Oral and maxillofacial pathology. Epithelial pathology

1. SQUAMOUS PAPILLOMA
Masayi Mackatiani K.

2. • Def: Benign proliferation of stratified squamous epithelium resulting in
papillary or vericiform mass
Human papilloma virus
• Lesion induced by HPV- ds DNA virus of papovavirus subgroup A
viruses integrated with the DNA of the host cell
• HPV- subtypes 6,11 identified in upto 50% of oral papillomas, as compared
with 5% in normal mucosal cells
• Mode of transmission unknown
• Low virulence and infectivity rate
• Latency- 3-12 months

3. Methods of identification in situ
• Hybridization
• Immunohistochemical analysis
• PCR
- Not visible with routine histopathologic
staining

4. Occurs in 1 out of every 250 adults
Makes up appx 3% of all oral lesions
submitted for biopsy

5. Clinical features
• Males=females
• Predominantly in children;
• epidemiology- at any age, often 30-50years
• Sites of predilection
 Tongue
 Lips
 Soft palate- Most common of the soft tissue masses
arising from the soft palate
• But any oral surface may be affected

6. • It’s a soft, painless, usually pedunculated,
exophylic nodule with numerous finger like
projections that impart a “cauliflower” or
wartlike appearance
• Projections may be pointed or blunted
• Lesions may be white, slightly red or normal in
colour depending on amount of surface
keratinization

7. An exophytic lesion of the
soft palate with multiple short, white
surface projections
A pedunculated lingual
mass with numerous long, pointed, and
white surface
projections. The smaller projections
around the base of
the lesion.

8. A pedunculated mass of
the buccal commissure,
exhibiting short or blunted
surface
projections and minimal white
coloration.

9. • The papilloma is usually solitary and enlarges
rapidly to a maximum size of about 0.5cm with
little or no change thereafter
• However lesions as large as 3cm have been
reported
• Difficult to distinguish this lesion clinically from:
Veruca vulgaris
Condyloma acumulatum
Veruciform xanthoma
Focal epithelial dysplasia

10. • Extensive coalescing papillary
lesions(papillomatosis) of the oral mucosa
may be seen in several skin disorders e.g
Nevus unius lateralis
Acanthosis nigricans
Focal dermal hypoplasia (Goltz-Gorlin)
syndrome

11. • Laryngeal papillomatosis, a rare and
potentially devastating disease of larynx and
pharynx has two distinct types
Juvenile onset
Adult onset
• Hoarseness is the usual presenting feature
• Rapidly proliferating papillomas in the juvenile
onset type may obstruct the airway

12. Histopathological features
• Proliferation of keratinized
stratified squamous epithelium
arrayed in finger like projections
with fibrovascular connective
tissue cores
• Connective tissue cores may
show inflammatory changes,
depending on amount of trauma
sustained by lesion
• Keratin layer is thickened in
lesions with whiter clinical
appearance and the epithelium
typically shows normal
maturation pattern

13. A pedunculated squamous
epithelial proliferation. There
are
multiple papillary projections
with fibrovascular connective
tissue cores.

14. papillary projections composed of
epithelium with thickened parakeratin
and spinous cell
layers and a central core of fibrous
tissue with enlarged vascular
structures

15. • Occasional papillomas demonstrate basilar
hyperplasia and mitotic activity
• Keilocytes, viral altered epithelial clear cells
with small dark(pyknotic) nuclei are
sometimes seen in prickle cell layer

16. Treatment
• Conservative surgical excision