Proliferative verrucous leukoplakia of the gingiva
Proliferative verrucous leukoplakia of the gingiva
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DOI：
10.1067/moe.2000.108950
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发表时间：
2000-12-01
影响因子：
--
通讯作者：
Regezi, JA
中科院分区：
文献类型：
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作者：
Fettig, A;Pogrel, MA;Regezi, JA
目标。这项研究的目的是描述一种看起来像是牙龈增生性疣状白斑的临床病理特征。加州大学旧金山分校1994年至1999年间诊断和治疗的10名患有复发和组织进行性牙周白斑的成人患者组成了这项研究的受试组。对其临床和显微特征进行复习。用免疫组织化学方法检测细胞增殖指数和P53蛋白的表达，用聚合酶链式反应(PCR)方法检测HPV DNA的存在。随着时间的推移，扁平皮损形成乳头状或疣状轮廓。虽然病变是复发的，但它们仅限于牙龈，并且没有出现多发性病变。一半的患者使用烟草，用聚合酶链式反应检测不到HPV。镜下6例以角化过度开始，3例最初表现为银屑病样伴明显炎症成分。随着复发，病变在组织学上逐渐变得不典型。这些皮损的增殖指数较正常上皮略有增加，10例中有4例P53染色阳性，表明这些皮损的角质形成细胞周期被破坏。P53染色阳性的机制(与野生型P53蛋白结合或P53基因突变)尚未确定。结论增生性疣状白斑(PVLC)是口腔增生性疣状白斑的一个亚型。它的特征是一种孤立的、反复出现的、渐进性的白色斑块，形成疣状结构，可能与HPV无关。PVLC的病程不可预测，并有发展为疣状或鳞状细胞癌的风险。目前还没有办法确定或预测哪些牙周白色病变将遵循为这组PVLG患者描述的临床过程。
Objective. The purpose of this study was to describe the clinical-pathologic features of what appears to be a gingival form of proliferative verrucous leukoplakia.Study design. Ten adult patients with recurrent and histologically progressive gingival leukoplakias who were diagnosed and treated at the University of California, San Francisco between 1994 and 1999, comprised the subject group for this investigation. Clinical and microscopic features were reviewed. Proliferation indices and p53 expression were evaluated immunohistochemically and the presence of human papillomavirus (HPV) DNA was determined by using polymerase chain reaction (PCR) amplification.Results, Lesions presented as solitary or regional flat/papillary/verrucal leukoplakias of the free and attached gingiva (tooth-bearing areas only). With time, flat lesions developed a papillary or verruciform profile. Although lesions were recurrent, they were confined to the gingiva, and multiple lesions did not develop. Half the patients used tobacco, and HPV could not be detected by using PCR. Microscopically 6 cases began as hyperkeratotic lesions, and 3 initially exhibited a psoriasiform pattern with a marked inflammatory component. With recurrences, the lesions became progressively atypical histologically. The proliferation indices for these lesions showed modest increases over normal epithelium, and positive p53 staining was evident in 4 of 10 cases, indicating a disruption of the keratinocyte cell cycle in these lesions. The mechanism associated with the positive p53 staining (protein binding to wild type p53 versus mutation of the p53 gene) was not determined. Lesions recurred after conservative scalpel or laser excision, and many developed into verrucous or squamous cell carcinoma.Conclusions, Proliferative verrucous leukoplakia of the gingiva (PVLC) appears to be a subset of oral proliferative verrucous leukoplakia. It can be characterized as a solitary, recurring, progressive white patch that develops a verruciform architecture and may not be associated with HPV. PVLC has an unpredictable course and is at risk for development into verrucous or squamous cell carcinoma. Currently there is no way to determine or predict which gingival white lesions will follow the clinical course described for this group of patients with PVLG.