precancerous conditions

 Chronic lip inflammation is the characteristic feature of actinic cheilitis (AC), a precancerous lesion that can develop into squamous cell carcinoma (SCC). Early detection and education of individuals at higher risk for AC can reduce the likelihood of developing SCC. This retrospective study sought to assess the demographic and clinicopathological attributes of 33 patients diagnosed with AC.

 Thirty-three cases were retrieved from the archive of the Department of Pathology of Sina Hospital, Hamadan, Iran, between 2009 and 2019. All information was recorded from the submission forms, including gender, age, anatomical location of the lesions, size, duration, outdoor occupation, and clinical aspects.

 There were 29 males and 4 females. The mean age was 62±14 years. Nine cases of older patients (>62 years) showed mild, moderate, and severe grades of dysplasia (3 cases for each degree). Fisher’s exact test indicated a significant difference between the presence of dysplasia and the age of the patients (P<0.001). In addition, a statistically significant distinction emerged concerning the presence of dysplasia and the size of the lesion (Fisher’s exact test, P<0.001). Likewise, a significant difference was found between the presence of dysplasia and the type of occupation regarding exposure to the sun (P<0.001). Finally, there was a significant difference between the presence of dysplasia and the duration of the disease (Fisher’s exact test, P<0.003).

 The clinicopathologic profile observed in the series of patients with AC revealed that patients were more frequently males, aged≤62 years. The predominant clinical features were erythematous and atrophic lesions. However, in cases with dysplasia, ulceration emerged as the most frequent clinical finding. Further research with larger sample sizes is imperative to explore the potential role of smoking and other environmental factors in the development of AC and its potential malignant transformation.

Cervical cancer is the fourth most frequently diagnosed cancer among Algerian women and the seventh in Batna. This study sought to evaluate the prevalence of precancerous and cancerous cervical lesions and identify the target age groups for focused screening efforts to facilitate the early detection of uterine cervical neoplasms.

A cross-sectional study was conducted for seven years, from January 2017 to December 2023. A total of 12623 Algerian women, aged 25 to 65, were screened cytologically using the Papanicolaou test as part of a national screening program for early detection of cancerous lesions and precursor lesions of cervical cancer.

The predominant age group was 30-39 years, accounting for 39.42%. In 98.19% of adequate smears, results were negative for intraepithelial lesions or malignancy (NILM). Of these, 3617 (29.66%) were standard, and 8301 (68.07%) exhibited non-specific inflammation. Epithelial cell abnormalities (ECAs) were observed in 225 (1.81%) of the smears. No cases of squamous cell carcinoma (SCC), adenocarcinoma, or adenocarcinoma in situ were reported. No significant association was detected (P<0.05) between age groups and the presence of precancerous cervical lesions. However, most abnormal Pap smears were found in women over 60 years old with 24 cases (4.10%) and 56 cases (3.13%) in the 50-59 age group.

The study found that 1.81% of cervical smears exhibited ECAs, with atypical glandular cells (AGCs) being the most prevalent (46.67%). The highest prevalence of abnormalities was observed in women over 50 years of age.

Vitamin D is a pro-steroid hormone with multiple systemic functions, including immune system regulation. The effect of serum levels of this vitamin on the progression of several illnesses, including oral cancer and psoriasis, has been reported. This study investigated the prevalence of vitamin D deficiency in patients with oral lichen planus (OLP), an autoimmune disease and precancerous lesion. This case-control study was conducted on 30 healthy individuals and 30 patients with OLP. The serum levels of vitamin D were measured by ELISA (enzyme-linked immunoassay), and vitamin D amounts lower than 10 ng/mL, 10 to 29 ng/mL, and 30 to 100 ng/mL were considered deficient, insubstantial, and adequate, respectively. Data were analyzed by Shapiro-Wilk, student’s t-test, chi-square, and logistic regression using SPSS 24.0 software. According to the results, 36.7% (n = 11) of patients and 43.3% (n = 13) of the control group had vitamin D deficiency. In logistic regression analysis, the association between OLP and vitamin D deficiency was insignificant (OR = 0.71, 95% CI : 0.23–2,20, P = 0.548). Also, the correlation between age and vitamin D deficiency was insignificant (OR = 0.96, 95% CI : 0.91–1.00, P = 0.061), but the relationship between gender and vitamin D deficiency was significant (OR = 4.2, 95% CI : 1.4–13.1, P = 0.013), with a 4.2-fold higher chance of vitamin D deficiency in women compared to men. The current study did not reveal a substantial correlation between vitamin D deficiency and OLP. Therefore, it seems that more studies considering the type and duration of lichen planus and a higher number of samples are necessary to evaluate the function of vitamin D in the pathogenesis of OLP.

Oral lichenoid lesions (OLL) could be premalignant lesions. Hence, it is critical to investigate the epidemiologic aspects of oral lichenoid lesions. This cross-sectional study evaluated the prevalence of oral lichenoid reaction in patients attending the Department of Oral Medicine, School of Dentistry, during 2007-2018. All clinically and histopathologically documented files of oral lichen planus (OLP)- like lesions were evaluated, and oral lichenoid reactions were identified. The site of oral involvement, potential causes of OLL, and medications accompanied with OLL were all documented. The data were analyzed using SPSS version 18. Of the 191 patients with OLL, 137 (71.7%) were females, and 54 (28.3%) were males, with a mean age of 46.242 ± 13.77. In contrast, the control group consisted of 190 patients with OLP. The control group included 112 women (58.9%) and 78 (41.5%) men. The mean age of patients with OLP was 45.4 ± 11.16 years old, which matched the OLL group. Medications (48.2%) and amalgam restorations (52%) were the two most common causes of lichenoid reaction. While levothyroxine was used more frequently (17.8%) in patients with OLP, anti-hypertensive (30.4%) medications were used more predominantly in patients with OLL. In the present research, 8.23% of lichenoid lesions and 4.2% of OLP exhibited dysplastic change. The prevalence of OLL was 15.8% in patients who were referred to the Department of Oral Medicine, School of Dentistry. The prevalence of dysplasia was statistically higher in OLL patients (P < 0.0001). The odds ratio was 4.6, 95% CI: 2.06-10.28. This study showed that the prevalence of dysplasia was statistically higher in OLL patients.

Bowen’s disease (BD) is an in situ squamous cell carcinoma ofthe skin. Pigmented Bowen’s disease (pBD) is a rare variant,representing less than 2% of all BD cases. We report a case ofGiant pBD arising from seborrheic keratosis in a 65-year-old man.The dermoscopy showed a scaly surface, structureless brown togrey-black areas with dotted vessels, glomerular and reticulatevessels, and a few brown globules. Histopathology was classicalwith a “windblown appearance”; prominent melanophages wereseen in the dermis. Owing to the size and thickness of the plaque,a wide excision with a split-skin graft was done. The graft uptakewas good, and the patient was followed up on days 4 and 26post-surgery. We present our experience with the diagnosis andmanagement of this rare case of giant pBD. To the best of ourknowledge, such a case has not been previously reported.

Statement of the Problem:

 Oral epithelial dysplasia (OED) is a common potentially malignant lesion of oral cavity that should be managed to prevent likely malignant transformation.

Here, we present a combination of binary grading system with complementary immunohistochemical (IHC) staining for Ki67 biomarker to provide a reproducible OED grading system.

In this cross-sectional study, seventy out of one hundred OED specimens, which were accompanied by IHC stained microscopic slides for Ki67 antigen were evaluated by four independent oral pathologists. Both three-tier and binary grading systems based on WHO microscopic criteria were employed , blindly in a four-step method with at least two-week interval between each observation. Intra- and inter-observational reliability was assessed using Kappa statistical analysis.

OED diagnosis based on binary system showed significant intra-observer reliability comparing to three-tier system without biomarker. Moreover, OED diagnosis based on binary system using Ki67 biomarker showed significant inter-observer reliability comparing to diagnosis in three tier system and based on binary system without Ki67 biomarker showed significant inter-observer reliability comparing to diagnosis based on three-tier system without Ki67.

Here, we found that application of IHC staining for Ki67 biomarker in binary system might provide a more reliable grading method for oral pathologist form different educational background.

Oral lichen planus (OLP) is a potentially malignant oral disorder that affects 0.5-2% of the general population with a malignant transformation rate of around 1.1%. Malignant transformation is characterized by the increased proliferation of basal layer cells under the influence of biomarkers released from the inflammatory infiltrate. This study was conducted to assess the expression of biomarkers in OLP and their possible predictive value for malignant transformation of these lesions.

A search for studies on tumor biomarkers in OLP was performed in the following databases: PubMed (MEDLINE, Cochrane Library), Web of Science, and Scopus. Data were analyzed using the statistical software RevMan 5.4 (The Cochrane Collaboration, Oxford, UK). For continuous outcomes, the estimates of effects of an intervention were expressed as mean differences (MD) using the inverse variance (IV) method, and for dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios (OR) using Mantel-Haenszel (M-H) method, all with 95% confidence intervals.

A total of 30 studies were included in this meta-analysis. OLP patients compared to controls without the disease had a significantly higher expression of mutated p53 protein (P<0.001), Ki-67 antigen (P<0.001), p16 protein (P<0.001), and cell proliferation nuclear antigen (PCNA) (P=0.04), but not blc-2 protein. In contrast, OLP patients showed 3.71 times higher probability of bcl-2 protein detection (P=0.01).

The expression of tumor biomarkers in OLP suggests the potentially malignant nature of some of these lesions

Early detection of premalignant oral lesions, especially in high-risk patients, is important to prevent mortality. Dysplastic changes are one of the elements of premalignant lesions which can be perceived in histopathologic examinations. The use of saliva is a promising method for diagnosing epithelial dysplasia, because it is non-invasive and easy to collect. This review evaluated the salivary biomarkers in patients with oral epithelial dysplasia (OED).

In this systematic review study, all English articles were searched in the PubMed, Cochrane Library, Web of Science, and Scopus databases until February 2021. The searches were done using the Medical Subject Heading (MeSH) terms and free keywords. Textual data were analyzed manually and significant differences in salivary levels of biomarkers between patients with dysplastic lesions and healthy controls were reported and analyzed.

Originally, 1726 articles were found, of which 17 case-control articles were selected according to the inclusion/exclusion criteria. In 85% of studies, proinflammatory cytokine levels were significantly increased in the groups with epithelial dysplasia compared to the control groups. Tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1α showed an increase in all OED cases, but IL-1β showed no significant difference between epithelial dysplasia and control groups. Salivary levels of 14 types of micro-ribonucleic acid (miRNA) were studied, the most important of which were miRNAs 21 and 31, indicating a significant increase in the epithelial dysplasia groups compared to the control groups.

Based on the results of this systematic review, evaluation of salivary cytokines (TNF-α, IL-6, and IL-1α) and miRNAs 21 and 31 may be a non-invasive method in the early detection and prognosis of epithelial dysplasia and may also be useful in developing new prevention and treatment strategies.

Actinic cheilitis (AC) is a potentially malignant disorder characterized by chronic lip inflammation, especially the lower lip, associated with accumulative exposure to solar radiation. The present study aimed to assess the possible risk factors related to AC.

A search for studies on AC risk factors was conducted in the following databases: PubMed (MEDLINE, Cochrane Library), Web of Science (WoS), and Google Scholar. For dichotomous outcomes, the estimates of the effects of intervention were expressed as odds ratios (ORs) using Mantel-Haenszel (M-H) method, and for continuous outcomes, the estimates of the effects of intervention were expressed as mean difference (MD) using the inverse variance (IV) method, both with 95% confidence intervals.

Twelve studies were considered in this meta-analysis. The factors from the highest to lowest risk of AC were having a low skin phototype (OR: 3.30), age >50 years (OR: 3.01), having high sun exposure, cumulative throughout life (OR: 2.13) as daily (OR: 2.00), being male (OR: 1.78), and being a drinker (OR: 1.56) or smoker (OR: 1.32). However, the use of sunscreen creams and caps/hats to protect against the sun were factors with no significant influence on the AC risk.

Chronic sun exposure in subjects with low skin phototypes is the main risk factor for AC.

Oral verrucous carcinoma (OVC) is a rare malignant tumor with a complex etiology. This tumor is more prevalent in men and buccal mucosa is the most common site of OVC. Altogether, OVC has a relatively good prognosis.

In this case report, a rare case of a 64-year-old female with history of consuming opium and involvement of hard palate was reported. Because of the high recurrence rate, a more aggressive approach was considered for second surgery. After 18 months of follow up, the patient was in good health condition and no sign of recurrence was noted.

Precancerous lesions may develop into OVC; Differentiation of OVC from other oral lesions is challenging for oral pathologists due to different origins of the lesion. In case of immediate relapse or recurrence after surgery, surgeons are forced to use more aggressive approaches to eliminate the lesion.

Induction of premalignant lesions in animal models is of high value for research purposes. This study aimed to induce dysplasia in hamster mucosal pouch for investigation of dysplastic lesions usingdimethylbenz(a)anthracene. The buccal pouch of 10 hamsters was painted with dimethylbenz(a)anthracene for 10 weeks every other day. At 5 and 10 weeks, they underwent histopathological analysis. Clinically, there was no change until week 7; after which mucosal thickening occurred. Hamsters scarified at 5 weeks and 10 weeks demonstrated mild and moderate dysplasia, respectively. dimethylbenz(a)anthracene is a useful tool for inducing dysplastic lesions in the buccal pouch mucosa of hamsters.

Although recent studies show the association of eosinophils with different tumors including oral malignancies, the role of eosinophils in premalignant conditions of the oral cavity is not known precisely. Therefore, this study aimed to determine the number of eosinophils in premalignant and malignant conditions of the oral cavity and its role in progression to malignancy.
This cross-sectional study was done on 50 samples with oral squamous cell carcinoma (OSCC), 18 with verrucous carcinoma, 13 with erosive lichen planus, and 10 with leukoplakia with mild dysplasia after confirmation of histopathological diagnosis. The samples were stained with Sirius Red. The total numbers of eosinophils in 10 areas were counted at a magnification of 400x (eosinophil/10HPF). Data are analyzed with Kruskal-Wallis test, Mann-Whitney test, and Spearman’s correlation test.
The mean number of eosinophils in OSCC, verrucous carcinoma, erosive lichen planus, and leukoplakia with mild dysplasia was 90.26, 59.72, 11.08 and 0.0 eosinophil/10HPF respectively. The mean number of eosinophils was significantly higher in malignant (OSCC and verrucous carcinoma) than premalignant (erosive lichen planus and leukoplakia with mild dysplasia) lesions of the oral cavity (P=0.0001). No significant correlation was found between the number of eosinophils with histopathologic grade, gender, and age in OSCC samples.
The greater number of eosinophils is seen in malignant than premalignant lesions of the oral cavity. It is recommended to consider the high number of eosinophils in premalignant lesions as an indicator for a more potential of preliminary oral lesions to undergo malignant transformation.

Most oral and oropharyngeal squamous cell carcinomas (OOSCCs) are in advanced stages at diagnosis, and treatment does not improve survival rates. Early recognition and diagnosis of OOSCCs might improve patient survival and reduce treatment-related morbidity. The purpose of this article is to create awareness among the general practitioners to recognize the premalignant and early malignant lesions and to review the different diagnostic aids for the detection of cancer.