Verrucal-Papillary Lesions
Verrucal-Papillary Lesions
• Reactive lesions:
•
•
•
•
•

Papillary hyperplasia
Condyloma Latum
Squamous Papilloma
Condylo...
Papillary hyperplasia
• Etiology

 Removable dentures

 Hard palate and trauma
 Microorganisms (Candida A)
Papillary hyperplasia
• Clinical features

 Site: Palate
 Erythematous, papillary cobblestone
 Ulceration is rare
Papillary hyperplasia
 Histopathology
 Small papillary projections covered with SSE
 Stroma is well vascularized

 Epi...
Papillary hyperplasia
 Differential diagnosis:
 Nicotine stomatitis
 Multiple squamous papillomas
 Acanthosis nigrican...
Condyloma Latum
 Etiology: Secondary syphilis
 Clinically: Most common in the perianal area

 Orally: Smooth, lobulated...
Squamous Papilloma
Oral Verruca Vulgaris

Etiology
 HPV [2, 6, 11, 57]
 2, 4 & 40

Cutaneous verruca

 3 & 10

Flat war...
Squamous Papilloma
Clinical features
 Most common papillary lesion of the oral mucosa
 Palate, lip and vermilion and oth...
Squamous Papilloma
Histopathology
 Growth of keratinized squamous epithelium

 Well vascularized stroma
 Inflammatory c...
Squamous Papilloma
Differential diagnosis

 Verruciform xanthoma [gingiva, skin, Langerhans cells]
 Condyloma acuminatum...
Squamous Papilloma
Treatment

 Remove by surgery or Laser
Condyloma Acuminatum
• Etiology
Cauliflower

 HPV 6 & 11
 Infectious lesion
 Frequent in HIV-infected persons
Condyloma Acuminatum
• Clinical features

 Common in the anogenital region and
may involve oral mucosa
Early stage: mult...
Condyloma Acuminatum
• Histopathology
 Papillary projections covered by hyperplastic SSE
 Might be keratinized or non-ke...
Condyloma Acuminatum
• Treatment

 Surgical excision:

 Scalpel
 Laser CO2
 Cryosurgery
Focal epithelial hyperplasia
Heck’s disease

 Etiology:
 - Common among Americans
 - Irritation
 - Vitamin deficiency
...
Focal epithelial hyperplasia
Heck’s disease
 Clinical features:

 - Multiple nodular soft tissue masses
 - Buccal, labi...
Focal epithelial hyperplasia
Heck’s disease

 Histopathology:
 - Acanthosis
 - Parakeratosis
 - Ballooning spinous cel...
Focal epithelial hyperplasia
Heck’s disease

 Treatment:

 - Regress spontaneously
 - Surgical removal
Keratoacanthoma
Etiology
 Benign lesion

 Common at sun exposed skin and less on the
vermilion
 Rarely on oral mucosa i...
Keratoacanthoma
Clinical features
•
•
•

Solitary or multiple
Rapid enlargement of the papule within 4-8 weeks
Asymptomati...
Keratoacanthoma
Histopathology
 Central keratin plug
 Marginal buttress of epithelium
 Pseudoepitheliomatous hyperplasi...
Keratoacanthoma
Differential diagnosis
 SCC
 Verruca vulgaris

Treatment
 Careful follow-up
 It may regress spontaneou...
Verrucous carcinoma
Etiology

o The use of tobacco [smoking or smokeless]
o HPV
Verrucous carcinoma
Clinical features
5% of oral SCC
Common sites: buccal mucosa and gingiva
Early stage [verrucous hyperp...
Verrucous carcinoma
Histopathology
Papillary surface, acanthotic and highly
keratinized epithelium
 Submucosal invasion ...
Verrucous carcinoma
Differential diagnosis
 SCC
 Proliferative verrucous leukoplakia

Treatment
 Surgery followed by ra...
Pyostomatitis vegetans
Etiology

• Benign chronic mucocutaneous disease
• Unknown etiology
• Many cases are associated wit...
Pyostomatitis vegetans
Clinical features

 Erythematous and edematous oral
mucosa
 Multiple yellow pustules 2-3 mm
 Pap...
Pyostomatitis vegetans
Histopathology

 Acanthosis

 Hyperkeratosis
 Pseudoepitheliomatous hyperplasia
 Inflammatory i...
Pyostomatitis vegetans
Treatment
 Controlling the associated diseases if present
 Topical corticosteroids may be used
 ...
Verruciform xanthoma
Etiology

• Unknown
• Immunologic disorder
Verruciform xanthoma
Clinical features
•
•
•
•
•

Well circumscribed
Papillary surface
Size: vary from 2mm. To 2cm.
May ap...
Verruciform xanthoma
Histopathology

 Parakeratinized papillomatous epithelium

 Elongated rete ridges
 Presence of xan...
Verruciform xanthoma
Treatment
 Conservative surgical excision
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Differential diagnosis
Papillary hyperplasia
Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Focal epithelial...
Papillary lesions
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Papillary lesions

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Oral Pathology II
Forth Year

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Papillary lesions

  1. 1. Verrucal-Papillary Lesions
  2. 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. 3. Papillary hyperplasia • Etiology  Removable dentures  Hard palate and trauma  Microorganisms (Candida A)
  4. 4. Papillary hyperplasia • Clinical features  Site: Palate  Erythematous, papillary cobblestone  Ulceration is rare
  5. 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. 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. 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. 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. 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. 10. Squamous Papilloma Histopathology  Growth of keratinized squamous epithelium  Well vascularized stroma  Inflammatory cell infiltration
  11. 11. Squamous Papilloma Differential diagnosis  Verruciform xanthoma [gingiva, skin, Langerhans cells]  Condyloma acuminatum [larger with broader base]  Darier’s disease [multiple]
  12. 12. Squamous Papilloma Treatment  Remove by surgery or Laser
  13. 13. Condyloma Acuminatum • Etiology Cauliflower  HPV 6 & 11  Infectious lesion  Frequent in HIV-infected persons
  14. 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. 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. 16. Condyloma Acuminatum • Treatment  Surgical excision:  Scalpel  Laser CO2  Cryosurgery
  17. 17. Focal epithelial hyperplasia Heck’s disease  Etiology:  - Common among Americans  - Irritation  - Vitamin deficiency  - HPV 13 and possibly 32  - Multi-focal epithelial hyperplasia
  18. 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. 19. Focal epithelial hyperplasia Heck’s disease  Histopathology:  - Acanthosis  - Parakeratosis  - Ballooning spinous cells
  20. 20. Focal epithelial hyperplasia Heck’s disease  Treatment:  - Regress spontaneously  - Surgical removal
  21. 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. 22. Keratoacanthoma Clinical features • • • Solitary or multiple Rapid enlargement of the papule within 4-8 weeks Asymptomatic nodules with central plug of keratin
  23. 23. Keratoacanthoma Histopathology  Central keratin plug  Marginal buttress of epithelium  Pseudoepitheliomatous hyperplasia  Intense mixed inflammatory infiltration  No malignancy
  24. 24. Keratoacanthoma Differential diagnosis  SCC  Verruca vulgaris Treatment  Careful follow-up  It may regress spontaneously if no  Surgical removal and HP examination
  25. 25. Verrucous carcinoma Etiology o The use of tobacco [smoking or smokeless] o HPV
  26. 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. 27. Verrucous carcinoma Histopathology Papillary surface, acanthotic and highly keratinized epithelium  Submucosal invasion by bulbous well differentiated epithelium  Minimal atypia
  28. 28. Verrucous carcinoma Differential diagnosis  SCC  Proliferative verrucous leukoplakia Treatment  Surgery followed by radiotherapy
  29. 29. Pyostomatitis vegetans Etiology • Benign chronic mucocutaneous disease • Unknown etiology • Many cases are associated with gastrointestinal disturbances
  30. 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. 31. Pyostomatitis vegetans Histopathology  Acanthosis  Hyperkeratosis  Pseudoepitheliomatous hyperplasia  Inflammatory infiltration  Ulceration and superficial epithelial necrosis
  32. 32. Pyostomatitis vegetans Treatment  Controlling the associated diseases if present  Topical corticosteroids may be used  Additional antibiotic and multivitamins may be employed
  33. 33. Verruciform xanthoma Etiology • Unknown • Immunologic disorder
  34. 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. 35. Verruciform xanthoma Histopathology  Parakeratinized papillomatous epithelium  Elongated rete ridges  Presence of xanthoma [foam] cells in the lamina propria  Langerhans cells
  36. 36. Verruciform xanthoma Treatment  Conservative surgical excision
  37. 37. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma Pyostomatitis vegetans Verruciform xanthoma
  38. 38. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  39. 39. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  40. 40. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  41. 41. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  42. 42. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  43. 43. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  44. 44. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  45. 45. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  46. 46. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  47. 47. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  48. 48. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  49. 49. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  50. 50. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma 
  51. 51. Differential diagnosis Papillary hyperplasia Condyloma latum Oral squamous papilloma Condyloma acuminatum Focal epithelial hyperplasia Keratoakanthoma Verrucous carcinoma   Because there’s no histopathology

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