• Save
Papillary lesions
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
647
On Slideshare
647
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
0
Comments
0
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Verrucal-Papillary Lesions
  • 2. Verrucal-Papillary Lesions • Reactive lesions: • • • • • Papillary hyperplasia Condyloma Latum Squamous Papilloma Condyloma Acuminatum Focal epithelial hyperplasia • Neoplasms: • Keratoacanthoma • Verrucous carcinoma • Unknown etiology: • Pyostomatitis vegetans • Verruciform xanthoma Verrucous leukoplakia
  • 3. Papillary hyperplasia • Etiology  Removable dentures  Hard palate and trauma  Microorganisms (Candida A)
  • 4. Papillary hyperplasia • Clinical features  Site: Palate  Erythematous, papillary cobblestone  Ulceration is rare
  • 5. Papillary hyperplasia  Histopathology  Small papillary projections covered with SSE  Stroma is well vascularized  Epithelium is hyperplastic with pseudoepitheliomatous features  No evidence of dysplasia Pseudoepitheliomatous epithelium Epithelial dysplasia Mild, moderate and severe Malignant invasion of epithelium
  • 6. Papillary hyperplasia  Differential diagnosis:  Nicotine stomatitis  Multiple squamous papillomas  Acanthosis nigricans  Cowden syndrome  Treatment and prognosis:  mild: soft tissue agents and liners  Surgical removal
  • 7. Condyloma Latum  Etiology: Secondary syphilis  Clinically: Most common in the perianal area  Orally: Smooth, lobulated or mushroom-like mass  HP: Acanthosis, intra- and intercellular edema, inflammatory cell infiltration  Treatment: It will regress after the treatment of syphilis Intracellular intercellular
  • 8. Squamous Papilloma Oral Verruca Vulgaris Etiology  HPV [2, 6, 11, 57]  2, 4 & 40 Cutaneous verruca  3 & 10 Flat warts  13 & 32 Focal epithelial hyperplasia  Transmission might be through direct contact
  • 9. Squamous Papilloma Clinical features  Most common papillary lesion of the oral mucosa  Palate, lip and vermilion and other parts of oral mucosa  Generally single and less than 1 cm.  Cauliflower-like surface
  • 10. Squamous Papilloma Histopathology  Growth of keratinized squamous epithelium  Well vascularized stroma  Inflammatory cell infiltration
  • 11. Squamous Papilloma Differential diagnosis  Verruciform xanthoma [gingiva, skin, Langerhans cells]  Condyloma acuminatum [larger with broader base]  Darier’s disease [multiple]
  • 12. Squamous Papilloma Treatment  Remove by surgery or Laser
  • 13. Condyloma Acuminatum • Etiology Cauliflower  HPV 6 & 11  Infectious lesion  Frequent in HIV-infected persons
  • 14. Condyloma Acuminatum • Clinical features  Common in the anogenital region and may involve oral mucosa Early stage: multiple pink nodules  Later it grows and coalesce to become:  Soft, broad-base papillary growth
  • 15. Condyloma Acuminatum • Histopathology  Papillary projections covered by hyperplastic SSE  Might be keratinized or non-keratinized  Upper level of epithelium demonstrate perinuclear cellular vacuolization [koilocytic cells]  Vascularized stroma with inflammatory infiltration Koilocytic cells
  • 16. Condyloma Acuminatum • Treatment  Surgical excision:  Scalpel  Laser CO2  Cryosurgery
  • 17. Focal epithelial hyperplasia Heck’s disease  Etiology:  - Common among Americans  - Irritation  - Vitamin deficiency  - HPV 13 and possibly 32  - Multi-focal epithelial hyperplasia
  • 18. Focal epithelial hyperplasia Heck’s disease  Clinical features:  - Multiple nodular soft tissue masses  - Buccal, labial mucosa and tongue  - Whitish to pinky in color
  • 19. Focal epithelial hyperplasia Heck’s disease  Histopathology:  - Acanthosis  - Parakeratosis  - Ballooning spinous cells
  • 20. Focal epithelial hyperplasia Heck’s disease  Treatment:  - Regress spontaneously  - Surgical removal
  • 21. Keratoacanthoma Etiology  Benign lesion  Common at sun exposed skin and less on the vermilion  Rarely on oral mucosa in such case it may originate from Fordyce’s granules  Other etiologic agents:  Viral infection  trauma  Chemical irritation …etc.
  • 22. Keratoacanthoma Clinical features • • • Solitary or multiple Rapid enlargement of the papule within 4-8 weeks Asymptomatic nodules with central plug of keratin
  • 23. Keratoacanthoma Histopathology  Central keratin plug  Marginal buttress of epithelium  Pseudoepitheliomatous hyperplasia  Intense mixed inflammatory infiltration  No malignancy
  • 24. Keratoacanthoma Differential diagnosis  SCC  Verruca vulgaris Treatment  Careful follow-up  It may regress spontaneously if no  Surgical removal and HP examination
  • 25. Verrucous carcinoma Etiology o The use of tobacco [smoking or smokeless] o HPV
  • 26. Verrucous carcinoma Clinical features 5% of oral SCC Common sites: buccal mucosa and gingiva Early stage [verrucous hyperplasia] is benign or may arise from leukoplakia • Indurate firm with invasion to the subjacent tissue • • •
  • 27. Verrucous carcinoma Histopathology Papillary surface, acanthotic and highly keratinized epithelium  Submucosal invasion by bulbous well differentiated epithelium  Minimal atypia
  • 28. Verrucous carcinoma Differential diagnosis  SCC  Proliferative verrucous leukoplakia Treatment  Surgery followed by radiotherapy
  • 29. Pyostomatitis vegetans Etiology • Benign chronic mucocutaneous disease • Unknown etiology • Many cases are associated with gastrointestinal disturbances
  • 30. Pyostomatitis vegetans Clinical features  Erythematous and edematous oral mucosa  Multiple yellow pustules 2-3 mm  Papillary projections of oral mucosa  male are more affected than female with mean age of 34 years
  • 31. Pyostomatitis vegetans Histopathology  Acanthosis  Hyperkeratosis  Pseudoepitheliomatous hyperplasia  Inflammatory infiltration  Ulceration and superficial epithelial necrosis
  • 32. Pyostomatitis vegetans Treatment  Controlling the associated diseases if present  Topical corticosteroids may be used  Additional antibiotic and multivitamins may be employed
  • 33. Verruciform xanthoma Etiology • Unknown • Immunologic disorder
  • 34. Verruciform xanthoma Clinical features • • • • • Well circumscribed Papillary surface Size: vary from 2mm. To 2cm. May appear on the skin Mean age 45 years
  • 35. Verruciform xanthoma Histopathology  Parakeratinized papillomatous epithelium  Elongated rete ridges  Presence of xanthoma [foam] cells in the lamina propria  Langerhans cells
  • 36. Verruciform xanthoma Treatment  Conservative surgical excision
  • 37. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma Pyostomatitis vegetans Verruciform xanthoma
  • 38. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 39. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 40. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 41. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 42. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 43. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 44. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 45. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 46. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 47. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 48. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 49. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 50. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  • 51. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma   Because there’s no histopathology