Terminological Problems

An exact and uniform terminology of SILs is a prerequisite for successful cooperation among pathologists as well as adequate understanding with clinicians. A considerable overlapping of clinical and histological terms relating to SILs has been widely noticed due to inade

1.2.1 General Considerations quate definitions in the past. In an attempt to avoid such misunderstandings, the most inconsistently used terms are discussed here and their use recommended strictly within the scope of definitions.

Various suggestions have been made that the terms "precancerous", "premalignant" or "precursor" lesions should be replaced with the expression "potentially malignant" signifying only an increased possibility and not necessarily a transition to malignant growth [125, 150, 181, 223, 297].

The most controversial term remains l eukoplakia. In the oral cavity, it has only a clinical meaning: white plaque that cannot be scraped off and cannot be given a specific diagnosis [14]. Over the decades, the definition of leukoplakia has changed considerably and has come to be properly called gallimaufry [342]. It has been generally accepted that leukoplakia should be used only as a clinical term without a specific his-topathological connotation. Analogically, erythropla-kia is a clinical term defining a red lesion that cannot be identified as another, specific lesion. Both expressions have also been applied for clinical use in the pharynx and larynx as merely clinical terms without consideration of their aetiology and histological features [181].

Keratosis is a histological term and denotes an increased amount of keratin on the surface of the squa-mous epithelium, often accompanied by granular cell layer [180, 181]. However, keratosis has been also used as a common term for classifying different grades of SIL, which does not seem to be appropriate, since not all cases of SIL display keratinising epithelium.

Dysplasia is a widely used histological term directly transferred from the uterine cervix to oral and la-ryngeal pathology indicating the architectural disturbance of squamous epithelium accompanied by cytologic atypia; it is divided into three groups: mild, moderate and severe [381]. Dysplasia has been replaced in the last two decades with new invented classifications, such as keratosis [20, 78], squamous intraepithelial neoplasia [79], oral intraepithelial neoplasia [200], laryngeal intraepithelial neoplasia [122], etc. to list only the most frequently used terminologies. These classifications contain only additional synonyms for dyspla-sia. They do not enhance our understanding of classification problems, but introduce other confusing terms for clinicians to deal with [20]. The only classification not based on cervical dysplasia or the subsequently introduced cervical intraepithelial system, is the Ljubljana classification of laryngeal SILs. The Ljubljana classification recognises four grades: squamous (simple) hyperplasia and basal and parabasal cell hyperplasia (abnormal hyperplasia) are benign categories; atypical hyperplasia (risky epithelium) is potentially malignant; and carcinoma in situ is a malignant lesion [125, 150, 183, 242].

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