It is composed of keratinocytes that arise from pluripotential germ cells in the basal layer of the embryonic ectoderm and results from mosaic postzygotic mutations. Verrucous hyperplasia must be distinguished with verrucous carcinoma because they have very thin line of distinction. Sixty consecutive ovh cases were collected from 2003 to 2004. A common and problematic finding in the highrisk diabetic foot, abstract although verrucous hyperplasia may be common in highrisk insensitive feet, the literature contains little discussion on this topic. Oral verrucous hyperplasia is a whitish or pinkinsh elevated pre malignant lesion which occurs rarely. A retrospective analysis for clinicopathologic features wanjari g sonalika, tegginamani anand department of oral and maxillofacial pathology, hitkarini dental college and hospital, jabalpur, madhya pradesh, india. Most commonly buccal mucosa affected in women and tongue in men. A clinicopathologic dilemma revisited using p53 as immunohistochemical marker. It resembles linear psoriasis both clinically and histologically. Proliferative verrucous leukoplakia of the gingiva. If lymph nodes are palpable, they usually present as an inflammatory reaction in large secondarily infected lesions. Proliferative verrucous leukoplakia appears as a single or multifocal growth involving several oral sites. Verrucous lesions arising in lymphedema and diabetic.
The dermis shows multiple, thinwalled, dilated bloodfilled spaces. Rarely, there may be associated abnormalities involving other ectodermal structures. Here we are presenting such a case of verrucous carcinoma over the leg unusual site. However, premalignant and malignant verrucous and papillary lesions pose a much greater diagnostic challenge, not helped by often confusing terminology. Treatment of verrucous carcinoma remains controversial. Exophytic verrucous hyperplasia of the oral cavity. Ilven inflammatory linear verrucous epidermal nevus, also known as ilven, is clinicopathological subgroup of epidermal nevus. Clinically and histologically oral verrucous hyperplasia, a potentially. The oral cavity is the most common site of this tumor. Proliferative verrucous leukoplakia of the gingiva pvlg appears to be a subset of oral proliferative verrucous leukoplakia.
Low power reveals hyperkeratosis and papillomatosis across the breadth of the specimen figures 2,3. The lesion presents as persistent linear, pruritic eruptions. Pdf oral verrucous hyperplasia is a verrucopapillary lesion of the oral mucosa which. Pdf oral verrucous hyperplasia ovh is a premalignant lesion that may transform into an oral.
Since then, various published case series have presented pvl as a disease with aggressive biological behavior due to its high probability of recurrence and a high rate of malignant transformation, usually higher than 70%. Case report verrucous carcinoma a diagnositic dilemma. Verrucous hyperplasia in oral cavity although considered to be benign lesion, it has great tendency to become malignant. Dec 17, 2017 verrucous carcinoma is a relatively uncommon, locally aggressive, clinically exophytic, lowgrade, slowgrowing, welldifferentiated squamous cell carcinoma with minimal metastatic potential. Review exophytic verrucous hyperplasia of the oral cavity. Verrucous carcinoma, squamous cell carcinoma, histology. Verrucous lesions of the oral cavity with warty and exophytic clinical presentations can have varied histopathology. Ovh represents a histopathological entity whose clinical features are not well recognised and is usually clinically indistinguishable from a verrucous carcinoma. Successful treatment of a large oral verrucous hyperplasia.
The lesions included in this spectrum ranges from benign lesions like papilloma, premalignant lesions like verrucous hyperplasia vh to malignant verrucous carcinoma vc. Verrucous hyperplasia is a histopathological entity with clinical features that may be. Verrucous carcinoma may occur in various head and neck locations, as well as in the genitalia. Epidermal hyperplasia forms fingerlike projections with the intervening. Oral verrucous hyperplasia ovh is a premalignant lesion that may transform into a verrucous carcinoma or a squamous cell carcinoma. Inflammatory linear verrucous epidermal naevus pathology. The biopsies of the histopathologically diagnosed cases spanning last 10 years were retrieved from the archives of the oral pathology department of the institution. Introduction oral verrucous carcinoma is a rare tumor first described by ackerman. Verrucous hyperplasia is a hyperplastic disease that manifests as coalescent warty papules at stump amputation sites. Cytologically bland squamous carcinoma characterized by blunt, pushing margins. Verrucous carcinoma grows gradually, has a tendency of local invasion and seldom metastasizes.
Pathology outlines verrucous hyperplasia proliferative. Oral epithelial dysplasia, atypical verrucous lesions and oral. Verrucous psoriasis vp is a rare variant of psoriasis characterized by hyperkeratotic, papillomatous plaques that clinically resemble verrucous carcinoma vc in lesion appearance and distribution. Verrucous carcinoma is a relatively uncommon, locally aggressive, clinically exophytic, lowgrade, slowgrowing, welldifferentiated squamous cell carcinoma with minimal metastatic potential. Essential features in distinguishing verrucous hyperplasia from verrucous carcinoma is the location of the thickened epithelium with respect to adjacent normal appearing epithelium. Verrucous hyperplasia synonyms, verrucous hyperplasia. Verrucous hyperplasia is a histopathological entity, which. Histopathologically, proliferative verrucous leukoplakia pvl changes gradually from a simple plaque of hyperkeratosis without dysplasia to verrucous hyperplasia, verrucous carcinoma or oral squamous cell carcinoma oscc. Dec 12, 2017 verrucous hyperplasia in oral cavity although considered to be benign lesion, it has great tendency to become malignant. Verrucous epidermal nevus ven is a benign, noninflammatory malformation usually present at birth or occurring within the first years of life.
Oral verrucous hyperplasia ovh is a premalignant lesion that may transform into an oral cancer. The main histopathological differential diagnosis of verrucous carcinoma is from leukoplakia, papilloma, pseudoepitheliomatous hyperplasia, verrucous hyperplasia and highly differentiated squamous cell carcinoma. As described above, papillary hyperplasia is a reactive condition, whereas verrucous hyperplasia is, at best, a potentially malig. Differential diagnoses in the histopathological examination should include keratosis, squamous papilloma, verrucous hyperplasia, and verrucous carcinoma. The present retrospective study was carried out to analyze the clinicopathological features of. Its is also considered to be an early form of verrucous carcinoma. Proliferative verrucous leukoplakia pvl is a recently delineated entity that is defined as a diffuse, white and smooth or papillary or wartlike area of the oral mucosa caused by varying degrees of epithelial hyperplasia. Microscopically controlled surgery mohs chemosurgery for treatment of verrucous squamous cell carcinoma of the foot epithelioma cuniculatum. Verrucous carcinoma verrucuous carcinoma is an uncommon kind of welldifferentiated squamous cell carcinoma. Jun 14, 2017 a wide variety of papillary and verrucous lesions can affect the oral mucosa. Because only a small part of the tumor was examined histologically, we still could not rule out the possibility of the concomitant presence of an oral verrucous carcinoma in other parts of the lesion. The histopathological diagnosis was a verrucous hyperplasia fig. Clinicopathological features and the 5year malignant transformation.
Clinical and histopathological diagnosis of these lesions is challenging. Synonyms for verrucous hyperplasia in free thesaurus. Underdiagnosed oral precursor lesion that requires retrospective clinicopathological correlation ozgur mete 1, yaren keskin 2, gunter hafiz 3, kivanc bektas kayhan 2, meral unur 2 dermatology online journal 16 5. Systematized verrucous epidermal nevus a case report pdf. Erythematous verrucous plaque on the hand mdedge dermatology. In verrucous carcinoma, there exhibits a downward growth pattern of rete. Papillary and verrucous lesions of the oral mucosa diagnostic. Verrucous carcinoma vc is an uncommon variant of squamous cell carcinoma. Verrucous hyperplasia definition of verrucous hyperplasia. It rarely occurs in the floor of the mouth and tongue. Printable verrucous carcinoma of the anus surgical.
Rarely, neoplastic transformation into squamous cell carcinoma, basal cell carcinoma have been reported in few cases. This can only be differentiated with biopsy of the lesion and its histopathology test. Surgery is the mainstay of treatment of this neoplasm. Vc is a locally invading tumor and does not spread to the local lymph nodes. B, histopathology of white lesion illustrated in a. Verrucous hyperplasia vh is a rare exophytic oral mucosal lesion which can. Oral verrucous hyperplasia ovh is a potentially malignant. Disseminated tinea of the verrucous type due to epidermophyton. We have reported a case of verrucous hyperplasia which was diagnosed and treated with buccal fat pad as graft. Often overlooked, it can be confused with verrucous carcinoma.
Aug 18, 2015 verrucous skin lesions on the feet in diabetic neuropathy is categorized as a pseudoepitheliomatous hyperplasia that can be triggered by various chronic inflammatory stimuli on the background of diabetic neuropathy. Pseudoepitheliomatous hyperplasia verrucous carcinoma is characterized by blunt, destructive downward growth this distinction is frequently not possible on histologic grounds alone. The biopsies of the histopathologically diagnosed cases spanning last 10 years were retrieved from the archives of the oral pathology. A 75yearold retired farmer presented with an erythematous verrucous plaque on the dorsal aspect of the left hand of 4 years duration. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which was first described in 1985 by hansen et al. It may lead to the gross enlargement of an organ, and the term is sometimes confused with benign neoplasia or benign tumor. Rarely, there may be associated abnormalities involving other ectodermal structures histology of inflammatory linear verrucous epidermal naevus. Verrucous carcinoma is a low grade malignancy and is a variant of squamous cell carcinoma. This is an open access article distributed under the terms of the creative commons attributionnoncommercialsharealike 3. For example, papillary hyperplasia is a reactive in. Superficial biopsies from the lesion 4 years prior to presentation revealed pseudoepitheliomatous hyperplasia suggestive of squamous cell carcinoma, which led to the excision of the lesion along with 2 digits of the left hand.
Superficial biopsies from the lesion 4 years prior to presentation revealed pseudoepitheliomatous hyperplasia suggestive of squamous cell carcinoma, which led to the excision of the lesion along. This form of cancer is often seen in those who chew tobacco or use snuff orally, so much so that it is sometimes referred to as snuff dippers cancer. Epidermal naevus falls into the category of benign epidermal tumours histology of epidermal naevus. Inflammatory linear verrucous epidermal naevus ilven is a distinct form of inflammatory epidermal naevus with a characteristic histopathology. Hyperplasia of the breast hyperplastic lesions of the breast include usual ductal hyperplasia, a focal expansion of the number of cells in a terminal breast duct, and atypical ductal hyperplasia, in which a more abnormal pattern of growth is seen, and which is associated with an increased risk of developing breast cancer. An abnormal increase in the number of cells in a tissue or organ, with consequent enlargement of the part or organ. Verrucous hyperplasia, papillary dysplasia, papillary and verrucous carcinoma the uncertainty as to the true nature of these lesions is betrayed by the morass of confusing and unsatisfactory terminology. Older reports of transformation of verrucous carcinoma following radiation therapy at various sites have not been supported by the recent literature. A highresolution version of this slide for use with the virtual microscope is available as eslide.
Intravascular thrombosis with recanalisation and hemorrhage can be seen figures 15. Essential features in distinguishing verrucous hyperplasia from verrucous carcinoma is the location of the thickened epithelium with respect to. Proliferative verrucous leukoplakia of the gingiva adam fettig, dmd,a m. Papillary and verrucous lesions of the oral mucosa. Verrucous hyperplasia is a histopathological entity, which shows considerable clinical and histological resemblance to verrucous carcinoma.
Oral epithelial dysplasia, atypical verrucous lesions and. Oral verrucous hyperplasia is a verrucopapillary lesion of the oral mucosa which possesses enigmatic features which make the diagnosis very much challenging. Verrucous carcinoma may involve the oral cavity, larynx, anogenital region, plantar surface of the foot, and, less commonly, other cutaneous sites. Verrucous hyperplasia article about verrucous hyperplasia. Scitech verrucous leukoplakia a diagnostic dilemma. In ilven, sections show skin with psoriasiform epidermal hyperplasia with alternating. Verrucous skin lesions on the feet in diabetic neuropathy is categorized as a pseudoepitheliomatous hyperplasia that can be triggered by various chronic inflammatory stimuli on the background of diabetic neuropathy. Atypical verrucous hyperplasia in a patient with proliferative verrucous leukoplakia.
Histology of inflammatory linear verrucous epidermal naevus. Verrucous carcinoma of the skin is an uncommon lowgrade squamous. Verrucous hyperplasia probably represents a morphological variant of verrucous carcinoma by slootwage j p and muller h 1983. Oral verrucous hyperplasia ovh is a premalignant lesion that may transform into an oral.
In verrucous haemangioma, the histopathology shows irregular papillomatosis, acanthosis and hyperkeratosis of the epidermis. The papillary or verrucoustype lesions are quite common in the oral region, representing 3% of all the biopsied oral lesions. Mar 22, 2011 oral verrucous hyperplasia is a whitish or pinkinsh elevated pre malignant lesion which occurs rarely. The most common site of origin of this type of cancer normally develops in gingiva gums, alveolar mucosa and buccal mucosa of the oral cavity or buccal cavity. There have been eight reports of vsldn 16 in the english. It is clinically inflammatory in nature with psoriasiform histopathology. Verrucous carcinoma of the leg a rare variant of squamous. A wide variety of papillary and verrucous lesions can affect the oral mucosa. Development of proliferative verrucous leukoplakia starts as a simple hyperkeratosis without epithelial dysplasia, verrucous carcinoma and then carcinoma.