Oral leukoplakia, a clinical-histopathological study in 412 patients

Rubert, Andrea; Bagán, Leticia; Bagán, José

doi:10.4317/jced.57091

Cited by 17 publications

(33 citation statements)

References 29 publications

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“…It has been reported in the literature that, clinically, leukoplakia usually presents as a homogeneous lesion. Scheifele et al observed homogeneous leukoplakia to clearly predominate (86.8%) as compared to non-homogenous type, 8 similarly, Rubert et al, found in their study that 81.6% of the patients were having homogeneous type of oral leukoplakia, in accordance to this, most of the cases in our study were found to be of homogenous leukoplakia [9] . In our study, majority of the cases which were diagnosed clinically diagnosed as leukoplakia presented a histological diagnosis of hyperkeratosis (45%) mild epithelial dysplasia (33.33%), which suggests a less aggressive nature.…”

Section: Discussionsupporting

confidence: 87%

Clinical and histopathological presentation of oral leukoplakia among different forms of tobacco users: A comparative study

Shrinivas¹,

Doni²

2021

Int. J. Appl. Dent. Sci.

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To compare the clinical and histopathological presentation of oral leukoplakia among different forms of tobacco users. Material and Methods: This study was carried out among 300 patients with oral leukoplakia, analyzing the corresponding clinical factors and histopathological findings, different forms of tobacco usage and assessing associations between the different clinical presentations and epithelial dysplasia. Results: Out of a total of 300 subjects, most (87.33%) of the subjects were males, among 138 tobacco chewers, maximum (60.87%) were having homogenous leukoplakia, among 85 tobacco smokers, maximum (61.18%) were seen with homogenous leukoplakia and among 77 subjects having mixed habit, maximum of 51.95% were diagnosed as having homogenous leukoplakia. The association between clinical type of leukoplakia and habit type was statistically not significant (Chi-square= 5.0806, p=0.5336). Majority of the cases which were diagnosed clinically diagnosed as leukoplakias presented a histological diagnosis of hyperkeratosis (45%) and mild epithelial dysplasia (33.33%). The association between histopathological type of leukoplakia and habit type was found to be statistically significant (Chi-square= 23.2166, p=0.0007). Conclusion: Most of the patients were having homogenous leukoplakia and majority of the cases which were diagnosed clinically diagnosed as leukoplakias presented a histological diagnosis of hyperkeratosis, mild epithelial dysplasia.

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Section: Discussionsupporting

confidence: 87%

Clinical and histopathological presentation of oral leukoplakia among different forms of tobacco users: A comparative study

Shrinivas¹,

Doni²

2021

Int. J. Appl. Dent. Sci.

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“…It is well established that the risk of malignant transformation is significantly associated to the localization of OLP. Thus, OLP, which developed on the tongue or at the floor of mouth progress more often into malignancy as OLP at other sides of the oral cavity [ 53 ]. Additionally, positive PD-L1 staining was significantly more likely in tongue squamous cell carcinomas [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Importance of the PD-1/PD-L1 Axis for Malignant Transformation and Risk Assessment of Oral Leukoplakia

et al. 2021

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Background: The programmed cell death ligand 1/programmed cell death receptor 1 (PD-L1/PD-1) Immune Checkpoint is an important modulator of the immune response. Overexpression of the receptor and its ligands is involved in immunosuppression and the failure of an immune response against tumor cells. PD-1/PD-L1 overexpression in oral squamous cell carcinoma (OSCC) compared to healthy oral mucosa (NOM) has already been demonstrated. However, little is known about its expression in oral precancerous lesions like oral leukoplakia (OLP). The aim of the study was to investigate whether an increased expression of PD-1/PD-L1 already exists in OLP and whether it is associated with malignant transformation. Material and Methods: PD-1 and PD-L1 expression was immunohistologically analyzed separately in the epithelium (E) and the subepithelium (S) of OLP that had undergone malignant transformation within 5 years (T-OLP), in OLP without malignant transformation (N-OLP), in corresponding OSCC and in NOM. Additionally, RT-qPCR analysis for PD-L1 expression was done in the entire tissues. Additionally, the association between overexpression and malignant transformation, dysplasia and inflammation were examined. Results: Compared to N-OLP, there were increased levels of PD-1 protein in the epithelial and subepithelial layers of T-OLP (pE = 0.001; pS = 0.005). There was no significant difference in PD-L1 mRNA expression between T-OLP and N-OLP (p = 0.128), but the fold-change increase between these groups was significant (Relative Quantification (RQ) = 3.1). In contrast to N-OLP, the PD-L1 protein levels were significantly increased in the epithelial layers of T-OLP (p = 0.007), but not in its subepithelial layers (p = 0.25). Importantly, increased PD-L1 levels were significantly associated to malignant transformation within 5 years. Conclusion: Increased levels of PD-1 and PD-L1 are related to malignant transformation in OLP and may represent a promising prognostic indicator to determine the risk of malignant progression of OLP. Increased PD-L1 levels might establish an immunosuppressive microenvironment, which could favor immune escape and thereby contribute to malignant transformation. Hence, checkpoint inhibitors could counteract tumor development in OLP and may serve as efficient therapeutic strategy in patients with high-risk precancerous lesions.

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“…In this study the age of patients also did not influence the risk of malignant transformation [ 28 ]. On the other hand, in retrospective research conducted by Rubert et al, in a group of 412 patients diagnosed with oral leukoplakia, females (281) predominated over males (131) [ 29 ]. In that research most patients (53.2%) were also non-smokers and did not consume alcohol (85%).…”

Section: Discussionmentioning

confidence: 99%

“…In the study, 57.1% of cases were diagnosed among female patients and 42.9% among male patients, which may lead to a conclusion that female patients might be more prone to malignant transformation of oral leukoplakia [ 29 ], which is the opposite result of the research conducted by Jayasooriya et al [ 28 ], Wang et al [ 27 ], and meta-analysis prepared by Matulić et al, which also revealed that there were no statistically significant differences in malignant transformation of oral leukoplakia between male and female patients [ 30 ]. Nevertheless, returning to the statement that the age of patients may influence the clinical symptoms of leukoplakia, the study by Rupert et al also seems to confirm this [ 29 ]. In their research, patients with clinically non-homogeneous lesions were older and lesions of non-homogeneous leukoplakia were larger than clinically homogenous to a statistically significant degree.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the most commonly diagnosed form of leukoplakia was the homogeneous form, which was diagnosed on the cheeks, less often on the gums and tongue. Although, according to Brouns et al, there is no association between localization of oral leukoplakia lesions and risk of malignant transformation [ 35 ], Rubert et al still observed that lesions localized on the tongue present a higher risk of malignization than other localizations of leukoplakia in the oral cavity [ 29 ]. Furthermore, systematic review conducted by Pinto et al revealed that leukoplakia lesions localized on both tongue and flor of the mouth present a higher risk of malignant transformation, however the tongue still remains the most common localization for the malignant transformation of oral leukoplakia [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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The Analysis of the Frequency of Leukoplakia in Reference of Tobacco Smoking among Northern Polish Population

Kusiak

Maj

Cichońska

et al. 2020

IJERPH

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Objective: The aim of the study was an updated analysis of the frequency of leukoplakia in reference to tobacco smoking among the northern Polish population. Material and Methods: Medical records of 5720 patients who suffer from abnormalities and oral mucosa diseases between January 2015–December 2018 were analyzed. Among them, 416 medical charts of patients with leukoplakia were selected. The study group consisted of 196 women and 220 men aged between 21–86 years (average 45.6 years). The analysis was conducted in terms of age, gender, and smoking tobacco. The basic criterion for inclusion in the study was the presence of oral leukoplakia confirmed by histopathological examination, recorded in the chart. Information about the patient’s active smoking was obtained from documented medical interviews. An active smoker was defined as a patient who smoked 10 or more cigarettes a day for at least the previous six months. The study used parametric and non-parametric statistical methods. Results: The highest incidence of leukoplakia was found in the age group 41–60 (46.6%), where the vast majority were active smokers (85.1%), and mostly men (86.2%). However, among patients with leukoplakia, the highest prevalence of smoking was found in the age group 21–40 years (86.8%) in women, where out of 38 patients with leukoplakia, 33 were active smokers. More patients with leukoplakia were observed in groups of smokers and it was statistically significant. Homogeneous form was the most commonly diagnosed form of leukoplakia in our study; it was found in almost 95% of cases. Leukoplakia was mainly observed on the cheeks. Changes on the gums, the alveolar process or the bottom of the tongue and mouth were rarely found. Conclusion: Our studies revealed that there is a statistically significant correlation between tobacco smoking and the presence of oral leukoplakia among the northern Polish population. It should be noted that dentists, in particular, are capable of early diagnosis and implementation of appropriate treatment of leukoplakia and, most often, crucial elimination of the main risk factor, which is smoking, and the implementation of effective tobacco control interventions.

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Oral leukoplakia, a clinical-histopathological study in 412 patients

Cited by 17 publications

References 29 publications

Clinical and histopathological presentation of oral leukoplakia among different forms of tobacco users: A comparative study

Clinical and histopathological presentation of oral leukoplakia among different forms of tobacco users: A comparative study

Importance of the PD-1/PD-L1 Axis for Malignant Transformation and Risk Assessment of Oral Leukoplakia

The Analysis of the Frequency of Leukoplakia in Reference of Tobacco Smoking among Northern Polish Population

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