Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA.
Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Mod Pathol. 2022 Aug;35(8):1034-1044. doi: 10.1038/s41379-022-01021-x. Epub 2022 Feb 19.
The aim of this multicenter retrospective study is to characterize the histopathologic features of initial/early biopsies of proliferative leukoplakia (PL; also known as proliferative verrucous leukoplakia), and to analyze the correlation between histopathologic features and malignant transformation (MT). Patients with a clinical diagnosis of PL who have at least one biopsy and one follow-up visit were included in this study. Initial/early biopsy specimens were reviewed. The biopsies were evaluated for the presence of squamous cell carcinoma (SCCa), oral epithelial dysplasia (OED), and atypical verrucous hyperplasia (AVH). Cases that lacked unequivocal features of dysplasia were termed "hyperkeratosis/parakeratosis not reactive (HkNR)". Pearson chi-square test and Wilcoxon test were used for statistical analysis. There were 86 early/initial biopsies from 59 patients; 74.6% were females. Most of the cases had a smooth/homogenous (34.8%) or fissured appearance (32.6%), and only 13.0% had a verrucous appearance. The most common biopsy site was the gingiva/alveolar mucosa (40.8%) and buccal mucosa (25.0%). The most common histologic diagnosis was OED (53.5%) followed by HkNR (31.4%). Of note, two-thirds of HkNR cases showed only hyperkeratosis and epithelial atrophy. A lymphocytic band was seen in 34.8% of OED cases and 29.6% of HkNR cases, mostly associated with epithelial atrophy. Twenty-eight patients (47.5%) developed carcinoma and 28.9% of early/initial biopsy sites underwent MT. The mortality rate was 11.9%. Our findings show that one-third of cases of PL do not show OED with most exhibiting hyperkeratosis and epithelial atrophy, but MT nevertheless occurred at such sites in 3.7% of cases.
本多中心回顾性研究旨在描述增殖性白色角化病（PL；也称为增殖性疣状白色角化病）的初始/早期活检的组织病理学特征，并分析组织病理学特征与恶性转化（MT）之间的相关性。本研究纳入了临床诊断为 PL 且至少有一次活检和一次随访的患者。回顾性分析初始/早期活检标本。评估活检标本中是否存在鳞状细胞癌（SCCa）、口腔上皮异型增生（OED）和不典型疣状增生（AVH）。缺乏异型增生明确特征的病例被称为“非反应性过度角化/不全角化（HkNR）”。采用 Pearson 卡方检验和 Wilcoxon 检验进行统计学分析。本研究共纳入 59 例患者的 86 份早期/初始活检标本，其中 74.6%为女性。大多数病例表现为光滑/均匀（34.8%）或裂沟状外观（32.6%），仅有 13.0%表现为疣状外观。最常见的活检部位是牙龈/牙槽黏膜（40.8%）和颊黏膜（25.0%）。最常见的组织学诊断是 OED（53.5%），其次是 HkNR（31.4%）。值得注意的是，HkNR 病例中有三分之二仅表现为过度角化和上皮萎缩。34.8%的 OED 病例和 29.6%的 HkNR 病例中可见淋巴细胞带，主要与上皮萎缩有关。28 例（47.5%）患者发生癌，28.9%的早期/初始活检部位发生 MT。死亡率为 11.9%。我们的研究结果表明，PL 的三分之一病例不表现为 OED，大多数表现为过度角化和上皮萎缩，但这些部位仍有 3.7%的病例发生 MT。
