PDF: Malignant Transformation and Treatment Recommendations of Chronic Hyperplastic Candidiasis—A Six-year Retrospective Cohort Study

Oral chronic hyperplastic candidiasis (CHC) is the most uncommon type of oral candidiasis with diverse manifestations. Up to date the diagnosis, long-term management and prognosis of this oral potentially malignant disorder remain obscure.

The aim of this study was to provide the recommendations guiding the diagnostic procedure, clinical management and prognosis assessment of CHC. 

Oral candidiasis or oral candidosis (OC) is the most common fungal infectious disease of oral mucosa, mainly caused by the opportunistic pathogen of Candida spp.

According to the different clinical manifestations, OC can be classified into pseudomembranous candidiasis, erythematous candidiasis and chronic hyperplastic candidiasis (CHC). 

Among these types, CHC is a rare type of OC, with an incidence of about 1.61% in OC patients, mainly affecting middleaged smoking men. 

The prevalence of chronic hyperplastic candidiasis is around 0.5% in Chinese patients with oral candidiasis. Up to date, there are no large sample size studies due to the rarity of CHC. 

Chronic hyperplastic candidiasis is of particular significance due to the difficulties of differential diagnose and more importantly, the potential of malignant transformation. 

It is clinically diversely manifested as thick white plaques, erythematous lesions or mixed red and heterogeneous white plaques, mimicking and commonly misdiagnosed as the diseases presented as white lesions such as lichen planus and leukoplakia.

As a result, the diagnosis of CHC is often difficult and time-consuming. To establish the diagnosis, besides the clinical manifestations, the sensitivity of laboratory tests such as exfoliative cytology and fungal culture is rather low. 

In order to rule out dysplasia or malignant conditions, the diagnosis must be based on histopathology. 

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