority of patients were females 29 (85.3%), with verrucous component (77.8%), with a gingival presentation (31.8 %) and with a preceding lichenoid area (44.1 %). 11 patients (32.4%) were affected by oral cancer during the follow-up, developing a total of 15 carcinomas. The mean age of MT was 67.2 ± 12.9 years, particularly 8 ± 8.5 from the onset of the lesions. Warty forms presented a higher mean estimate for MT (15.2 years, 95% CI 4.4-26 years) than nodular forms (1.9 years, 95% CI 1.9-1.9) (p = 0.019). Patients with an initial PVL diagnosis suffered a higher risk of malignancy, particularly 15.55 times (95% CI 1.69-143.17; p = 0.015) than those who did present a preceding area with lichenoid morphology.
Conclusion:
PVL presented a high MT rate and sometimes displayed preceding oral lichenoid areas in early stages. Further studies are needed to understand the impact of these lichenoid areas in PVL progression.
... United States of America (Fettig et al., 2000;Hansen et al., 1985, Morton et al., 2007Shopper et al., 2004;Silverman & Gorsky, 1997;Upadhyaya et al., 2018;Vigliante et al., 2003;Villa et al., 2018), United Kingdom (Zakrzewska et al., 1996), Malaysia (Ghazali et al., 2003), Spain (Bagan et al., 2004(Bagan et al., , 2011García-Delaney et al., 2016;Garcia-Pola et al., 2016), Brazil (Gouvêa et al., 2010;Milani et al., 2019;Navarro et al., 2004), India (Badam et al., 2013), Israel (Akrish et al., 2015(Akrish et al., , 2017 and Italy (Favia et al., 2021). ...
... Eleven publications (52.38%) were categorized as moderate risk of bias (Akrish et al., 2017;Badam et al., 2013;Bagan et al., 2004Bagan et al., , 2011Favia et al., 2021;Fettig et al., 2000;Garcia-Pola et al., 2016;Navarro et al., 2004;Shopper et al., 2004;Silverman & Gorsky, 1997;Zakrzewska et al., 1996). Seven articles were graded as low risk of bias (33.33%) (Akrish et al., 2015;García-Delaney et al., 2016;Ghazali et al., 2003;Gouvêa et al., 2010;Hansen et al., 1985;Milani et al., 2019;Vigliante et al., 2003), and three papers (14.28%) were characterized as high risk of bias (Morton et al., 2007;Upadhyaya et al., 2018;Villa et al., 2018). ...
Objective:
This study aimed to evaluate prognostic outcomes of PVL-derived oral squamous cell carcinomas (P-OSCC) based on recurrence, new primary tumour, metastasis and survival information.
Study design:
Five databases and grey literature were searched electronically with the following main keywords (proliferative verrucous leukoplakia, squamous cell carcinoma and malignant transformation) to answer the following review question: 'Are survival outcomes for P-OSCC worse?' based on the PECOS principle. The Joanna Briggs Institute Critical Appraisal tool was used to identify possible biases and assess the quality of each of the primary studies.
Results:
A total of 21 articles met the inclusion criteria, and the results of this systematic review suggest that P-OSCC can recur and generate new primary tumours; however, metastases are rare. Thus, most patients remain alive for an average period of 5 years.
Conclusion:
Apparently, P-OSCC has better clinical prognostic characteristics than conventional OSCC. There is a lack of information on the main prognostic outcomes of P-OSCC; therefore, specific studies must be performed to achieve a better comparison between P-OSCC and conventional OSCC progression.
... Then, their titles and abstracts were screened and 45 papers selected for full-text reading (22 of them did not meet our eligibility criteria and were excluded; their references and exclusion reasons are listed in the Supplementary Materials, pp.[32][33][34]. Finally, 23 studies were included in the systematic review's final sample-23 for qualitative evaluation and 21 for quantitative meta-analysis-[5][6][7]22,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. ...
Proliferative verrucous leukoplakia (PVL) is contemplated by the World Health Organization (WHO) as an oral potentially malignant disorder (OPMD) with a high the highest malignant transformation ratio among all OPMD (approximately 50%). Our aim was to evaluate the current evidence in relation to the prognosis of oral carcinoma developed in patients with proliferative verrucous leukoplakia (PVL-OC). We searched PubMed, Embase, Web of Science and Scopus for published studies (upper date limit = June 2021). We evaluated the quality of studies (QUIPS tool). We carried out meta-analyses, examined inter-study heterogeneity through subgroup and meta-regression analyses, and performed sensitivity and small-study effects analyses to test the stability and reliability of results. 23 studies met inclusion criteria (505 patients with PVL, of which 288 developed a total of 504 carcinomas). The meta-analyzed overall mortality rate was 21.29% (pooled proportions [PP] = 95% confidence intervals [CI] = 8.77–36.36) for PVL-OC, clearly lower than the 34.7–50% mortality rate for conventional oral cancer reported in previous studies. In comparison with a single study reporting on conventional oral cancers, mortality was significantly lower for PVL-OC (hazard ratio = 0.29 [95%CI = 0.10–0.89], p = 0.03). Univariable meta-regression verified that case series that presented higher proportions of verrucous carcinomas showed a better survival of PVL-OC (p = 0.05), but not with higher proportion of oral squamous cell carcinomas (p = 0.74). Significant differences were not found for other relevant variables such as follow up period (p = 0.44) or multiple tumor development (p = 0.74). In conclusion, PVL-OC show favorable prognostic parameters, especially with regard to the mortality rate.
... not by atrophic, erosive, and/or plaque-type areas. Bearing in mind this last subtype (i.e., OLP or OLLs showing plaque-type areas), some authors have described the development of multiple widespread leukoplakias in patients previously diagnosed simply as pathologies inside the lichenoid spectrum.32 Chainani et al.33 described the same progression to OL in a cohort of patients initially diagnosed as OLP.Prompted by discussed literature, Gilligan et al.25 hypothesized that a subset of PVL cases could be presented as the evolution of OLP or OLLs but also could be a continuum of the same precancerous condition in the context of field cancerization. ...
Background
Proliferative verrucous/multifocal leukoplakia (PVML) is an oral potentially malignant disorder (OPMD) that exhibits high rates of malignant development (MD). This study aimed to analyse the risk of MD of PVML, as well as to investigate the possible risk factors associated with its malignisation.
Methods
A bibliographical search of the Pubmed, Embase, Web of Science, and Scopus databases was conducted. PVML MD rates were calculated as a pooled proportion, and the risk factors were calculated as risk ratios, using fixed and random models based on the presence of heterogeneity.
Results
From a total of 417 records, 16 articles were retrieved for inclusion. The subgroup analysis revealed a higher MD rate in the studies that were conducted in America, and, likewise, said studies involved a longer follow-up time (>6 years). There was a non-significant lower risk of malignisation among males. A negative correlation was observed between MD and the year in which the studies were published.
Conclusions
The pooled MD of PVML was 65.8% (95% CI:55.3-76.2, p < 0.001). Prospective studies of PVML must be designed using simple and universal clinical diagnostic criteria to be able to make an early diagnosis of this important OPMD and acknowledge the frequency of MD.
... Flores et al. [17] 2016 2A B Garcìa-Pola et al. [18] 2016 2A C Borgna et al. [19] 2016 2A C Thomson et al. [20] 2018 2A B Upadhyaya et al. [21] 2018 2A C Villa et al. [5] 2018 2A C Bagan et al. [22] 2019 2A C Koh et al. [23] 2019 2A B Favia et al. [24] 2020 2A C Llorens et al. [25] 2020 2A B McParland and Warnakulasuriya [26] 2020 2A C ...
... Overall, the total number of patients with a diagnosis of PVL was 699. The mean age, reported in 19 studies, involving a total of 573 patients [2,5,[7][8][9][10][11][13][14][15][16][17][18][19][20][21][22][23]25], was 64.2 ± 10.5 years, while follow-up had a variable duration, from 3.3 to 16 years (mean value 7.2 ± 6.3 years) ( Table 3). The percentage of male and female subjects, reported in 20 articles [2,5,[7][8][9][10][11][13][14][15][16][17][18][19][20][21][22][23]25,26], was, respectively, 33.3% (208 out of 624) and 66.7% (416 out of 624), with a mean age of 59.6 years for men and 70.2 years for women [2,5,7,8,10,14,17,18,20,21,23,25,26] (Table 3). ...
... The mean age, reported in 19 studies, involving a total of 573 patients [2,5,[7][8][9][10][11][13][14][15][16][17][18][19][20][21][22][23]25], was 64.2 ± 10.5 years, while follow-up had a variable duration, from 3.3 to 16 years (mean value 7.2 ± 6.3 years) ( Table 3). The percentage of male and female subjects, reported in 20 articles [2,5,[7][8][9][10][11][13][14][15][16][17][18][19][20][21][22][23]25,26], was, respectively, 33.3% (208 out of 624) and 66.7% (416 out of 624), with a mean age of 59.6 years for men and 70.2 years for women [2,5,7,8,10,14,17,18,20,21,23,25,26] (Table 3). ...
Aim:
The aim of the present systematic review was to investigate the risk of malignant transformation of proliferative verrucous leukoplakia (PVL).
Materials and methods:
the search was carried out using a combination of terms (leukoplakia OR leucoplakia) AND (multifocal OR proliferative) on the following databases: PubMed, Scopus, Web of Science (WOS Core Collection), Cochrane Library, selecting only articles published since 1985 and in the English language. Demographic, disease-related, and follow-up data extracted from the studies included in the qualitative synthesis were combined. Weighted means ± standard deviations were calculated for continuous variables, while categorical variables were reported as frequencies and percentages. Dichotomous outcomes were expressed as odd ratios (ORs) with 95% confidence intervals (CIs). Odd ratios for individual studies were combined using a random-effects meta-analysis, conducted using Review Manager 5.4 Software (Cochrane Community, Oxford, England).
Results:
twenty-two articles were included, with a total of 699 PVL patients, undergoing a mean follow-up of 7.2 years. Sixty-six percent of patients were females, with a mean age of 70.2 years, and 33.3% were males, with a mean age of 59.6 years. Most patients were non-smokers and non-alcohol users, and the gingiva/alveolar ridge mucosa was the most involved anatomical site by both PVL appearance and malignant transformation. A total of 320 PVL patients developed oral verrucous carcinoma (OVC) or conventional oral squamous cell carcinoma (OSCC) because of malignant transformation of PVL lesions (45.8%). A statistically significant 3.8-fold higher risk of progression to conventional OSCC was found compared to OVC in PVL patients, with women being 1.7 times more likely to develop oral cancer than men, as a consequence of PVL progression. Moreover, a statistically significant higher likelihood of developing conventional OSCC in female PVL patients than in males was found. In 46.5% of patients with PVL malignant transformation, multiple carcinomas, in different oral sites, occurred during follow-up.
Conclusions:
PVL is an aggressive lesion, which, in a high percentage of cases (almost 50%), undergoes malignant transformation, mainly toward OSCC. The female gender is most affected, especially in the elderly, with a negative history for alcohol and tobacco consumption.
... No dysplasia had been present in initial biopsy but it appeared during several years follow up, often with development of PVL clinical characteristics(Sperandio et al., 2016).It is recommended that the term lichenoid dysplasia should not be used, and pathologists should diagnose all oral epithelial dysplastic lesions with a lichenoid immune response as dysplasia, unless clinico-pathological correlation produces compelling reasons to consider that lichen planus is present. This recommendation is based on the fact that many early biopsies in PVL show lichenoid features with minimal dysplasia(Garcia-Pola et al., 2016;Fernandes et al., 2017)) ...
Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three‐grade and binary systems are summarised and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV‐ associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists’ viewpoint.
... After duplicates removal, 341 records were considered potentially eligible and screened according to titles and abstracts, leaving a sample of 49 studies for full text evaluation. Finally, 24 studies meeting all eligibility criteria were included for critical analysis and evidence synthesis in our scoping review [4,[6][7][8][9][10]13,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Table 3 summarizes the characteristics of the 24 selected studies, which reported on a total of 631 patients with PVL. ...
... Another research question is related to what extent it is necessary to demonstrate the malignant transformation of a white lesion in order to consider it as a PVL. All of the four diagnostic criteria for PVL proposed malignant transformation as a common fact in the PVL evolution, although not required for diagnosis [10][11][12][13]; 100% of studies included in our current paper (24/24) [4,[6][7][8][9][10]13,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] also corroborate this proposition, i.e., no study indicates malignancy as a mandatory criterion for diagnosis. Papers published in this regard by the WHO Collaborating Center for Oral Cancer [5] describe PVL as an aggressive form of leukoplakia, among other reasons due to its tendency to become malignant and to develop multiple carcinomas. ...
... Two of the four proposals for diagnostic criteria for PVL published consider resistance to treatment as a mandatory criterion [10,12], while Cerero-Lapiedra [11] propose it as a major not mandatory criterion. Only two papers (8.33%) [30,32] of those analyzed in this scoping review report data on treatment recurrence. Garcia-Pola et al. (2016) consider recurrence to treatment as a mandatory criterion, therefore, reporting 100% of recurrences (14 recurrences), while Garcia-Chias et al. (2014) consider it as a major but not mandatory criterion, reporting 25% of recurrences (10 recurrences in 40 treated PVLs). ...
Proliferative verrucous leukoplakia (PVL) is considered as an oral potentially malignant disorder (OPMD) that presents with a high tendency to recurrence after treatment and has the highest malignant transformation ratio among all OPMD (50%). Evidence-based publications have indicated that the malignant evolution reported is significantly related to the inconsistent diagnostic criteria used in primary-level studies; so, it has been hypothesized that the risk of oral cancer for this disease could even be underestimated. This is important because PVL requires specific management protocols, evidence-based, aimed at the early diagnosis of cancer developing in these lesions. We present a scoping review—a novel approach to mapping the available literature on a given topic to provide an overview of the available research evidence and to highlight possible gaps in the evidence—especially related in our study to the diagnostic aspects of PVL, and to issue a conceptual proposal and diagnostic criteria for PVL. We conclude that PVL is a white, multifocal and progressive lesion with a high malignant transformation rate which is diagnosed mainly around the age of 60 years without any specific histological characterization. We also advise a personal reflection on the level of certainty with which the clinician makes the diagnosis of a particular case of PVL.
... Considering the history of breast carcinoma and oral lichen planus, this particular location should have deserved prior meticulous examinations using adjunct methods during the last 2 years, so that the risk of malignant transformation of the area could be monitored [2,3]. The malignant transformation of oral lichen planus has been reported to range between 0 and 10% in 1.5 to 10 years of follow up [4][5][6][7]. It is suggested that there may be a higher frequency of OLP lesions transforming into squamous cell carcinoma in tongue, buccal mucosa and gingiva [4][5][6][7]. ...
... The malignant transformation of oral lichen planus has been reported to range between 0 and 10% in 1.5 to 10 years of follow up [4][5][6][7]. It is suggested that there may be a higher frequency of OLP lesions transforming into squamous cell carcinoma in tongue, buccal mucosa and gingiva [4][5][6][7]. Adjunct devices and methods may aid to provide noninvasive and real-time data regarding the malignant potential of suspicious mucosal lesions and early diagnosis of oral squamous cell carcinoma [2,3]. While their clinical efficacy varies according to the settings of the study and the studies population, the adjuncts are expected to have major benefits for high-risk individuals [3]. ...
