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Dysplasia of the upper aerodigestive tract squamous epithelium.

Eversole LR - Head Neck Pathol (2009)

Bottom Line: Cytologically atypical cells are considered to represent precancerous changes predicting an increase risk for carcinomatous transformation.Inter- and intra-rater reliability studies among pathologists have disclosed low correlation coefficients for four part grading systems, whereas improved agreement is achieved (kappa correlation values) using the Ljubljana systems.Loss of heterozygosity (LOH) at 3p and 9p microsatellite domains, DNA ploidy analysis and nuclear image analyses may have predictive value as molecular and histomorphological biomarkers.

View Article: PubMed Central - PubMed

Affiliation: Oral Pathology Diagnostic Services, 4945 Mercury Street, San Diego, CA 92111, USA. lrebge@aol.com

ABSTRACT
Dysplasia of the oral, laryngeal and oropharyngeal stratified squamous epithelia is a microscopically defined change that may occur in clinically identifiable lesions including erythroplakia, leukoplakia and erythroleukoplakia, lesions that convey a heightened risk for carcinomatous progression. Dysplastic lesions have been classified microscopically according to degree of cytologic atypia and changes in architectural patterns, usually on a three part or four part gradation scale. Vocal cord epithelial lesions are graded according to either the Ljubljana or the World Health Organization (WHO) system whereas oral dysplasias are generally classified according to WHO criteria. Cytologically atypical cells are considered to represent precancerous changes predicting an increase risk for carcinomatous transformation. Inter- and intra-rater reliability studies among pathologists have disclosed low correlation coefficients for four part grading systems, whereas improved agreement is achieved (kappa correlation values) using the Ljubljana systems. Evidence forwarded by some studies supports the prognostic value of progressively severe dysplastic changes for carcinomatous transformation; however, some studies indicate that the presence of a clinically defined lesion without microscopic evidence of dysplasia also connotes increased risk for carcinomatous transformation. Loss of heterozygosity (LOH) at 3p and 9p microsatellite domains, DNA ploidy analysis and nuclear image analyses may have predictive value as molecular and histomorphological biomarkers.

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Related in: MedlinePlus

The Ljubljana grading system for vocal cord precancerous lesions. a. Simple hyperplasia, b abnormal hyperplasia, c. atypical (risky) hyperplasia, d carcinoma in situ
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Fig2: The Ljubljana grading system for vocal cord precancerous lesions. a. Simple hyperplasia, b abnormal hyperplasia, c. atypical (risky) hyperplasia, d carcinoma in situ

Mentions: The Ljubljana grading system devised in Slovenia by Kambic and Gale [3, 5] for laryngeal precancerous lesions divides stages of progressing dysplastic changes into three categories: “simple” hyperplasia characterized by epithelial thickening without atypical cytologic changes, “abnormal” hyperplasia represented by bulbous rete pegs and hyperplasia of the basal/parabasilar compartment with nuclear crowding and enlargement, and “atypical” hyperplasia represented by cytologic atypia extending into the upper strata (Fig. 2). Carcinoma-in situ is reserved for those lesions with pronounced top to bottom atypia and a loss of normal stratification. Table 1 compares the Ljubljana and WHO models.Fig. 2


Dysplasia of the upper aerodigestive tract squamous epithelium.

Eversole LR - Head Neck Pathol (2009)

The Ljubljana grading system for vocal cord precancerous lesions. a. Simple hyperplasia, b abnormal hyperplasia, c. atypical (risky) hyperplasia, d carcinoma in situ
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2807542&req=5

Fig2: The Ljubljana grading system for vocal cord precancerous lesions. a. Simple hyperplasia, b abnormal hyperplasia, c. atypical (risky) hyperplasia, d carcinoma in situ
Mentions: The Ljubljana grading system devised in Slovenia by Kambic and Gale [3, 5] for laryngeal precancerous lesions divides stages of progressing dysplastic changes into three categories: “simple” hyperplasia characterized by epithelial thickening without atypical cytologic changes, “abnormal” hyperplasia represented by bulbous rete pegs and hyperplasia of the basal/parabasilar compartment with nuclear crowding and enlargement, and “atypical” hyperplasia represented by cytologic atypia extending into the upper strata (Fig. 2). Carcinoma-in situ is reserved for those lesions with pronounced top to bottom atypia and a loss of normal stratification. Table 1 compares the Ljubljana and WHO models.Fig. 2

Bottom Line: Cytologically atypical cells are considered to represent precancerous changes predicting an increase risk for carcinomatous transformation.Inter- and intra-rater reliability studies among pathologists have disclosed low correlation coefficients for four part grading systems, whereas improved agreement is achieved (kappa correlation values) using the Ljubljana systems.Loss of heterozygosity (LOH) at 3p and 9p microsatellite domains, DNA ploidy analysis and nuclear image analyses may have predictive value as molecular and histomorphological biomarkers.

View Article: PubMed Central - PubMed

Affiliation: Oral Pathology Diagnostic Services, 4945 Mercury Street, San Diego, CA 92111, USA. lrebge@aol.com

ABSTRACT
Dysplasia of the oral, laryngeal and oropharyngeal stratified squamous epithelia is a microscopically defined change that may occur in clinically identifiable lesions including erythroplakia, leukoplakia and erythroleukoplakia, lesions that convey a heightened risk for carcinomatous progression. Dysplastic lesions have been classified microscopically according to degree of cytologic atypia and changes in architectural patterns, usually on a three part or four part gradation scale. Vocal cord epithelial lesions are graded according to either the Ljubljana or the World Health Organization (WHO) system whereas oral dysplasias are generally classified according to WHO criteria. Cytologically atypical cells are considered to represent precancerous changes predicting an increase risk for carcinomatous transformation. Inter- and intra-rater reliability studies among pathologists have disclosed low correlation coefficients for four part grading systems, whereas improved agreement is achieved (kappa correlation values) using the Ljubljana systems. Evidence forwarded by some studies supports the prognostic value of progressively severe dysplastic changes for carcinomatous transformation; however, some studies indicate that the presence of a clinically defined lesion without microscopic evidence of dysplasia also connotes increased risk for carcinomatous transformation. Loss of heterozygosity (LOH) at 3p and 9p microsatellite domains, DNA ploidy analysis and nuclear image analyses may have predictive value as molecular and histomorphological biomarkers.

Show MeSH
Related in: MedlinePlus