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White lesions of the oral cavity are not uncommon though majority of them are benign. This case report documents a rare case of idiopathic linear leukoplakia of gingiva with no apparent etiology. Initial examination revealed a non-scrapable linear white lesion on the marginal and papillary gingiva of upper right teeth region. Incisional biopsy was...
Citations
... 15 Likewise, in a case of "idiopathic linear leukoplakia of gingiva", the patient presented with linear white lesions on the maxillary facial and palatal gingiva of multiple teeth. 19 Incisional biopsy showed hyperplastic oral epithelium with para-/ortho-keratosis, with a lymphocytic band and no dysplasia. The patient had two recurrences following excisional biopsies, but no recurrence was noted at two year follow-up post electrosurgery. ...
... The presence of white lesions on marginal gingiva of multiple teeth that showed rapid progression, recurrence and benign histopathology fit the proposed criteria for PVL. 19 Another study reported two cases of isolated white lesions on the marginal gingiva of teeth, one provisionally diagnosed as frictional keratosis. 13 The final diagnoses of the biopsied lesions were epithelial hyperplasia consistent with KUS, and verrucous hyperplasia with no features of epithelial dysplasia. ...
Background:
Potentially malignant lesions of the gingiva may frequently present as well-demarcated white lesions confined to the marginal gingiva. These lesions often become thick and verrucoid and spread along the marginal gingiva to encircle the tooth. Some cases of marginal gingival leukoplakia, over time, progress to extensively involve the gingiva fulfilling the criteria for proliferative verrucous leukoplakia (PVL). The objective of this study is to raise awareness of this pattern of leukoplakia by reporting a series of cases of marginal gingival leukoplakia.
Methods:
An IRB approved retrospective search of UF and UNMC oral biopsy services was performed for all gingival biopsies. Inclusion criteria included cases (a) exhibiting marginal gingival leukoplakia, and (b) with accompanying clinical images.
Results:
A total of 30 cases of marginal gingival leukoplakia were included. All cases presented as well-demarcated leukoplakias, either on the buccal or lingual gingival margin, or circumferentially forming a "ring around the collar" of single or multiple teeth. Eight patients had recurrent lesions and twelve had multifocal involvement. Six of the 12 patients with multifocal involvement presented with a "ring around the collar". The histopathologic diagnoses were representative of benign lesions in 7 cases, premalignant in 13, and malignant or suggestive of malignancy in 10 cases. Seven patients had carcinoma at the time of first biopsy, whereas 6 cases showed progression at time of follow-up.
Conclusion:
This study aims to raise awareness that marginal gingival leukoplakia may represent potentially malignant lesions, and if circumferential and/or thick, may be the first manifestation of PVL. This article is protected by copyright. All rights reserved.
... As the lesion described in the present report is a rare occurrence, difficulties were encountered when naming the lesion, especially with references to the terms "keratosis" and "leukoplakia." According to literature, similar lesions have been named as linear gingival keratosis [3] as well as linear gingival leukoplakia [9]. When linear gingival keratosis/leukoplakia reported in literature [10] was compared with the present lesion, it did not show bone erosion. ...
... When linear gingival keratosis/leukoplakia reported in literature [10] was compared with the present lesion, it did not show bone erosion. In contrast to lesions reported in literature [9,10], the present lesion showed dysplasia and p16 positivity. However, in this case, the lesion was diagnosed as an early stage of PVL rather than linear gingival keratosis, due to the fact that it occurred in a female in the gingiva and also as it was refractory to surgical management. ...
This report describes a case of proliferative verrucous leukoplakia (PVL) of the gingiva with no discernible aetiology, which presented in a 36-year-old female. The initial nonscrapable gingival lesion was treated with CO 2 laser ablation, and the histopathological evaluation was carried out. The presence of koilocytic cells in the superficial epithelium led to immunohistochemical investigations with p16 antibody, which showed strong nuclear positivity and slight cytoplasmic positivity in >50% of the cells with >25% confluency. However, it was not possible to confirm the presence of HPV infection with further investigations due to logistic reasons. The lesion recurred twice within a short time despite the surgical resection following the first recurrence. Thus, this paper presents a case of proliferative verrucous leukoplakia, which demonstrated a significant resistance to routine treatment protocols recommended in the management of such lesions.
... It is the most prevalent precancerous lesion of the oral mucosa. Some oral leukoplakia will transform into cancer [15]. The annual risk of malignant transformation of leukoplakia, if not malignant already at the first visit, is approximately 2-3% [16]. ...
... The annual risk of malignant transformation of leukoplakia, if not malignant already at the first visit, is approximately 2-3% [16]. Approximately 70% of oral leukoplakias are found on the lip vermillion, buccal mucosa and gingiva [15]. In the study by Cebeci et al., white lesions were observed in 2.2% of patients [17]. ...
... In the study by Cebeci et al., white lesions were observed in 2.2% of patients [17]. Gender, age and oral distribu- tion of leukoplakia in our study were confirmed in other studies [15][16][17]. In our opinion, clinical characteristics and the risk of malignant transformation in predominantly white lesions of the alveolar ridge ("alveolar ridge keratosis") and the buccal gingiva ("frictional keratosis") is lower than for similar lesions located on the borders of the tongue or the floor of the mouth. ...
Introduction:
Oral lesions are divided into non-neoplastic lesions, potentially malignant lesions and neoplastic lesions. More clinical data are needed to determine their helpful clinical pattern.
Aim:
To present the epidemiological, clinical and histopathological characteristics of the oral lesions.
Material and methods:
The retrospective study group comprised records of 208 patients which were reviewed according to selected epidemiological and clinical features. All the biopsy specimens were classified into: reactive lesions, precancerous lesions/potentially malignant lesions, salivary gland pathologies, benign and malignant tumours.
Results:
The lower lip was the most common site involved followed by buccal and vestibular mucosa. The most frequent diagnoses were fibroma, mucocele and papilloma. The predominant pathomorphological forms were nodule and bulla. The most frequent salivary gland pathology was mucocele. Fibroma was the most frequent pathomorphological diagnosis, followed by mucocele and reactive lesions such as irritation fibroma (IF) and granuloma.
Conclusions:
In cases of oral mucosal lesions, we propose the following algorithm: the exclusion of all odontogenic and iatrogenic causes; the detection and elimination of harmful habits, parafunctions and irritants from the oral cavity especially from the vestibule of the oral cavity and from the lips; all surgical treatment should be performed only after the proper detection and elimination of causative factors to decrease the risk of recurrence; excisional biopsy or in more diffuse lesions incisional biopsy is recommended to confirm clinical diagnosis; and consideration of other factors that can modify the clinical pattern of oral lesions, such as oral hygiene, systemic diseases, and drugs.
... Oral leukoplakia may be located on lip vermillion, gingival, tongue and floor of mouth, and it is on these latter regions that there is a higher risk of malignancy (around 43%) [38,40]. Oral leukoplakia distribution may be local or disseminated [41] (Figure 6 -A, F). Histological examination reveals a range of epithelium changes varying from innocuous hyperplasia to dysplasia of varying degrees [18]. ...
Introduction
Leukoplakia of the marginal gingivae is uncommon and in most cases reported up to date represents a manifestation of proliferative verrucous leukoplakia. The clinical and pathologic features of two cases of leukoplakia confined to the marginal gingiva are described and their biologic significance is discussed.
Case Presentation
The cases involved two female patients, non‐smokers, aged 82 and 57. The lesions clinically appeared as small, well‐demarcated white plaques on the marginal gingiva of posterior teeth. After being totally excised, microscopic examination showed keratosis of unknown significance in the first patient and verrucous hyperplasia in the latter, while immunohistochemistry for p16 INK4A was negative for both. There was no recurrence in 7 months and 5 months after excision, respectively.
Conclusion
A white plaque on the marginal gingiva may be overlooked due to its small size or may be misdiagnosed as frictional keratosis. However, it may represent leukoplakia, a potentially malignant disorder. Therefore, diagnosis and management should follow the established guidelines for leukoplakia.
Idiopathic leukoplakia is a rare potentially malignant lesion, usually found on the tongue with an increased risk of malignant transformation
as compared to the tobacco associated form. The risk of malignant transformation increases with age. Diagnosis poses a challenge to
the clinician as it is diagnosed by exclusion of other possible causes leading to hyperkeratosis. We present one such rare case in an
elderly male patient who was followed up for a year to record the course of the lesion and to report recurrences, if any.
