Oral verrucous hyperplasia versus oral verrucous carcinoma: A clinicopathologic dilemma revisited using p53 as immunohistochemical marker

Molecular landscape of proliferative verrucous leukoplakia: a systematic review

Proliferative verrucous leukoplakia (PVL) is a rare oral potentially malignant disorder characterised by multifocal origin and unpredictable long-term evolution to oral squamous cell carcinoma (OSCC) or oral verrucous carcinoma (OVC). Currently no predictive biomarkers are in clinical use. We aimed to explore the genomic profile of PVL. A total of 685 cases in 26 studies were included in this review. Genomic data were presented in 15% of studies and biomarker analysis was reported in 85% of studies. At first clinical presentation, PVL is characterised by a high loss of heterozygosity (LOH), similar to OSCC, and low copy number alterations (CNA). As these progress, more CNAs and mutations in CDKN2A and alterations to ELAVL1 expression are noted, but no TP53 mutations are identified. There is significantly lower LOH at 17p in early PVL compared with OSCC (p = 0.037). Deletions in chromosomal loci 17q12, 5q31.1 and amplifications in 7q11.2, 7q22 are shared between early lesions and OVC. PVL shows CNAs at 11q31. WNT signalling pathway genes (SUZ12, CTTN and FOLR3) are enriched in CN-altered regions. PVL stroma shows significantly lower α-SMA and higher CD34 expression than OVC and OSCC. The exact genomic landscape is currently unclear, and further studies are necessary to unravel this mystery.

Verrucous hyperplasia and verrucous carcinoma in head and neck: use and benefit of methotrexate

Background and aim: Verrucous hyperplasia (VH) and verrucous carcinoma (VC) of the head and neck are two (pre)malignant entities that are slowly progressive with low tendency to metastasize. However, they can reduce the patient's Quality of Life (QoL) and may even transform into squamous cell carcinoma (SCC). As they are typically approached by surgical resection, some patients do not qualify for surgery. Methotrexate may be a systemic alternative but the response is mostly not durable. This case report tries to illustrate the potential role of methotrexate in VH/VC of the head and neck.Method: We describe four cases of patients with VH or VC of the head and neck who received methotrexate (40-60 mg/m²) in a weekly or two-weekly interval.Results: Two patients received methotrexate in a neoadjuvant setting. The first patient achieved a macroscopical complete response after 16 cycles and remained in remission after surgery. The second patient suffered from residual disease after 26 cycles and refused radical surgery.Two other patients refused surgery at the time of diagnosis and were proposed methotrexate as a salvage treatment. The first patient had an ongoing response on methotrexate after >60 cycles. The second patient achieved macroscopical complete remission after 28 cycles of methotrexate but suffered relapse by developing an oropharyngeal SCC in the same region.Conclusion: When surgery is not desirable in VH and/or VC, patients can be treated with methotrexate which has a reasonable effect and seems to be well tolerated. Nevertheless, surgery should be the preferred strategy to achieve complete remission.

Evaluation of the presence of myofibroblasts and matrix metalloproteinase 1 expression in the stroma of oral verrucous hyperplasia and verrucous carcinoma

Background

Oral verrucous carcinoma is a low-grade subtype of oral squamous cell carcinoma that should be differentiated from oral verrucous hyperplasia, a premalignant lesion. Stromal activated myofibroblasts known as cancer-associated fibroblasts have an active role in the initiation and progression of the cancers via secretion of different molecules including matrix metalloproteinases.

Aims

This study is designed to understand the differences in the presence of myofibroblasts and expression of matrix metalloproteinase-1 in the adjacent stroma of verrucous carcinoma and oral verrucous hyperplasia (OVH).

Settings and Design

Cross-sectional study.

Material and Methods

Twenty-seven OVH, 19 oral verrucous carcinoma (OVC), and 8 cutaneous verrucous carcinoma (CVC) specimens were analyzed for immunohistochemical (IHC) expression of α-smooth muscle actin (αSMA) and MMP-1.

Results

IHC studies for αSMA expression in nonvascular stromal cells of the adjacent stroma revealed mild or no expression in 81.4%, 73.7%, and 62.5% of the cases of OVH, OVC, and CVC groups, respectively. No significant difference was seen in αSMA expression index between OVH and OVC groups (Adj. Sig. = 0.220) and between OVC and CVC groups (Adj. Sig. = 1.00). Pairwise analysis revealed a significant difference in MMP-1 expression index between the groups. No significant correlation was observed between MMP-1 expression index and αSMA expression index in OVH (pv = 0.358) and OVC (pv = 0.388) groups.

Conclusion

The differences in MMP-1 expression between OVH and OVC can be used as an adjunctive aid in challenging cases including disoriented or inadequate samples.

Procedures and pitfalls in incisional biopsies of oral squamous cell carcinoma with respect to histopathological diagnosis

This review has addressed the issues faced by a diagnostic pathologist during routine assessment of haematoxylin and eosin stained incisional biopsies from oral squamous cell carcinoma patients. Herein, the pragmatic means undertaken, has highlighted routinely faced problems & encounters determined at various levels as clinical, laboratory and diagnostic pitfalls, when possible, tips offered towards procedures and guidance. Also, dealt with subtypes of oral squamous cell carcinoma, differential diagnosis, and relevant prognostic indicators that can navigate the surgeon to take quick decisions. It speaks of the journey of biopsied material from the clinician to the laboratory until the generation of the final report. Although histopathological evaluation is a confirmatory tool for any clinically suspected lesion it mandates the co-operation of faculty from varied disciplines. The onus lies on a pathologist to establish standard protocols to oversee, audit the laboratory operating procedures from time and again. Technical errors and faults at the office desk doesn't come under the purview of this review.

Utility of Photodynamic Therapy in Dentistry: Current Concepts

The significant growth in scientific and technological advancements within the field of dentistry has resulted in a wide range of novel treatment modalities for dentists to use. Photodynamic therapy (PDT) is an emerging, non-invasive treatment method, involving photosensitizers, light of a specific wavelength and the generation of singlet oxygen and reactive oxygen species (ROS) to eliminate unwanted eukaryotic cells (e.g., malignancies in the oral cavity) or pathogenic microorganisms. The aim of this review article is to summarize the history, general concepts, advantages and disadvantages of PDT and to provide examples for current indications of PDT in various subspecialties of dentistry (oral and maxillofacial surgery, oral medicine, endodontics, preventive dentistry, periodontology and implantology), in addition to presenting some images from our own experiences about the clinical success with PDT.

Clinicopathologic analysis of verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma as part of the clinicopathologic spectrum of oral proliferative verrucous leukoplakia: A literature review and analysis

OBJECTIVE

Proliferative verrucous leukoplakia is classified as a potentially malignant disorder because of its high rate of malignant transformation. PVL progresses in a series of clinical stages where the early stage represents multiple, multifocal leukoplakias with a high recurrence rate. The intermediate and late stages are clinically exophytic lesion, diagnosed microscopically as verrucous hyperplasia that often progresses into verrucous carcinoma and/or squamous cell carcinoma. There is no single histologic definition and the diagnosis is retrospective following observed progression of the disorder. The goal of the current study was to conduct a literature review and analysis of PVL in the later stages to gain further knowledge on their clinicopathologic features.

DATA SOURCES

Medline's PubMed and Google Scholar were searched for adequately documented cases from 1985 to 2018. References of published articles were searched for additional cases.

REVIEW METHODS

Overall, 57 manuscripts were analyzed. 35/57 manuscripts provided adequate data on the clinicopathologic features in the premalignant and malignant stages.

RESULTS

Malignant transformation rate was 50% (average of 57 months). Gingiva, palate and buccal mucosa were the most common locations. Clinicopathologic features included; well differentiated carcinoma (78%), perineural invasion (3%), lymph node metastasis (4%); distant metastasis (0%), average duration of illness (65 months), DOD-dead of disease (44%). Moderate dysplasia, severe dysplasia and carcinoma in situ were exceptionally uncommon in the premalignant stages (0.8%).

CONCLUSION

Prognostic factors such as perineural invasion, lymph node metastasis and distant metastasis were uncommon occurrences which may have practical implications on treatment. Further studies are needed to substantiate our findings.

Lichenoid Characteristics in Premalignant Verrucous Lesions and Verrucous Carcinoma of the Oral Cavity

Verrucous hyperkeratosis (VH), verrucous carcinoma (VC) and the relentless, truly pre-malignant variant proliferative verrucous leukoplakia often exhibit lichenoid histologic features that may create a diagnostic dilemma for pathologists. This study aims to evaluate and categorize the frequency and the histopathologic patterns of lichenoid features seen in these lesions. Following IRB approval, cases of VH and VC from 1994 to 2014 were retrieved from the archives of UF Oral Pathology Biopsy Service. A panel of 4 board-certified oral and maxillofacial pathologists reviewed and scored the presence or absence of 5 lichenoid features: band-like infiltrate (BLI), saw tooth rete ridges (STRR), interface stomatitis (IS), civatte bodies (CB), and basement membrane degeneration (BMD). Cases not fulfilling the stringent selection criteria were excluded. A total of 70 cases of VH and 56 cases of VC were included. Approximately 25% of both VH and VC cases exhibited 3 or more lichenoid features. By Chi square testing, BLI (p = 0.000), IS (p = 0.005), and CB (p = 0.026) were significantly more common in VC than VH. Gingival lesions had significantly less frequent BLI (p = 0.004) and IS (p = 0.024) versus other sites. However, STRR was significantly more common in VH than VC (p = 0.000) in the gingiva. (p = 0.002). Statistical analysis revealed that the only significant valid association was the increased presence of band-like infiltrate in VC over VH (p = 0.001). Lichenoid features are common in both VH and VC and may represent a nonspecific inflammatory response to the dysplasia or malignancy rather than concomitant lichenoid disease. This could lead to significant under diagnoses of these premalignant or potentially malignant lesions by pathologists.