Verrucal / Papillary Lesions Flashcards by Alex Ko Kam

It is composed of benign epithelium and amounts of supporting connective tissue

Squamous papilloma (oral warts)

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The most common papillary lesions of the oral mucosa and accounts for approximately 2.5% of all oral lesions

Squamous papilloma / oral wart

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What is an exophytic?

Growing outward beyond the surface epithelium

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What is a wart

Papillary lesion that projects outward

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What is verrucous

Flat and blunt, nob-like projections

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The putative etiologic agent of papillomas of the upper aerodigestive tract, is a member of the papovirus group

HPV

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It is a DNA virus containing a single molecule of double-stranded DNA compromising approximately 8000 nucleotide base pairs

HPV

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HPV specifically infects ____ epithelial cells and establishes productive infection only in the ___ epithelium of the skin and mucosa

Basal epithelial cells

Stratified squamous epithelium

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Replication of HPV occurs within the ___ of epithelial cells with the viral genome expressed in both early and late stages

Nuclei

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Location of oral squamous papilloma

Vermillion portion of the lips

Intraoral mucosal site

Hard and soft palate and uvula

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Accounts for approximately 1/3 of all lesions.

Measures less than 1cm

clinically asymptomatic

Pink to white exophytic granular or cauliflower-like surface alterations

Oral squamous papilloma

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Solitary lesions are most common

Oral squamous papilloma

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Oral warts are common in patients with ???

HIV particularly in patients treated with (HAART)

Human immunodeficiency virus

Highly active antiretroviral therapy

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An exaggerated growth of benigh squamous epithelium

Oral squamous papilloma

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Histologic architecture of oral squamous papilla may mimic the pattern of the ____ wart

Cutaneous

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Histopathology of oral squamous papilloma

Exophytic

Finger-like projections extensions of epithelium

Supported by a well vascularized CT

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HPV subtype of oral papilloma

HPV 2, 6, 11, 57

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HPV subtype of focal epithelial hyperplasia

HPV 13, 32

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HPV subtype of dysplastic wart

16, 18, others

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HYV subtype of verruca vulgaris, skin

2, 4, 40, others

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HPV subtype of flat wart

3, 10

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HPV subtype of condyloma acuminatum

6, 11, others

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HPV subtype of laryngeal papilloma

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HPV subtype of conjunctival papilloma

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HPV subtype of maxillary sinus papilloma

Nononcogenic subtypes

2, 6, 11 and 57

Common oral epithelial proliferation that is most caused by HPV

Papilloma

HPV lesion that is HIV-positive patients only Only in oral mucosa

Dysplastic oral warts

DD of oral squamous papilloma

Verruciform xanthoma Papillary hyperplasia Condyloma acuminatum

Treatment of oral squamous papilloma

Surgical excision - treatment of choice Or Laser ablation

Prognosis of oral squamous papilloma

Recurrence is uncommon, except for patients infected with HIV

An angiogenital wart caused by HPV that may also involve the oral mucosa

Condyloma Acuminatum

Nucleus of cell is pyknotic, dense, created and raisin like Periphery of nucleus has a clear cytoplasm

Koilocytes

What is a koilocytes

Pyknotic nucleus and clear cytoplasm

Is condyloma acuminatum an opportunistic infection?

Yes, increase incidence in HIV patients

HPV subtypoe of condyloma acuminatum

6 and 11

Condyloma acuminatum spread through?

Skin-to-skin contact Skin-to-mucosa contact Sexual transmission

Soft, broad-based exophytic papillary growth that may be keratinized or nonkeratinized

Condyloma acuminatum

Formation is a group of numerous pink nodules that grow and ultimately coalesce

Early condyloma acuminatum

Papillary projections extending from the base of each lesions are covered by stratified squamous epithelium that is often parakeratotic but at times may be nonkeraatinized

Condyloma acuminatum

Koilocytosis in condyloma acuminatum is usually found in where?

Upper level epithelial cells

DD of condyloma acuminatum

Focal epithelial hyperplasia Verruca vulgaris

Treatment of condyloma acuminatum

Surgical excision may consists of: - cryosurgery - scalpel excision - electrodesiccation - laser ablation NO ANTIVIRAL TREATMENT AVAILABLE

Prognosis of condyloma acuminatum

Recurrences are common

HPV subtype of focal epithelial hyperplasia

13 and 32

Characterized by the presence of numerous nodular soft tissue masses distributed over the mucosal surfaces, escpecially the buccal mucosa, labial mucosa, tongue, and gingiva

Focal epithelial hyperplasia

Lesion is similar in color with the surrounding mucosa If in areas of occlusal trauma, may appear whitish because of keratinization

Focal epithelial hyperplasia

Asymptomatic and incidenatl finding = gender predilection Wide age range HIV px receiving HAART, multifocal distribution of lesions may be noted

Focal epithelial hyperplasia

Consistent finding of focal epithelial hyperplasia

Acanthosis and parakeratosis

Prominent clubbing and fusion of epithelial ridges Enlarged ballooning cells with abnormal nuclear chromatin patterns within the spinous layer

Focal epithelial hyperplasia

Chromatin are abnormal and seems to undergo mitosis or dividing

Mitosoid bodies (feh)

Degenerating keratinocytes that simulate cells in mitoses

Mitosoid bodies

DD of focal epithelial hyperplasia

Verruca vulgaris Multiple squamous papillomas

Treatment of focal epithelial hyperplasia

Surgical removal Laser ablation

Appears on the hard palate and is associated with a removable prosthesis

Papillary hyperplasia

Associated with an ill fitting or loose denture that creates a potential space between the denture base and tissue

Papillary hyperplasia

Organism that grows in papillary hyperplasia

Candida albicans

Does papillary hyperplasia is associated with HPV infection?

No, it is not

Cobblestone like appearance on hard palate regions -Similar to nicotine stomatitis but no red dots

Papillary hyperplasia

Commonly involved location of papillary hyperplasia

Mucosa of the palatal vault and less in the alveolar ridge or the palatal incline

Numerou small exophytic fronds or papillary projections covered with intact parakeratotic stratified squamous epithelium

Papillary hyperplasia

The epithelium of this lesion is supported by hyperplastic central cores of well vascularized stromal tissue

Papillary hyperplasia

What does papillary hyperplasia mimics if severe

Squamous cell carcinoma

Demonstrates pseudoepitheliomatous features

Papillary hyperplasia

DD of papillary hyperplasia

1. Multiple hamartoma syndrome ( Cowden’s syndrome) Nicotine stomatitis Darier’s disease Benign fibroepithelial proliferations

Patients with papillary hyperplasia usually have other stgmata of the syndrome, including ___ ___ ___

Hamartomatous papules of the skin Benign and malignant breast lesions Malignancies of the thyroid and kidney

Treatment of papillary hyperplasia

Siurgical removal Denture refabrication Removal of appliance at bedtime and soaking in a weak disinfecting antifunal medium Good oral hygiene Topical antifungal

An uncommon, benign oral mucosal lesion that occasionally may be found on the skin, typically on the genitalia

Verruciform xanthoma

Gene muration of verruciform xanthoma

Exon 6 of the 3 beta-hydroxysteroid dehydrogenase (NSDHL)

An incidental finding, most cases are whites, no gender predilection Average age is 45yo

Verruciform xanthoma

Flat or slightly raised, with a papillomatous or verrucous surface composed of parakeratinized epithelial cells

Verruciform xanthoma

Papillary overgrowth Invaginated crypts between paillary projections Presence of foam cells or xanthoma cells within the epithelium

Verruciform xanthoma

Characteristic of foam cells

Granular to flocculent cytoplasm that may contain periodic acid-schiff (PAS) positive, diastase-resistant granules or lipid droplets or both

Immunihistochemical markers which identify the foam cells to be of monocyte/macrophage lineage is?

CD68 and CD163

DD of verruciform xanthoma

Squamous papilloma Pappilary squamous carcinoma Verrucous carcinoma Condyloma acuminatum

Treatment for verruciform xanthoma

Conservative excision. No recurrence

Size of verruciform xanthoma

More than 2cm

Idiopathic or associated with gene mutation

Verruciform xanthoma

Thickening of the epidermis caused by an increased number of squamous cells

Acanthosis

HPV infects ___ squamous epithelium

Stratified squamous epithelium