Clinical manifestations of oral proliferative verrucous leukoplakia: A systematic review.

OBJECTIVE: The aim of this systematic review was to gather the available evidence about proliferative verrucous leukoplakia. This systematic review was conducted to answer the question: "What are the main clinical features of PVL patients?". MATERIAL AND METHODS: A systematic review of the literature was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. An electronic research was carried out using different electronic databases; PubMed, and Scopus. Inclusion criteria were papers which reported at least 10 patients with proliferative verrucous leukoplakia and were published not more than 10 years ago. RESULTS: A total of 285 records were identified through databases, although only 6 of them were eligible. Most patients were women, above 60 years of age (67.4). Additionally, 28 of them were non-smokers (66.6%) and 24 were non-habitual drinkers (57.1%). The most common locations were gingiva (50.9%), buccal mucosa (44.9%), and tongue (40.6%) CONCLUSION: Level C can be established to conclude the proliferative verrucous leukoplakia demographic data, risk factors, malignant transformation, and location. A strict follow-up on these patients should be mandatory, even after surgical management since they have a high recurrence rate and a malignant transformation.

Oral verrucous Carcinoma on mandibular right alveolar region.

Verrucous carcinoma, a low-grade variant of squamous cell carcinoma, defined as a diagnostically squamous cell neoplasia involving lip, oropharyngeal, and laryngeal mucosa and named as 'Ackerman's tumour' by Ackerman in 1948. It usually occurs in the lower lip region and this is one such case in which a painful proliferative growth was evident over the right alveolar region for the period of 8 months. Radiological investigations, biopsies were performed followed by surgical excision of the lesion.

Verrucous carcinoma of the tongue.

A 75-year-old woman with full dentures had a progressive growth on the tongue for the past 15 years. She reported ulceration of the lesion 4 months prior that was accompanied by pain and odinophagia. She denied addiction to alcohol or tobacco. On examination, there was an ulcerated, vegetating, verrucous lesion, with yellow-whitish areas intermingled with erythematous areas, being infiltrated and having well-defined borders, on almost all areas of the back of the tongue (Figure 1). No adjacent lymphadenopathy was found. Biopsy of the tongue was compatible with verrucous carcinoma demonstrating squamous cell neoplasia with prevailing areas of rounded borders. There were "tunnels" filled with parakeratotic material surrounded by an extensive inflammatory response, plus isolated foci of neutrophils inside the tumor (Figure 2). There were relatively well-differentiated neoplastic cells with little cytological atypia. In addition, there were several foci of individual or grouped dyskeratotic cells (Figure 3), plus tunnelling of parakeratotic material and an intratumor inflammatory response (Figure 4). Following surgical removal, the woman underwent chemotherapy and radiation treatment.

Oral carcinoma cuniculatum: an unacquainted entity with diagnostic challenges-a case report.

BACKGROUND: Oral carcinoma cuniculatum (OCC) is an unacquainted well-differentiated subtype of oral squamous cell carcinoma, which displays unique clinic-pathological features. Up to date, OCC remains rare with about 75 reported cases, and is frequently missed or even misdiagnosed. CASE PRESENTATION: The aim of the present work was: to report a case of OCC in mandibular gingiva and to highlight its main clinic-pathological diagnostic features: with an exophytic cobble-stone surface and a characteristic endophytic burrowing architecture, as well as to differentiate between it and other closely similar lesions including verrucous carcinoma, papillary squamous cell carcinoma, and well-differentiated conventional oral squamous cell carcinoma. CONCLUSIONS: An accurate diagnosis of OCC entails awareness of the clinicians and pathologists about its entity, proper knowledge of the diagnostic clinical and histopathological evidence, and the ability to differentiate it from closely similar lesions.

Cuneiform (cuniculatum) variant of oral squamous cell carcinoma revisited: Presentation of two cases and literature review of a rare entity.

BACKGROUND: Oral carcinoma cuniculatum (OCC) is a rare, locally aggressive tumor, which tends to invade underlying bone. We present two cases of OCC, one demonstrating invasion of the mandible and the other limited to the tongue. METHODS: An 87-year-old male presented with a right-sided buccogingival lesion. Biopsy results led to a diagnosis of verrucous hyperplasia, which was later revised to OCC. Additionally, a 94-year-old female presented with a left lateral tongue lesion. A biopsy showed in-situ and invasive keratinizing squamous cell carcinoma that was later defined as a soft tissue OCC. RESULTS: Following surgical resection, the diagnosis of OCC was established in both patients. We provide a comprehensive literature review of OCC in the context of both case presentations. CONCLUSIONS: OCC is a rare entity, which has a tendency to be misdiagnosed. We emphasize the importance of recognizing the common features of OCC in order to aid in accurate diagnosis.

Carcinoma Cuniculatum of the Oral Cavity: A Series of 6 Cases and Review of Literature.

Carcinoma cuniculatum (CC) is a rare variant of squamous cell carcinoma (SCC) that is characterized by minimal cytologic atypia and a unique deeply infiltrative growth pattern resembling rabbit burrows (cuniculi). With less than 75 cases reported in the head and neck, the clinical and pathologic spectrum of this entity remains poorly understood. A retrospective review of the clinical and pathologic features of archival cases of oral CC was performed. A total of six cases of oral CC were identified. Age ranged from 25-77 years; the male-to-female ratio was 5:1. All patients had a long-standing history of tobacco and betel-quid consumption. The tumors were distributed in the gingivobuccal sulcus (n = 2), the tongue (n = 2), buccal mucosa (n = 1), and the palate (n = 1). Histology in all cases typically revealed a tumor composed of well-differentiated squamous epithelium, devoid of atypia, lining deeply infiltrative, large-sized, branching, keratin-filled cavities, resembling rabbit-burrows. Dense lymphocytic infiltrates and discharging micro-abscesses were regular features. Underlying bone invasion and lymph node metastasis were observed in 1 patient. One patient with a tongue tumor developed locoregional recurrence at 10 months while none developed distant metastasis. Oral CC is a rare and under-recognized variant of SCC with locally aggressive behavior. Lack of familiarity with this variant exacerbated by the absence of cytologic anaplasia makes CC susceptible to multiple negative biopsies and erroneous diagnoses. Awareness of this clinicopathologic entity is essential to allow its accurate diagnosis and optimal management.

Oral human papilloma virus infection: an overview of clinical-laboratory diagnosis and treatment.

OBJECTIVE: The aim of this review is to describe the "hot points" of current clinical governance for oral HPV comprising the use of new diagnostic molecular procedures, namely, Pyrosequencing and Next Generation Sequencing. MATERIALS AND METHODS: The data on oral HPV was collected through two levels of research. First for all, we used the canonical medical search engines, PubMed, and Medline, followed by the study of current commercial tools for HPV diagnosis, particularly within commercial companies involved in the molecular procedures for HPV detecting and genotyping. RESULTS: Different medical procedures are now described and used throughout the world in HPV diagnosis and treatment. However, the laboratory methods are often validated and used for genital infections, and, in these cases, data are missing in the literature as regards the clinical approach for oral lesions. CONCLUSIONS: Dental care units are often the front line for a clinical evaluation of a possible HPV lesion in the oral cavity, which means that correct clinical governance could avoid a viral neoplastic progression of this disease with great advantages for the patient. In this case, the problem is due to the difficulty in lesion recognition but also and more especially the absence of correct laboratory diagnosis and subsequent treatment in the clinical course.

Sinonasal verrucous carcinoma with oral invasion.

Verrucous carcinoma is a rare warty variant of squamous cell carcinoma, most often seen in the oral cavity and larynx. Its occurrence in the sinonasal tract is rare. This tumor constitutes approximately 1% of all sinonasal neoplasms. The clinical presentation and the histopathological features of verrucous carcinoma are a subject of continuous discussion amongst diagnosticians and pathologists. A case with oral and nasal presentation of this tumor is reported here.

Practitioners' challenges in diagnosing oral and maxillofacial tumors.

OBJECTIVE: Oral cancer is an increasingly growing health care burden in many parts of the world. Due to the relatively low prevalence of oral cancer, screening will lead to a low yield and a high proportion of false positive results. Clinical examination without histologic diagnosis can lead to misdiagnosis in over 40% of cases, especially when premalignant lesions are involved. However, clinical examination is effective especially in detecting the early stages of oral cancer, particularly in high-risk patients, such as smokers and alcoholics. The purpose of the current paper is to describe several cases of failure to diagnose lesions in the oral cavity during clinical and radiographic examinations, and to discuss how these diagnosis failures may be mitigated. METHOD AND MATERIALS: A series of three cases of oral tumors ranging from benign to malignant that were not recognized and referred in a timely manner, are presented. CONCLUSION: The difficulties faced by clinicians in diagnosing oral lesions are elucidated in this case series. The current case series, presenting instances in which pathologies were not detected and/or treated in spite of obvious signs, should serve as a warning for dental professionals. The general practitioner is the "first line of defense" for symptomatic and asymptomatic patients, and therefore the implementation of well-established screening protocols is of paramount importance. In light of the low sensitivity ratio of oral examinations, use of biopsies is mandatory when a lesion is suspected.

Primary intraosseous verrucous carcinoma developing from a maxillary odontogenic cyst: case report.

Primary intraosseous carcinoma (PIOC) is an extremely rare lesion, almost always occurring in cranial bones. The origin of this tumor, specific to the maxillae, is associated with the cells of the epithelial rests of Malassez. Among the histotypes which can be included in these neoplasms, verrucous carcinoma is of particular interest due to its rarity: only a single case has been reported to date. After a short survey of the literature, the authors describe a directly observed case of verrucous carcinoma arising from a maxillary odontogenic cyst.

Verrucous carcinoma of maxillary antrum.

Verrucous carcinoma of the paranasal sinuses is a rare malignant tumour. It occurs most frequently in the oral cavity and larynx. We present a case of extensive verrucous carcinoma of the maxillary sinus. This paper discusses the clinical and histological features and modes of treatment. All previous reports of verrucous carcinoma cases of paranasal sinuses are reviewed.

Carcinoma verrucoso en lengua de paciente geriátrica. Informe de caso clínico / Verrucous carcinoma in the tongue of a geriatric patient. Clinic case report

Resumen Se informa el caso de un paciente femenino de 80 años de edad, la cual presenta un crecimiento exofítico en el borde lateral izquierdo de la lengua con dolor a la masticación y deglución de alimentos y bebidas; es referida por el odontólogo del Hospital Primario del municipio de Villanueva, departamento de Chinandega, Nicaragua, al área de Diagnóstico en Patología Bucal de la Facultad de Odontología de la Universidad Nacional Autónoma de Nicaragua, León (UNAN-León). A la exploración clínica se observa lesión exofítica en la zona posterior del borde lateral izquierdo de la lengua de aspecto papilomatoso, y ocupa además el reborde alveolar del mismo lado. El diagnóstico definitivo histopatológico fue carcinoma verrucoso.

Abstract We report the case of an 80-year-old female patient, who presents an exophytic growth on the left lateral border of the tongue with pain when chewing and swallowing food and drinks; who is referred by the Dentist of the Primary Hospital of the municipality of Villanueva, department of Chinandega, Nicaragua to the area of Oral Pathology Diagnostics of the National Autonomous University of Nicaragua, Dental School León (UNAN-León). An exophytic lesion was observed in the posterior area of the left lateral border of the papillomatous aspect of the tongue, occupying in addition the alveolar ridge on the same side. The definitive histopathological diagnosis was Verrucous carcinoma.

Rapid-onset postchemoradiotherapy rhabdomyosarcoma of the maxillofacial region.

Radiation-induced sarcomas of the head and neck are rare and tend to occur decades after treatment. We report a case of rapid-onset postchemoradiotherapy rhabdomyosarcoma of the maxillofacial region and briefly review the literature.

Sialadenoma papilliferum with potentially malignant features.

Sialadenoma papilliferum (SP) is a benign non-invasive lesion with slow and limited growth. This report describes an unusual SP that enlarged rapidly and presented as an extensive intraoral tumour highly suspicious for verrucous carcinoma. Radiographic resorption of the underlying bone was evident in the mandible. This type of destructive growth does not conform to any previously reported SP. Histological features were also atypical: surface verrucous hyperplasia and deeper florid cystic-duct adenoma. Overall, the SP is likely to be considered a borderline lesion with malignant potential. Four published cases of malignancy associated with SP showed completely different clinical and pathological settings, further obfuscating the concept of malignant SP.

A unique presentation of a squamous cell carcinoma in a pregnant patient.

The literature reports an increasing occurrence of carcinoma in the young adult nonsmoking and nondrinking population. With it, this trend brings the potential for new comorbidities. This report discusses one such case in which a 30-year-old woman, 28 weeks pregnant, was diagnosed with a hybrid verrucous carcinoma/squamous cell carcinoma. Several years preceding the presentation of the hybrid lesion, the patient had an odontogenic cyst associated with the same region. The original lesion was reported to have mucosal change overlying it. Newly available immunohistochemical stains were used to review the lesion to assess the potential for aggressiveness and proliferative changes. All the biomarkers were unremarkable, suggesting that the progression of the initial lesion could not have been predicted with the current immunohistochemical stains. This report discusses the diagnosis and treatment of this unusual scenario involving progression of a benign lesion to a malignant hybrid.