International Journal of Current Medical And Applied Sciences, vol.6. Issue 3, May: 2015. PP: 190-192.
Squamous Papilloma : A Case Report
Neha Desai*, Lata Kale**, Vishal Patil*** & Anand Swami*
*Post Graduate Student, **Professor and HOD, Department of oral Medicine and Radiology,
***Post Graduate student, Department of Oral and Maxillofacial Surgery, C.S.M.S.S. , Dental
College and hospital, Aurangabad,[MS],India.
Corresponding Email ID: [email protected]
Case Report
Subject: Dental Sciences
----------------------------------------------------------------------------------------------------------------------------- --------------------case of squamous papilloma of buccal mucosa along
Abstract:
with a review of the literature.
Papillary and verruciform epithelial proliferations
are quite common in the oral and para-oral region,
representing at least 3% of biopsied oral lesions.
Many are thought to be induced by viral infection of
the epithelium. These exophytic proliferations may
often shown tendency to undergo neoplastic changes.
The papilloma is a benign mucosal mass produced by
a strain of the papilloma virus, the virus which
produces skin warts. However unlike warts
papilloma is not contagious, like a wart, and can be
removed by conservative surgery or laser
destruction. Here we present you a case of benign
squamous papilloma of left buccal mucosa.
Key Words: Squamous papilloma, human papilloma
virus, ELISA, p53 Immunohistochemical assay.
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Introduction:
Papillary and verruciform epithelial proliferations
are quite common in the oral and para-oral region,
representing at least 3% of biopsied oral lesions . The
squamous papilloma is the fourth most common
benign epithelial neoplasm of oral epithelium, and
are associated with human papilloma virus (HPV)
types 6, and 11 [1]. The sites of predilection for
localization of the lesions include the tongue and soft
palate, but any surface of the oral cavity can be
affected [2]. Non-keratinized lesions appear coral
pink; if keratinized, they are white. Some have a
cauliflower surface whereas others have discrete
finger-like projections. Though clinically innocuous in
rare circumstances, oral squamous papilloma may
herald
the
serious
precancer proliferative
verruciform leukoplakia, thus requiring correct
diagnosis and prompt treatment. Here we present a
Case Report:
A 37-year-old married male reported to the
department of Oral Medicine of C.S.M.S.S Dental
College and hospital Aurangabad with a chief
complaint of pain in lower left back region of jaw due
to partially erupted third molar. On general
examination a papillary growth was observed on left
buccal mucosa (Figure 1). History regarding the
growth revealed that it was first seen about six to
eight months prior as a slow-growing non-tender
papule. And since there were no associated
symptoms patient had no complaint regarding the
same. Patient also reported of habitual cheek bite
with same. The present lesion was seen in region of
36, 37 with relation to buccal mucosa. The lesion was
exophytic and sessile in nature, roughly triangular in
shape, pinkish in colour at base and appeared white
towards apex with multiple finger like projections on
surface. It was soft in consistency, 1.5 cm × 1 cm in
size, (Figure 2). The surrounding mucosa appeared
normal. There was no other any such lesion in oral
cavity nor extraorally. Past medical, dental and
personal history was non-contributory. The left
submandibular lymph nodes were palpable and
tender. Provisional diagnosis of the oral papilloma
was made and the patient was advised special
investigation of ELISA. The ELISA test was negative.
Surgical excision of the lesion was performed with a 1
mm margin to the depth of the submucosa (Figure
3,4). The histopathological diagnosis of squamous
papilloma was made at 10 × magnification under H &
E staining (Figure 5). The patient was recalled later
for follow up and no recurrence was seen even after 6
months.
Copyright @ 2015 Logic Publications, IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327.
Page | 190
Neha Desai, Lata Kale, Vishal Patil, Sneha Chaudhari & Anand Swami
Fig 1. Left buccal mucosa with
exophytic papillary growth
Fig 4. Exicised tissued
Fig 2.Triangular growth with multiple fingure Fig 3. Exicisional biopsy done under
like projections base appears pink with
local anaesthesia
keratinisation at tip.
Fig 5. H&E stain showing papillary finger like projections
with thick hyperkeratotic squamous epithelium and stroma
showing moderate chronic inflammatory reaction
Discussion:
Papillary lesions are those that are tumefactive with a
cauliflower like surface. Some are pedunculated and
others are sessile. Some are single; others are
multiple or diffusely involve broad areas of the oral
mucosa. The squamous papilloma is the fourth most
common oral mucosal mass and forms 3-4% of all
biopsied oral soft tissue lesions. It was first reported
as a gingival "wart" by Tomes in 1848 and is a
localized,
benign
HPV-induced
epithelial
hyperplasia [1].
The exact etiology is not known but human pailloma
virus is most commonly associated with the lesion
with HPV 6 and 11 in squamous cell papilloma and
condylomas acuminatum, while HPV 2 and 57 were
more prevalent in verruca vulgaris lesions [3]. Other
risk factors for oral HPV induced lesions are immunecompromised conditions like HIV infection and renal
transplantation, patients with current or previous
infection with hepatitis-B virus and AIDS patients
undergoing highly active anti-retroviral therapy
(HAART) regimen [4]. Which make screening of these
patients for Hepatitis-B and HIV infections an
important part in diagnosis .In current case HepatitisB and HIV infections were ruled out by ELISA.
Oral and oropharyngeal squamous papilloma occur
mainly between 30 and 50 years of age and may
occur below 10 years [5]. The age of patient in
current case coincides within this age range.
Squamous papillomas are seen in mouth as well as
nasal and paranasal and laryngeal regions. These
extra oral lesions have a very high recurrence rate
and proliferative growth potential The laryngeal
lesions may cause asphyxiation [1,6]. Intraorally
lesions have predisposition for, hard and soft palate,
other sites are vermillion border of lips or any
mucosal surface. In current case lesion was present
on buccal mucosa Squamous papillomas may be
divide into two types as: isolated or solitary and
multiple or recurring. The solitary type is seen in
adult oral cavity while multiple form is seen in child’s
laryngo-tracheo-bronchial complex or in HIV positive
patients. [7]. The HPV lesions generally are infective
while on contrary squamous papilloma appears to
have an extremely low virulence, infectivity rate and
does not seem contagious [1]. However malignant
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Logic Publications @ 2015, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327.
potential may be commonly seen in the multiple
recurring type [7].
Histologically Many long, thin, and finger-like
projections extend 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 are the HPV altered cells with
pyknotic and crenated nuclei which is surrounded by
an edematous or optically-clear zone. These
koilocytes may or may not be seen. The HPV
detection can be confirmed with the help of PCR
(polymerase chain reaction). DNA of the HPV can also
be detected in tissue by in situ hybridization using
radioisotope-labeled specific probes [2]. In a study to
assess the malignant potential by Immuno-histochemical assays for p53 protein were negative for the
great majority of the specimens evaluated thus
confirming the benign nature of lesion [8].
In current case owing to lack of these advanced
techniques HPV identification was not done.
The differential diagnosis should include other
papillary and verruciform lesions in the oral cavity.
These include squamous papilloma, verruca vulgaris
condyloma accuminatum, focal epithelial hyperplasia,
fungiform
papilloma,
verruciform
xanthoma,
proliferative verrucous leukoplakia (PVL) and
verrucous carcinoma. Often squamous papilloma may
be clinically and microscopically indistinguishable
from verruca vulgaris which is virus induce focal
papillary hyperplasia of epidermis. However erruca
vulgaris is caused by HPV 2, 4, 40 Strains as opposed
to squamous papilloma caused by 6 and 1. Verruca
vulgaris is contagious and often seen due to
autoinoculation by patient with skin lesions in oral
cavity where it is rarely seen [1].
The treatment includes a conservative surgical
exicision that includes the base by either routine
excision or laser ablation. Modlities other than
surgery include use of liquid nitrogen cryotherapy,
topically
applied
keratinolytic
agents
like
salicyclicacid and lactic acid [1]. Other recent
advances include use of intralesional injections of
interferon, electrocautery or cryosurgery [7].
Recurrence is uncommon, with squamous papilloma
except in HIV positive patients and in a small
proportion of treated cases [1,8]. Often lesions are
left untreated for years without progression into
malignancy.
Conclusion:
Various papillary lesions that manifest in oral cavity
with similar picture to Squamous papilloma and it is
important for dentist to identify these lesions
correctly and differentiate the benign squamous
papilloma from more serious pathologies that require
prompt treatment.
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International Journal of Current Medical And Applied Sciences [IJCMAAS], volume.6. Issue 3. .
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