Squamous Papilloma : a Case Report

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 ------Abstract: case of squamous papilloma of buccal mucosa along Papillary and verruciform epithelial proliferations with a review of the literature. are quite common in the oral and para-oral region, representing at least 3% of biopsied oral lesions. Case Report:

Many are thought to be induced by viral infection of A 37-year-old married male reported to the the epithelium. These exophytic proliferations may department of Oral Medicine of C.S.M.S.S Dental often shown tendency to undergo neoplastic changes. College and hospital Aurangabad with a chief The papilloma is a benign mucosal mass produced by complaint of pain in lower left back region of jaw due a strain of the papilloma virus, the virus which to partially erupted third molar. On general produces skin warts. However unlike warts examination a papillary growth was observed on left papilloma is not contagious, like a wart, and can be buccal mucosa (Figure 1). History regarding the removed by conservative surgery or laser growth revealed that it was first seen about six to destruction. Here we present you a case of benign eight months prior as a slow-growing non-tender squamous papilloma of left buccal mucosa. papule. And since there were no associated Key Words: Squamous papilloma, human papilloma symptoms patient had no complaint regarding the virus, ELISA, p53 Immunohistochemical assay. same. Patient also reported of habitual cheek bite ------with same. The present lesion was seen in region of Introduction: 36, 37 with relation to buccal mucosa. The lesion was

Papillary and verruciform epithelial proliferations exophytic and sessile in nature, roughly triangular in are quite common in the oral and para-oral region, shape, pinkish in colour at base and appeared white representing at least 3% of biopsied oral lesions . The towards apex with multiple finger like projections on squamous papilloma is the fourth most common surface. It was soft in consistency, 1.5 cm × 1 cm in benign epithelial neoplasm of oral epithelium, and size, (Figure 2). The surrounding mucosa appeared are associated with human papilloma virus (HPV) normal. There was no other any such lesion in oral types 6, and 11 [1]. The sites of predilection for cavity nor extraorally. Past medical, dental and localization of the lesions include the tongue and soft personal history was non-contributory. The left palate, but any surface of the oral cavity can be submandibular lymph nodes were palpable and affected [2]. Non-keratinized lesions appear coral tender. Provisional diagnosis of the oral papilloma pink; if keratinized, they are white. Some have a was made and the patient was advised special cauliflower surface whereas others have discrete investigation of ELISA. The ELISA test was negative. finger-like projections. Though clinically innocuous in Surgical excision of the lesion was performed with a 1 rare circumstances, oral squamous papilloma may mm margin to the depth of the submucosa (Figure herald the serious precancer proliferative 3,4). The histopathological diagnosis of squamous verruciform leukoplakia, thus requiring correct papilloma was made at 10 × magnification under H & diagnosis and prompt treatment. Here we present a E staining (Figure 5). The patient was recalled later for follow up and no recurrence was seen even after 6 months.

Neha Desai, Lata Kale, Vishal Patil, Sneha Chaudhari & Anand Swami

Fig 1. Left buccal mucosa with Fig 2.Triangular growth with multiple fingure Fig 3. Exicisional biopsy done under exophytic papillary growth like projections base appears pink with local anaesthesia keratinisation at tip.

Fig 4. Exicised tissued Fig 5. H&E stain showing papillary finger like projections with thick hyperkeratotic squamous epithelium and stroma showing moderate chronic inflammatory reaction

Discussion: important part in diagnosis .In current case Hepatitis- Papillary lesions are those that are tumefactive with a B and HIV infections were ruled out by ELISA. cauliflower like surface. Some are pedunculated and Oral and oropharyngeal squamous papilloma occur others are sessile. Some are single; others are mainly between 30 and 50 years of age and may multiple or diffusely involve broad areas of the oral occur below 10 years [5]. The age of patient in mucosa. The squamous papilloma is the fourth most current case coincides within this age range. common oral mucosal mass and forms 3-4% of all Squamous papillomas are seen in mouth as well as biopsied oral soft tissue lesions. It was first reported nasal and paranasal and laryngeal regions. These as a gingival "wart" by Tomes in 1848 and is a extra oral lesions have a very high recurrence rate localized, benign HPV-induced epithelial and proliferative growth potential The laryngeal hyperplasia [1]. lesions may cause asphyxiation [1,6]. Intraorally The exact etiology is not known but human pailloma lesions have predisposition for, hard and soft palate, virus is most commonly associated with the lesion other sites are vermillion border of lips or any with HPV 6 and 11 in squamous cell papilloma and mucosal surface. In current case lesion was present condylomas acuminatum, while HPV 2 and 57 were on buccal mucosa Squamous papillomas may be more prevalent in verruca vulgaris lesions [3]. Other divide into two types as: isolated or solitary and risk factors for oral HPV induced lesions are immune- multiple or recurring. The solitary type is seen in compromised conditions like HIV infection and renal adult oral cavity while multiple form is seen in child’s transplantation, patients with current or previous laryngo-tracheo-bronchial complex or in HIV positive infection with hepatitis-B virus and AIDS patients patients. [7]. The HPV lesions generally are infective undergoing highly active anti-retroviral therapy while on contrary squamous papilloma appears to (HAART) regimen [4]. Which make screening of these have an extremely low virulence, infectivity rate and patients for Hepatitis-B and HIV infections an does not seem contagious [1]. However malignant

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potential may be commonly seen in the multiple Recurrence is uncommon, with squamous papilloma recurring type [7]. except in HIV positive patients and in a small Histologically Many long, thin, and finger-like proportion of treated cases [1,8]. Often lesions are projections extend above the surface of mucosa. Each left untreated for years without progression into finger- like projection is lined by stratified squamous malignancy. epithelium and contains a thin central connective tissue. The spinous cells proliferate in a papillary Conclusion: pattern. Koilocytes are the HPV altered cells with pyknotic and crenated nuclei which is surrounded by Various papillary lesions that manifest in oral cavity an edematous or optically-clear zone. These with similar picture to Squamous papilloma and it is koilocytes may or may not be seen. The HPV important for dentist to identify these lesions detection can be confirmed with the help of PCR correctly and differentiate the benign squamous (polymerase chain reaction). DNA of the HPV can also papilloma from more serious pathologies that require prompt treatment. be detected in tissue by in situ hybridization using radioisotope-labeled specific probes [2]. In a study to References: assess the malignant potential by Immuno-histo- chemical assays for p53 protein were negative for the 1. Bond TE. Bond’s book of oral disease. Squamous great majority of the specimens evaluated thus papilloma, fourth edition [Internet]. United states, confirming the benign nature of lesion [8]. 1999. In current case owing to lack of these advanced 2. Neville BW, Damm DD, Allen CM, Bouquot JE, Oral techniques HPV identification was not done. & maxillofacial pathology. 2nd ed, 2004,,304-305. The differential diagnosis should include other 3. Patury T P,Castro G, Filho I B. Prevalence of human papillary and verruciform lesions in the oral cavity. papillomavirus (HPV) in oral cavity and These include squamous papilloma, verruca vulgaris oropharynx. Brazilian journal of condyloma accuminatum, focal epithelial hyperplasia, otorhinolaryngology, 72(2):272-82 fungiform papilloma, verruciform xanthoma, 4. Deshingkar Sanket Abhaykumar, Barpande Suresh proliferative verrucous leukoplakia (PVL) and Ramchandra. Gingival Wart: An Uncommon Lesion. verrucous carcinoma. Often squamous papilloma may International Journal of Oral & Maxillofacial be clinically and microscopically indistinguishable Pathology; 2011:2(4):59-62. from verruca vulgaris which is virus induce focal 5. Kumar BP, Khaitan T, Ramaswamy P, Pattipati papillary hyperplasia of epidermis. However erruca S. Squamous papilloma. Int J vulgaris is caused by HPV 2, 4, 40 Strains as opposed Stomatol Occlusion Med. 2013;6:106–9. to squamous papilloma caused by 6 and 1. Verruca 6. Mundra R. K.. Sinha Richi. Agrawal Richa vulgaris is contagious and often seen due to Squamous Papilloma: An Unusual Presentation as a Large Pedunculated Mass over Buccal Mucosa, autoinoculation by patient with skin lesions in oral EJNSO ,2014, 1[1], 7-9 cavity where it is rarely seen [1]. The treatment includes a conservative surgical 7. Jaju P. P, Suvarna P. V, and Desai R. S, , Squamous pailloma: case report and literature review, exicision that includes the base by either routine International Journal of OralScience, 2010, 2 [4], excision or laser ablation. Modlities other than 222–225. surgery include use of liquid nitrogen cryotherapy, 8. Carneiro T, Marinho SA, Verli FD, Mesquita ATM, topically applied keratinolytic agents like Lima NL, Miranda JL. Oral squamous papilloma: salicyclicacid and lactic acid [1]. Other recent clinical, histologic and immunohistochemical advances include use of intralesional injections of analyses. J Oral Sci, 2009, 51(3): 367–372. interferon, electrocautery or cryosurgery [7]. ------

International Journal of Current Medical And Applied Sciences [IJCMAAS], volume.6. Issue 3. . Page | 192