Proliferative Verrucous Leukoplakia Workup

Updated: Feb 20, 2019
  • Author: Rahat S Azfar, MD; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Workup

Laboratory Studies

Although no definitive role has been identified for human papillomavirus (HPV) infection, lesional polymerase chain reaction testing for HPV DNA may be performed. In addition, flow cytometric analysis of tissue may have a role in detecting lesions of proliferative verrucous leukoplakia (PVL) early in the course of disease. Furthermore, increased expression of Mcm-2 as detected by immunohistochemistry may be helpful in identifying areas of potential malignant transformation within lesions of proliferative verrucous leukoplakia. [24, 25] A small 2016 study of salivary proteins has shown an association with low-expression levels of angiotensin and dipeptidyl peptidase 1 proteins in proliferative verrucous leukoplakia patients versus controls, suggesting that these could be used as potential biomarkers of disease in the future. [26]

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Procedures

Perform an oral biopsy using either a scalpel or a brush biopsy, and use computer-aided analytical techniques to detect dysplasia or carcinoma.

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Histologic Findings

Histology findings can range from verrucous hyperplasia to verrucous carcinoma to less-differentiated carcinoma and can include any combination of these histologic features. Additionally, a lymphocytic lichenoid infiltrate without evidence of significant basilar vacuolization has been reported in some cases. [10, 20] One or more of these histologic features may appear in a single biopsy specimen, multiple biopsies taken at the same time, or from serial biopsies over time. [27] Because of this variability, the diagnosis of proliferative verrucous leukoplakia (PVL) is based mainly on clinical findings. [28, 29]

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