Architectural Alterations in Oral Epithelial Dysplasia are Similar in Unifocal and Proliferative Leukoplakia
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ORIGINAL PAPER
Architectural Alterations in Oral Epithelial Dysplasia are Similar in Unifocal and Proliferative Leukoplakia Chia‑Cheng Li1 · Soulafa Almazrooa2 · Ingrid Carvo1 · Alfonso Salcines1 · Sook‑Bin Woo1,3,4 Received: 5 July 2020 / Accepted: 21 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The current WHO histopathologic criteria for oral epithelial dysplasia (ED) are based on architectural and cytologic alterations, and do not address other histopathologic features of ED. Here we propose new diagnostic criteria including architectural, organizational, and cytologic features for oral ED. Cases of unifocal leukoplakia (UL) and proliferative leukoplakia (PL) with clinical photographs and follow-up information were identified. Only cases that showed minimal cytologic atypia or mild ED were used to demonstrate critical architectural changes as defined in this study. Eight biopsies from eight UL patients and 34 biopsies from four PL patients were included. The biopsies showed (a) corrugated, verrucous or papillary architecture, (b) hyperkeratosis with epithelial atrophy, (c) bulky squamous epithelial proliferation, and (d) demarcated hyperkeratosis and “skip” segments. The architectural alterations defined here are as important as the currently used criteria for the diagnosis of ED. Clinicopathologic correlation when diagnosing oral ED is also of the utmost importance in accurate diagnosis. Keywords Oral epithelial dysplasia · Malignant transformation · Architectural alteration · Leukoplakia · Proliferative verrucous leukoplakia
Introduction Oral leukoplakia is a precancerous condition [1]. It was defined in 2005 as “a white plaque of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer,” and this definition still stands today [1, 2]. As such, a true leukoplakia is a clinical term only after having ruled out other specific diagnoses. Histopathologically, leukoplakia exhibits hyperkeratosis or parakeratosis, epithelial atrophy or hyperplasia, epithelial dysplasia (ED), carcinoma-in-situ or invasive squamous cell * Chia‑Cheng Li Chia‑[email protected] 1
Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
2
Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
3
Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA, USA
4
Center for Oral Pathology, StrataDx Inc, Lexington, MA, USA
carcinoma (SCC) [2, 3]. Leukoplakia progresses to malignancy in 0.1–36.4% of cases and the time to malignant transformation varies depending on the study, the severity of ED, and the length of follow-up [4–8]. Leukoplakias that exhibited ED at the time of biopsy showed malignant transformation in 6.6–36.4% of the cases, while lesions without ED at the time of biopsy showed malignant transformation rate of 0.1–14.0% [9–13]. Histopathologic signs of ED are currently divided in
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