This is largely due to the overlapping clinical and pathologic early features with conventional multifocal leukoplakia with dysplasia. Proliferative verrucous leukoplakia is an intriguing disease, which occurs particularly in women aged greater than 60 years, is not associated with tobacco and alcohol, and has a high risk of. Shopper, dds, med, is an associate pr ofessor in the department of or al diagnosis, oral medicine, and radiology. White lesions both physiologic as well as pathologic are relatively frequent in the oral cavity, the most common pathology being oral leukoplakia ol. Proliferative verrucous leukoplakia is multifocal and progressive lesion with a high rate of malignant transformation. Proliferative verrucous leukoplakia pvl is a disease of extensive or multifocal verrucouslike lesions that has a high risk of recurrence and malignant transformation into a carcinoma. This type is characterised by widespread and multifocal appearance, often in patients without known risk factors.
Proliferative verrucous leukoplakia of the gingiva how. Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of. K institute of dental sciences, belgaum, karnataka, india 3 department of oral medicine and radiology, k. Pdf proliferative verrucous leukoplakia victor lopes. Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy. It is considered to have a high rate of malignant transformation with implications in terms of lifelong monitoring both clinically and histopathologically. Proliferative verrucous leukoplakia of the gingiva, report. Proliferative verrucous leukoplakia is a recalcitrant, often widespread and multifocal distinct type of leukoplakia. Proliferative verrucous leukoplakia pvl is a rare variant of oral leukoplakia ol with a high tendency for malignant transformation. The oral cancer foundation genetic and rare diseases. 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.
Oral leukoplakia is a white patch or plaque that develops in the oral cavity and is strongly associated with smoking. This condition is characterized by usually extensive, papillary or verrucoid keratotic plaques that tends to slowly enlarge into adjacent mucosal sites. Proliferative verrucous leukoplakia, squamous cell. It should be acknowledged that some lesions may initially be pinkish or even red rather than white. Oral leukoplakia is classified into homogeneous, non homogeneous and proliferative verrucous leukoplakia. It starts as a white plaque of thickened skin hyperkeratosis that eventually spreads and forms rough, wartlike verrucous lesions that may look. The term proliferative verrucous leukoplakia pvl has been defined by hansen et al. Pvl behaves in a more aggressive and relentless manner than the more innocuous white oral lesions that it can resemble clinically. Among them oral leukoplakia ol is quite prevalent 0. Proliferative verrucous leukoplakia of the gingiva listed as pvlg. B pvl in the buccal mucosa with different clinical patterns. During the course of the disease verrucous lesions develop. Proliferative verrucous leukoplakia pvl and verrucous hyperplasia vh are two interrelated oral mucosal lesions.
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. In general, nonhomogeneous leukoplakia has a higher malignant transformation risk. Due to the scarcity of reports on pvl five cases of pvl are presented. Proliferative verrucous leukoplakia and its progression to. Patients with this condition represent a unique clinically and pathologically progressive characteristic from conventional leukoplakia. Intraoperative consultation upper aerodigestive tract ioc. With the introduction of the term pvl the previously. Proliferative verrucous leukoplakia of the gingiva, report of two cases with malignant transformation nadereh ghanee dmd, selene saraf, mary nathanson kilo md and kristina waggoner pacific northwest kaiser dental, usa case report open access journal of clinical and anatomic pathology.
Carcinoma, proliferative verrucous leukoplakia and ebv med oral patol oral cir bucal. Other synergistic risk factors include alcohol consumption, chronic irritation, fungal infections such as candidiasis. Case report of rapidly progressive proliferative verrucous. Proliferative verrucous leukoplakia clinical presentation. Proliferative verrucous leukoplakia pvl is a distinct clinical form of oral leukoplakia defined by its progressive clinical course, changing clinical and histopathological features, and potential to develop into cancer. The diagnosis can only be achieved through the keen clinical observation of the temporal progression in individual patients to verrucous andor conventional squamous carcinoma. The cliniopathological features that define dysplastic oral epithelium are listed below 4. Pdf proliferative verrucous leukoplakia a recalcitrant. Dear editor, it has recently been published in world journal of surgical oncology a progressive case report of the still enigmatic process proliferative verrucous leukoplakia pvl. Proliferative verrucous leukoplakiapvl is rare high risk form of leukoplakia first described by hansen and.
Verrucous hyperplasia vh is the histopathological finding most likely representing part of the pvl diagnosis. Proliferative verrucous leukoplakia a clinico pathological entity. A noval approach to the treatment of proliferative. 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 papilloma proliferative verrucous leukoplaia. Proliferative verrucous leukoplakia and its related. If you have problems viewing pdf files, download the latest version of adobe reader. Oral proliferative verrucous leukoplakia revisited introduction after its introduction in 1985 by hansen et al.
Pdf proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which was first described in 1985 by hansen et al. It is proliferative verrucous leukoplakia of the gingiva. There are not enough studies about proliferative verrucous leukoplakia in the. Case report use of collagen matrix to improve wound repair.
Proliferative verrucous leukoplakia proliferative verrucous leukoplakia pvl is a recognized high risk subtype of nonhomogenous leukoplakia. Proliferative verrucous oral leukoplakia is a subtype of verrucous leukoplakia according to some authors3,6. An external file that holds a picture, illustration, etc. An aggressive form of oral leukoplakia thomas p shopper, robert b brannon and william h stalker thomas p. A proliferative verrucous leukoplakia pvl in the lower attached gingival, vestibular sulcus and gradually extended along left alveolar ridge. Whereas nonhomogeneous and proliferative kind is quite uncommon and rare respectively. As mentioned above, most pvl cases processed to malignancy over many years, sometimes 20 years. Proliferative verrucous leukoplakia genetic and rare diseases nih. Current evidence in diagnosis and treatment of proliferative.
Ideally leukoplakia is leathery on palpation but verrucous leukoplakias have an irregular surface because of its exophytic and proliferative nature. 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. Oral leukoplakia and proliferative verrucous leukoplakia. 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%. 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. Proliferative verrucous leukoplakia pvl is an aggressive, recalcitrant form of. Proliferative verrucous leukoplakia pvl is a rare form of oral. Optimal management of proliferative verrucous leukoplakia.
Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Pdf on apr 3, 2017, mervet moussa and others published oral proliferative verrucous leukoplakia. The development of proliferative verrucous leukoplakia in. Proliferative verrucous leukoplakia pvl is a rare potentially malignant lesion of oral mucous that firstly described by hansen et al in 1985. After this study, these lesions were named oral proliferative verrucous leukoplakia opvl.
Verrocous leukoplakias are early phases of oral squamous cell carcinomas in 70% cases which is a cause of high morbidity and mortality worldwide 6. It can be characterized as a solitary, recurring, progressive white patch that develops a verruciform architecture and may not be associated with hpv. It is well recognized that proliferative verrucous leukoplakia may show a spectrum of histopathological changes, ranging from hyperkeratosis with or without dysplasia to verrucous hyperplasia. It mainly involves the lining inside of the cheeks buccal mucosa and tongue. Most commonly resistant to all forms of therapy as. The aim of this paper was to assess the nonsurgical treatment of oral leukoplakia ol. Oral lichen planus, proliferative verrucous oral leukoplakia, malignant oral lichen planus, multifocal verrucous oral lichen planus, proliferative verrucous oral lichen planus. It is uncommon, and usually involves the buccal mucosa and the gingiva the gums. Twenty cases with a clinical and biopsy proven diagnosis of pvl. Schmalbach md, facs1 1department of otolaryngology head and neck surgery, wilford hall medical center, lackland afb, texas. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which was first described in 1985 by hansen et al. Proliferative verrucous leukoplakia pvl is a rare less recognized form of oral leukoplakia. Each has been shown to have a considerable propensity to progress to carcinomaeither verrucous or conventional squamous cell carcinoma of.
Proliferative verrucous leukoplakia of the gingiva pvlg appears to be a subset of oral proliferative verrucous leukoplakia. Wound repair after oral mucosal biopsy 8366 int j clin exp med 2017. Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus. Case report an unusual case report of an early proliferative. Proliferative verrucous leukoplakia is an aggressive type of leukoplakia that almost invariably develops into malignancy. Soames and southam reported mutations of p53 in the cells from dysplastic areas of some leukoplakias who smoke and drink heavily. Objectiveproliferative verrucous leukoplakia pvl is a rare and. Examination early in the disease process may reveal isolated areas of leukokeratosis, sometimes with adjacent erythematous mucosa, as. The primary outcomes of interest were clinical resolution, malignant transformation, followup, and recurrence of ol. A rare, recalcitrant, and lethal form of leukoplakia necessitate special attention. Proliferative verrucous leukoplakia med oral patol oral cir bucal. However, this report described a case of rapid progress, which had malignant. Because of the lack of defined pathologic lesions, identifying patients with the early diagnosis of pvl is challenging. Proliferative verrucous leukoplakia pvl is a rare type of oral leukoplakia, where white patches that have a high risk of becoming cancerous.
Proliferative verrucous leukoplakia genetic and rare. The aim of this study was to evaluate the malignant potential of pvl and determine its possible association with highrisk human papillomavirus hpv. Carcinoma, proliferative verrucous leukoplakia and ebv epsteinbarr virus in oral proliferative verrucous leukoplakia and squamous cell carcinoma. 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. 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 is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. The homogeneous leukoplakia is the most common type of this condition involving uniform white patches and is not serious. Since then, various published case series have presented pvl as a. The lesion arose about one month before and had never regressed. The diagnosis of this entity is predicated on a temporal constellation of clinical features and histopathologic findings.
How to treat leukoplakia with vitamins natural home. To analyze the studies about proliferative verrucous leukoplakia and develop a concise update. Proliferative verrucous leukoplakia pvl is a rare oral leukoplakia and has four features such as chronic proliferation, multiple occurrences. Proliferative verrucous leukoplakia pvl is defined as an aggressive, relentless and recalcitrant form of leukoplakia that has a high propensity for malignant transformation. For language access assistance, contact the ncats public information officer. The development of proliferative verrucous leukoplakia in oral lichen. Proliferative verrucous leukoplakia pvl is a recognized high risk subtype of nonhomogenous leukoplakia. Interobserver variability in the diagnosis of proliferative verrucous. Pdf download for optimal management of proliferative verrucous. Proliferative multifocal leukoplakia better name that. Risk factors include all forms of tobacco use forms including cigar, cigarette, beedi, and pipe. It involves multiple mucosal areas with confuent, exophytic and proliferative features.