Proliferative Verrucous Leukoplakia (PVL)

Abstract

Proliferative verrucous leukoplakia (PVL) is a rare less recognized form of oral leukoplakia. Patients with this condition represent a unique clinically and pathologically progressive characteristic from conventional leukoplakia. Because of the lack of defined pathologic lesions, identifying patients with the early diagnosis of PVL is challenging. This is largely due to the overlapping clinical and pathologic early features with conventional multifocal leukoplakia with dysplasia. The diagnosis can only be achieved through the keen clinical observation of the temporal progression in individual patients to verrucous and/or conventional squamous carcinoma. We present a brief view of the clinicopathologic and biological characteristics of PVL and discuss diagnosis, differential diagnosis, and management.

Epidemiologic Trends in Head and Neck Cancer and Aids in Diagnosis

“…Moreover, PVL generally lacks specific morphologic features including the classical microscopic features of epithelial dysplasia making PVL specifically a clinical diagnosis. Clinically and microscopically PVL may mimic the plaque variant of lichen planus because of its multifocal involvement and frequent presentation of lichenoid inflammation in the biopsy 33 .…”

Low expression of angiotensinogen and dipeptidyl peptidase 1 in saliva of patients with proliferative verrucous leukoplakia

“…Proliferative verrucous leukoplakia (PVL) is a seldom variant of oral leukoplakia with an unique behavior characterized by persistent progression to malignancy[1-7]. The rate of malignant transformation of PVL ranges from 40%-100%[1,3,5,8-12].…”

“…Recent reviews on PVL have considered lesions with lichenoid aspects that progress to classical PVL phenotype in addition to the clinical aspect of multiple hyperkeratotic white plates with verrucous and expansive nature[6,7,16]. Four histological features are encountered over the course of the disease: Hyperplasia and hyperkeratosis with no epithelial dysplasia; multifocal expansion of lesions with or without varied grade of dysplasia; verrucous hyperplasia; and verrucous carcinoma or frankly invasive oral squamous cell carcinoma (OSCC)[5-7].…”

“…Four histological features are encountered over the course of the disease: Hyperplasia and hyperkeratosis with no epithelial dysplasia; multifocal expansion of lesions with or without varied grade of dysplasia; verrucous hyperplasia; and verrucous carcinoma or frankly invasive oral squamous cell carcinoma (OSCC)[5-7]. Nevertheless, not all lesions present with histopathological progression involving verrucous hyperplasia and verrucous carcinoma before OSCC.…”

“…Nevertheless, not all lesions present with histopathological progression involving verrucous hyperplasia and verrucous carcinoma before OSCC. Currently, four main stages may be encountered during PVL development: Initial focal involvement, geographic expansion (multifocal) over time, development of a warty appearance and finally, development of a cancer[6,7]. …”