增生性疣狀白斑－病例報告

Proliferative Verrucous Leukoplakia: Case Report

10.7023/TJFM.200506.0108

林憶珊(Yi-Shan Lin)；呂宜興(Yi-Shing Leu)

proliferative verrucous leukoplakia ； oral leukoplakia ； carcinoma

台灣家庭醫學雜誌

15卷2期（2005 / 06 / 01）

108 - 117

繁體中文

增生性疣狀白斑(proliferative verrucous leukoplakia, PVL)是一種罕見的口腔內白色病灶，一開始的變化通常只是單獨的上皮過度角質化(hyperkeratosis)，病灶生長緩慢、持續而不可逆，但接下來常會擴散變成多發病灶並外凸如疣狀(wartlike)。它比一般的口腔白斑有更強烈的惡性傾向，為發展成疣狀癌(verrucous carcinoma)或鱗狀細胞癌(squamous cell carcinoma)的高危險群，且對任何治療幾乎都沒有很好的效果。本篇報告一位五十五歲男性病患，在發現口腔白斑後，歷經十四年的追蹤，其口腔白斑一直持續再發，後來轉變為疣狀癌及鱗狀細胞癌，即使經過二十八次手術、五次化學治療及兩個療程的放射治療，仍無法控制，最後造成病患死亡。 希望藉此病例及歷年文獻之回顧，探討口腔白斑以及增生性疣狀白斑的危險因子、鑑別診斷、病程演變與治療，讓基層醫師在臨床上診治口腔白斑時能有所警覺及參考。

Proliferative verrucous leukoplaskia (PVL) is a rare oral white lesion. It usually begins as simple hyerkeratosis, which is slow-growing, persistent, and irreversible, but tends to spread, and become multifocal, exophytic and wart-like. It behaves more aggressively than other forms of oral leukoplakia. It is at high risk to develop into verrucous or squamous cell carcinoma that are virtually resistant to all forms of therapy. In this case report, we present a 55-year-old male patient who had been suffering from oral leukoplakia since 14 years ago. Despite regular follow-up at our out-patient department, the oral lesions recurred repeatedly and progressed to verrucous carcinoma and squamous cell carcinoma. Even after 28 surgical operations, 5 courses of chemotherapy and 2 courses of radiotherapy, the cancer remained uncontrolled until his death. Through this case presentation and journal review, we discuss the risk factors, differential diagnosis, clinical course and treatment of oral leukoplakia and PVL, to serve as a reference for doctors taking care of patients with oral leukoplakia.