Verrucal / Papillary Lesions Flashcards
It is composed of benign epithelium and amounts of supporting connective tissue
Squamous papilloma (oral warts)
The most common papillary lesions of the oral mucosa and accounts for approximately 2.5% of all oral lesions
Squamous papilloma / oral wart
What is an exophytic?
Growing outward beyond the surface epithelium
What is a wart
Papillary lesion that projects outward
What is verrucous
Flat and blunt, nob-like projections
The putative etiologic agent of papillomas of the upper aerodigestive tract, is a member of the papovirus group
HPV
It is a DNA virus containing a single molecule of double-stranded DNA compromising approximately 8000 nucleotide base pairs
HPV
HPV specifically infects ____ epithelial cells and establishes productive infection only in the ___ epithelium of the skin and mucosa
Basal epithelial cells
Stratified squamous epithelium
Replication of HPV occurs within the ___ of epithelial cells with the viral genome expressed in both early and late stages
Nuclei
Location of oral squamous papilloma
Vermillion portion of the lips
Intraoral mucosal site
Hard and soft palate and uvula
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
Solitary lesions are most common
Oral squamous papilloma
Oral warts are common in patients with ???
HIV particularly in patients treated with (HAART)
Human immunodeficiency virus
Highly active antiretroviral therapy
An exaggerated growth of benigh squamous epithelium
Oral squamous papilloma
Histologic architecture of oral squamous papilla may mimic the pattern of the ____ wart
Cutaneous
Histopathology of oral squamous papilloma
Exophytic
Finger-like projections extensions of epithelium
Supported by a well vascularized CT
HPV subtype of oral papilloma
HPV 2, 6, 11, 57
HPV subtype of focal epithelial hyperplasia
HPV 13, 32
HPV subtype of dysplastic wart
16, 18, others
HYV subtype of verruca vulgaris, skin
2, 4, 40, others
HPV subtype of flat wart
3, 10
HPV subtype of condyloma acuminatum
6, 11, others
HPV subtype of laryngeal papilloma
11
HPV subtype of conjunctival papilloma
11
HPV subtype of maxillary sinus papilloma
57
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
- 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
