Department of Pathology, 1 University of New Mexico Health Sciences Center, MSC08 4640, Albuquerque, NM, 87131, USA.
Head Neck Pathol. 2023 Sep;17(3):607-617. doi: 10.1007/s12105-023-01558-6. Epub 2023 May 19.
Squamous verrucous proliferative lesions of oral cavity can pose a diagnostic challenge for the general pathologist, especially on small biopsies. The superficial nature of incisional biopsies and inconsistent histologic terminologies used for these lesions contribute to often-discrepant clinical diagnosis, resulting in delayed treatment. This study aims to explore the proliferative squamous lesions of oral cavity, correlate biopsy & resection diagnoses, and evaluate possible reasons for discrepant diagnosis (if any).
A retrospective review of oral verrucous squamous lesions was undertaken. Pathology database was searched for oral cavity biopsies from January2018 through August2022 with the keywords: atypical, verrucous, squamous, and proliferative. Cases with follow-up were included in this study. A blinded review of the biopsy slides was performed and documented by a single head and neck pathologist. Demographic data, biopsy and final diagnosis were recorded.
Twenty-three cases met criteria for inclusion. The mean patient age was 61.1 years with a male: female ratio of 1.09. Most frequent site was lateral border of tongue (36%) followed by buccal mucosa and retromolar trigone. The most common biopsy diagnosis was "Atypical squamoproliferative lesion, excision recommended" (n = 16/23, 69%) with 13/16 showing conventional squamous cell carcinoma (SCC) on follow-up resection. 2/16 atypical cases underwent repeat biopsy for confirmation of diagnosis. Overall, conventional SCC was the most prevalent final diagnosis (73%, n = 17), followed by verrucous carcinoma (17%, n = 4). On slide review, six initial biopsies were reclassified as SCC, while one final diagnosis was reclassified as a hybrid carcinoma (on resection specimen). Diagnostic concordance (biopsy and resection) was observed in three cases, all three were recurrences. The primary reasons for discrepant diagnosis on initial biopsies were found to be 1. Obscuring inflammation, 2. Superficial biopsies, and 3. Under recognition of morphologic features (e.g., tear shaped rete, loss of polarity, dyskeratotic cells, paradoxical maturation) that help differentiate dysplasia from reactive atypia.
This study highlights the rampant interobserver variability in diagnosis of oral cavity squamous lesions and emphasizes importance of identifying morphologic clues that can aid in correct diagnosis, thereby helping in adequate clinical management.
口腔的鳞状疣状增生性病变对普通病理学家来说可能具有诊断挑战性，尤其是在小活检标本上。切取活检的表浅性和用于这些病变的不一致的组织学术语导致临床诊断经常存在差异，从而导致治疗延迟。本研究旨在探讨口腔的增生性鳞状病变，比较活检和切除诊断，并评估可能存在的诊断差异的原因（如果有）。
对口腔疣状鳞状病变进行回顾性研究。通过关键词：非典型、疣状、鳞状和增生性，在 2018 年 1 月至 2022 年 8 月期间，对口腔活检的病理数据库进行了搜索。包括有随访的病例。由一名头颈部病理学家对活检切片进行盲法复查并记录。记录人口统计学数据、活检和最终诊断。
23 例符合纳入标准。患者平均年龄为 61.1 岁，男女比例为 1.09。最常见的部位是舌侧缘（36%），其次是颊黏膜和磨牙后三角。最常见的活检诊断为“非典型鳞状增生性病变，建议切除”（n=23/23，69%），其中 13/16 例在随访切除时显示为常规鳞状细胞癌（SCC）。2/16 例非典型病例进行了重复活检以确认诊断。总的来说，常规 SCC 是最常见的最终诊断（73%，n=17），其次是疣状癌（17%，n=4）。在切片复查中，6 例初始活检被重新分类为 SCC，而 1 例最终诊断被重新分类为混合癌（在切除标本上）。在 3 例病例中观察到活检和切除的诊断一致性，这 3 例均为复发。在初始活检中诊断差异的主要原因是 1. 炎症模糊，2. 活检表浅，3. 形态特征识别不足（例如，泪滴状网、极性丧失、角化不良细胞、反常成熟），这些特征有助于将发育不良与反应性非典型区分开来。
本研究强调了口腔鳞状病变诊断中的观察者间变异很大，并强调了识别有助于正确诊断的形态学线索的重要性，从而有助于进行适当的临床管理。
