Proliferative verrucous leukoplakia and its progression to oral carcinoma: report of three cases

Abstract

Proliferative verrucous leukoplakia (PVL) is a distinct clinical form of oral leukoplakia defined by its progressive clinical course, changing clinical and histopathologic features, and potential to develop into cancer. PVL behaves in a more aggressive and relentless manner than the more innocuous white oral lesions that it can resemble clinically. We present three cases of PVL that progressed to carcinoma and discuss the histopathologic findings that may either hinder or assist in the diagnosis.

Proliferative verrucous leukoplakia, squamous cell carcinoma and axillary metastasis

“…The poor prognosis in cases with axillary metastasis may result from the high risk of simultaneous occurrence of other distant metastasis (16). Presentation of distant metastasis is usually in the late course of the disease and almost invariably means an unfavorable prognosis (11). Pulmonary metastases are the most frequent in HNSCC, accounting for 66% of distant metastases.…”

“…Distant metastases from head and neck SCC are relatively common, mainly after recurrence of local or regional disease, but metastases from the upper aerodigestive tract to the axillary lymph nodes is an unusual event (12,14). The metastases drainage way can be suggested mainly by location, size of the primary tumor and regional lymph nodal control (11). Under certain conditions, however, this drainage way may become unpredictable with some metastases bypassing the expected lymph node group ("skip metastases"), occurring at the contralateral side of the neck (cross-over of the lymphatic drainage) or even affecting axillary lymph nodes (12,13).…”

“…Other sites include bone (hip, long bones or vertebral column), liver, skin, mediastinum and bone marrow (11). Patients with prior history of axillary metastases should have regular monitoring of their lymph nodes as part of their routine follow-up.…”

“…PVL presents multifocal or diffuse extension, tendency to recur after treatment and high risk of malignant transformation (1)(2)(3)(4)(5)(6)(7)(8).Several studies have reported high rates of malignant transformation which varies from 60% to 100% (2,3,9,10). Metastasis from oral squamous cell carcinoma (SCC) follows a predictable way of lymphatic drainage that varies particularly according to the anatomic site, size and histopathological features (11). Eventually, metastasis can follow an unpredictable pattern and involve unexpected lymph nodes such as contralateral cervical lymph nodes, low jugular-carotid lymph nodal chain and even axillary lymph nodes (12,13).…”

A case of oral multiple primary cancer including Spindle Cell Carcinoma

“…More than 150 cases of PVL have been reported [10][11][12][13][14][15][16] and the rate of malignant conversion during the disease course is higher than 70% [11]. Malignant conversion to SCC and verrucous carcinoma (VC) has been reported [10][11][12][13][14][15][16], but there has been no case of conversion of PVL with an anaplastic change to SPCC. Thus, the present case provides the first example of such a course of PVL.…”