Squamous Cell Papilloma

INTRODUCTION

Oral squamous papilloma is a generic term that is used to include papillary and verrucous growths composed of benign epithelium and minor amounts of supporting connective tissue. It is a benign exophytic papillary growth of Stratified squamous epithelium. The squamous cell papilloma is the fourth most common mucosal mass and is associated with Human papilloma virus (HPV)- types 6 and 11. The occurrence of these lesions is influenced by smoking, infections, dietary deficiencies and hormonal changes. The route of transmission of HPV virus is unknown for oral lesions. It commonly occurs between the ages of 30 to 60 years.

CASE REPORT

A 66 years old male patient was reported with a painless soft tissue growth on right side of the palate in relation to 15-16.

Onintraoral clinical examination, the lesion was white, solitary, well defined about 4-5mm in size, sessile, circumscribed and exophytic growth having a cauliflower like appearance. It was non-tender, firm in consistency and arose from underlying soft tissue. After seeing past history, patient suffered from verrucous hyperplasia with mild dysplasia about 10 years back on the opposite side of the palate. The lesion was surgically excised without any postoperative complications. The excised lesion was sent for histopathological examination which confirms the Oral Squamous Papilloma.

CLINICAL FEATURES:

• Oral squamous papillomas may be found on the vermilion portion of the lips and any intraoral mucosal site, with a predilection for the hard and soft palate and the uvula.
• The later three sites account for approximately one third of all lesions.
• In our case, the lesion is seen on posterior region of hard palate adjacent to the maxillary right first premolar.
• It is painless, usually white but sometimes pink in color.
• The lesions generally measure less than 1 cm in range and appear as exophytic growth made up of numerous finger like projections with a roughened, granular and Cauliflower- like appearance.
• It is a well circumscribed tumor which is pedunculated (Mostly) or sessile (sometimes).
• The lesions are generally asymptomatic as was in the present case.
• Squamous papillomas are traditionally divided into two types: Isolated-solitary and Multiple-recurring.
• Patients who are HIV positive often have multiple oral lesions.

CLINICAL PICTURES

HISTOLOGICAL FEATURES

After clinical evaluation, excisional biopsy of the lesion was performed and the specimen were fixed and stained with hematoxylin and eosin, for routine histopathological examination.

• CHARECTERISTIC FEATURE–Many long thin, “finger like projections” extending above the surface of mucosa.
• Each finger like projection is lined by Stratified squamous epithelium and contains a thin central connective tissue.
• The spinous cells proliferate in a papillary pattern.
• Koilocytes – HPV altered cells may be seen.
• The upper epithelial layer shows pyknotic nuclei often surrounded by edematous or optically clear zone the so called “KOILOCYTIC” cell.
• Chronic inflammatory cells are also present.
• Occasionally, Basilar hyperplasia may be present.

DIAGNOSIS

On the basis of above clincal evaluation and thehistopathological examination,which reveals finger like projections, presence of Koilocytes and inflammatory cells etc.the final diagnosis was established as an Oral Squamous Papilloma.

ROLE OF HPV

Human Papilloma virus (HPV) is a member of “Papovavirus” group. It is a DNA virus containing a single molecule of double stranded DNA. The viruses are nonenveloped ranging from 45nm to 55nm.The class of HPVs is very large with more than 100 subtypes and these viruses are associated with many conditions of squamous epithelium.

LESIONS CAUSED BY HUMAN PAPILLOMA VIRUS

DIFFERENTIAL DIAGNOSIS

Verruciform xanthoma has predilection for gingiva and alveolar ridge, while condyloma are larger than papilloma with broader base and appear pink to red.

TREATMENT

Surgical removal of the lesion including the base of mucosa into which the pedicle or stalk is inserted, is the treatment of choice for oral squamous papilloma’s either by routine excision or laser ablation. Other treatment modalities includes-

• Electro cautery
• Cryosurgery
• Intralesional injections of Interferon
• Laser ablation
• Topical podophyllin
• Imiquimod

PROGNOSIS

If the excision is done properly then recurrence is rare. As in our case,one year follow- up was performed, and there was no evidence of recurrence of the lesion.Recurrence is uncommon, except for lesions in patients with HIV. The recurrence rate is very low for the solitary type compared with multiple lesions.

REFERENCES