Squamous papilloma

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. T he 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