Differential Diagnosis of Proliferative Verrucous Leukoplakia in Tongue: Report of a Case

Abstract

Background:  Proliferative verrucous leukoplakia (PVL), a rare and aggressive form of oral leukoplakia (OL) of unknown etiology. Associated with tobacco, Human Papillomavirus, and Candida Albicans. It is characterized by progressive multifocal lesions with an inadequate therapeutic response, high recurrence, and a tendency to become malignant. 

Clinical Presentation: Male patient, 54 years old, systemically healthy, smoker.  White lesion on dorsal midtongue, in the posterior 2/3 of the tongue, with a slightly exophytic shape that did not come off when scraping, with defined edges associated with erythematous mucosa. In the right side, in the middle there was another similar lesion. An incisional biopsy: The one located in the right area presented epithelial hyperplasia, covered by a thick layer of keratin, and the one in the left area presented hyperkeratinized epithelium, withering of the basement membrane and of the subepithelial lymphocyte band, resulting in the histopathological diagnosis of hyperkeratosis. Elimination of smoking habits, and periodic controls were indicated. 

Clinical Relevance:  LVP predominantly affects women over 60 years of age. It tends to progress from a single to multifocal lesions distributed over the gingiva, jugal mucosa, alveolar ridge, and tongue, with exophytic growth, a verrucous appearance with keratinized areas. Histology can show a variety of features, from hyperkeratosis in the early stages, acanthosis, and atypia, which can then progress to verrucous hyperplasia, warty carcinoma, and finally squamous cell carcinoma. Currently, there is no effective therapeutic protocol, since it has a high recurrence, making it essential to avoid risk factors and monitor periodically. 

Conclusion: PVL is a multifocal pathology, with high recurrence and potential for malignancy. Its early diagnosis is essential to carry out an adequate follow-up, in addition to centering its treatment on eliminating risk factors, performing periodic controls, and biopsies.