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Differentiated dysplasia is a frequent precursor or associated lesion in invasive squamous cell carcinoma of the oral cavity and pharynx

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Abstract

The source of precursor lesions of squamous cell carcinoma (SCC) of the oral cavity and pharynx, their classification, and grading are controversial. In contrast, vulvar and penile cancer precursor lesions are known to be related to human papillomavirus or chronic inflammation and can be described using the vulvar intraepithelial neoplasia (VIN) classification system (VIN 1–3) or as differentiated vulvar intraepithelial neoplasia (dVIN), respectively. Oral and pharyngeal SCC precursor lesions are more etiologically diverse, and the spectrum of lesions may thus be wider. No international consensus exists regarding the histological types of precursor lesions or the significance of individual types. We therefore reviewed resection specimens and preceding biopsies of 155 patients with SCC of the oral cavity and pharynx (excluding tonsils) and identified five basic patterns of SCC-associated or precursor lesions: (1) pleomorphic (22/155), (2) basaloid (5/155), (3) differentiated (63/155), (4) mixed (42/155), and (5) verrucous (12/155). Keratinization was a common but variable feature in differentiated, mixed, and verrucous dysplasia. In 11/155 patients, no precursor lesion could be identified. Progression of isolated differentiated dysplasia (ranging from months to years) was documented in 13/155 (8 %) of patients. Our data suggest that full-thickness epithelial dysplasia of pleomorphic or basaloid type is present in <20 % of oral and pharyngeal SCC, and differentiated dysplasia is a frequent precursor or associated in situ lesion. Failure to recognize differentiated dysplasia results in the underdiagnosis of many patients at risk for invasive carcinoma. These results indicate a need to refine criteria to distinguish differentiated dysplasia from morphologically related lichenoid lesions.

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Abbreviations

SCC:

Squamous cell carcinoma

VIN:

Vulvar intraepithelial neoplasia

dVIN:

Differentiated vulvar intraepithelial neoplasia

HPV:

Human papilloma virus

CIN:

Cervical intraepithelial neoplasia

PeIN:

Perineal intraepithelial neoplasia

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Acknowledgments

We thank Prof. Dr. Manfred Dietel and Dr. Anja Schmitt for their critical reading of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland

    Ruza Arsenic

  2. University of Zurich, Zurich, Switzerland

    Michael O. Kurrer

  3. Institute for Pathology, University Hospital Charité, Charitéplatz 1, 10117, Berlin, Germany

    Ruza Arsenic

  4. Gemeinschaftspraxis für Pathologie, Cäcilienstrasse 3, Postfach 1520, 8032, Zurich, Switzerland

    Michael O. Kurrer

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  1. Ruza Arsenic
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Correspondence to Ruza Arsenic or Michael O. Kurrer.

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Arsenic, R., Kurrer, M.O. Differentiated dysplasia is a frequent precursor or associated lesion in invasive squamous cell carcinoma of the oral cavity and pharynx. Virchows Arch 462, 609–617 (2013). https://doi.org/10.1007/s00428-013-1412-6

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  • DOI: https://doi.org/10.1007/s00428-013-1412-6

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