Squamous Papilloma and Verruciform Xanthoma (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)

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1. Squamous Papilloma/ (Oral Wart) Verruciform xanthoma Verruca-Papillary Lesions

2. Contents

3. Squamous Papilloma (Oral Wart) Oral squamous papilloma is a generic term that used to include papillary and verrucous growths composed of benign epithelium and minor amounts supporting connective tissue

4. Etiology and Pathogenesis HPV types and their known associations DNA virus 1- benign 2- malignant Specifically infect basal epithelia cells and establishes a productive infection only on stratified squamous epithelium

5. Clinical feature less than 1 cm Lateral tongue (granular)

6. Clinical feature Floor of mouth

7. Clinical feature Oral wart , Palate (cauliflower like)

8. Histopathology

9. Papilloma Exophytic Finger like extension of epithelium supported by well vascularized connective tissue

10. Oral wart

11. Koilocytic cell Epithelial nuclei that are pyknotic and centered surrounded by edematous or optically clear zone

12. Oral wart Positive brown staining nuclei are seen In upper level keratinocytes

13. Dysplastic oral warts

14. Dysplastic oral warts A , Note normal epithelium at far right B , stain for proliferation marker [PCNA] showing positive nuclear staining (red) in most keratinocytes

15. Differential Diagnosis

16. Verruciform xanthoma Uncommon benine oral mocusal lesion that occasionally may be found on the skin typically on the genitalia

17. Etiology and Pathogenesis

18. Clinical feature: “whites” granular and papillary (2 mm to 2 cm)

19. Histopathology Elongated epithelial ridge extend into the lamina propria at a uniform depth Note the uniformly invaginated crypts alternate with papillary extension

20. Histopathology Note Xanthoma cells (foamy macrophages) in the lamina propria or connective tissue papillae Foam? (PAS) No evidence of dysplasia and atypia

21. Differential Diagnosis

22. References