Verrucous Leukoplakia — ORE Part 1 MCQ

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HardOral PathologyVerrucous LeukoplakiaORE Part 1

A 55-year-old man presents with a white plaque on his tongue that has been present for 3 months. He chews tobacco. Biopsy shows verrucous epithelial hyperplasia without invasion of the basement membrane. What is the most likely diagnosis?

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Correct answer: A — Verrucous leukoplakia (verrucous hyperplasia)

Explanation lettering: D = shown as C · C = shown as D

The key discriminator is the histopathological finding of 'verrucous epithelial hyperplasia without invasion of the basement membrane.' Verrucous hyperplasia represents an early, potentially malignant lesion (Option A)—a pre-invasive stage within the proliferative verrucous leukoplakia spectrum. In contrast, verrucous carcinoma (Option B), despite often displaying an intact-appearing basement membrane on routine H&E staining, is defined by invasion into the subepithelial connective tissue; this invasive feature is absent in the case presented. Options C (conventional SCC), D (benign viral lesion unrelated to tobacco), and E (HIV-associated lesion with different clinical and histopathological features) are not compatible with the clinical or histological picture. The diagnosis of verrucous hyperplasia/leukoplakia requires close long-term surveillance for potential malignant transformation.

Reference: Clinicopathologic analysis of verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma as part of the clinicopathologic spectrum of oral proliferative verrucous leukoplakia: A literature review and analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/31630872/