Oral proliferative verrucous leukoplakia: A case report with
White lesions both physiologic as well as pathologic are relatively frequent in the oral cavity, the most common pathology being oral leukoplakia (OL). There are many variants of OL, one of which is oral proliferative verrucous leukoplakia (OPVL). It is a rare, but highly aggressive form of OL, which requires special awareness on the part of the clinician. Therefore, it is recommended to have the earliest possible diagnosis and total excision of this lesion.

A 60 year old male patient reported with the chief complaint of missing teeth in upper and lower jaw since 2 years and wanted replacement. There was a history of reduced mouth opening since last 2 years and his past medical history, including his family history was unremarkable. Patient gave a history of tobacco chewing since childhood 2 3 times/day but has quit the habit completely since last 2 years.

Extra oral examination revealed right and left submandibular lymphadenopathy, which was non tender and mobile. Intra oral examination revealed white verrucous, slightly raised lesion with a granular texture measuring approximately 4 cm × 4 cm in size on maxillary anterior alveolus in relation to tooth number 12 21, extending to upper vestibule including labial frenum. Similar lesion was present on left mandibular alveolus in relation to tooth number 31 35 including vestibule and labial mucosa, crossing the midline.

Superioinferiorly the lesion presented as a thin linear raised band on the left side of the oral cavity extending from left upper vestibule to lower vestibule. On palpation, the growth was firm, non tender, non fluctuant and non compressible. Based on the history and clinical examination, a provisional clinical diagnosis of OPVL was made.

Patient was subjected to following investigations to reach to a probable diagnosis:
• Toluidine blue staining used as routine staining was positive in this area, which was then completely excised
• A complete hemogram was performed and all the values were in the normal range
• An excisional biopsy was performed at left mandibular alveolus region and the excised tissue was sent for histopathological analysis.

Histopathological examination revealed hyperkeratotic epithelium showing dysplastic features like basilar hyperplasia and hyperchromatic cells extending up to the lower third of epithelium. The stroma was made up of collagen fibers with plump to spindle shaped fibroblasts along with patchy distribution of inflammatory cells predominately lymphocytes and plasma cells seen in the juxta epithelial region.

Histologically, the lesion was diagnosed as hyperkeratosis with mild dysplasia. The overall clinical and histopathological findings were considered diagnostic for OPVL; hence, the final diagnosis.

Subsequent to histological diagnosis, the entire lesion was surgically excised using electrocautery and the region was sutured.

Read in detail here: http://medind.nic.in/cab/t13/i2/cabt13i2p258.pdf