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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 28  |  Issue : 1  |  Page : 102-104

Squamous papilloma: A report of two cases with review of literature


Department of Oral Medicine and Radiology, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India

Date of Web Publication8-Sep-2016

Correspondence Address:
Abhishek Kumar Singh
Department of Oral Medicine and Radiology, Seema Dental College and Hospital, Rishikesh - 249 203, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.189978

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   Abstract 

Squamous papillomas are common lesions of the oral mucosa with predilection for mucosa of hard and soft palate. As an oral lesion, it raises concern because of its clinical appearance, which may mimic an epithelial malignancy such as verrucous carcinoma or condyloma acuminatum. Pathogenesis of this lesion though largely unknown can be attributed to human papillomavirus infection, however, slight controversy regarding its viral origin exists. In this compilation, two cases of oral squamous papilloma are presented along with a review of literature.

Keywords: Alveolar mucosa, exophytic growth, human papilloma virus, lip, papilloma


How to cite this article:
Singh AK, Malik U, Malhotra S, Kumar A. Squamous papilloma: A report of two cases with review of literature. J Indian Acad Oral Med Radiol 2016;28:102-4

How to cite this URL:
Singh AK, Malik U, Malhotra S, Kumar A. Squamous papilloma: A report of two cases with review of literature. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2019 Sep 18];28:102-4. Available from: http://www.jiaomr.in/text.asp?2016/28/1/102/189978


   Introduction Top


Oral squamous papilloma (OSP) is the fourth most common mucosal mass which accounts for 3–4% of all biopsied lesions. Clinically, this entity is manifested as a papillary or verrucous exophytic mucosal mass due to benign proliferation of the stratified squamous epithelium. The close resemblance of this entity with verrucous carcinoma and the chief etiological factor associated with its development, the human papillomavirus (HPV) raises a doubt about its close association with malignancy.[1] Persistent infection with HPV is considered to be the main etiologic agent for the development of cervical cancers; however, recent studies now indicate the presence of HPV in majority of white oral mucosal lesions manifesting as flat, exophytic, wart-like, or papillary proliferations. These lesions could be considered as clinical manifestations of oral HPV infections. Association of such oral lesions is seen with low-risk HPV types such as HPV6, 11, 13, and 32 and association of high-risk types of HPV such as HPV16, 18, 31, 33, and 35 are mainly seen with cervical cancers.[2]HPV infection of the oral cavity, oropharynx, larynx, and skin occurs early in life through the birth canal or through close contact with infected persons, may persist for a long time and in association with other factors promoting cell proliferation and transformation, leads to more severe disease.[3] However, HPV prevalence in malignant head and neck tumors varies widely (1–100%).[4] High-risk HPV types have been detected in hyperplastic and dysplastic mucosal lesions of the oral cavity.[5] Keeping in mind, the association of this lesion with oral dysplasias and carcinomas an early diagnosis clinically as well as histopathologically becomes essential. In this paper, two cases of squamous papilloma in the form of oral lesions are discussed along with a review of literature.


   Case Reports Top


Case report-1

A 55-year-old male patient reported to the out-patient department (OPD) with a chief complaint of missing teeth and a small growth on the lower lip. The patient was edentulous from past 5 years without any history of denture wearing. His past dental and past medical history were insignificant. All the vital signs were within the normal range. The extraoral examination did not reveal any abnormality. On the lower lip, an exophytic, sessile growth was present in the middle of the lower labial mucosa measuring 0.5 × 0.5 cm in diameter, which appeared to be predominantly pink with an irregular surface. All the inspectory findings were confirmed on palpation. The growth was nontender and soft to slightly firm in consistency with an induration <1 mm. The lesion was totally asymptomatic and was gradually increasing in size [Figure 1]. On the basis of clinical examination, a provisional diagnosis of verruca vulgaris was made. An excisional biopsy of the lesion was done and tissue was sent for histopathological examination. Histopathologically, the lesion showed proliferation of the spinous layer cells, following digit form pattern with a delicate core of fibrous connective tissue constituting the supporting stroma suggestive of squamous papilloma [Figure 2].
Figure 1: Exophytic growth over vermilion border of lower lip

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Figure 2: Histopathological picture in case-1

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Case report-2

A 33-year-old female patient reported to the OPD with a chief complaint of missing teeth and growth on the left upper alveolar mucosa. The patient was edentulous since 1 year and had no history of denture wearing. Her past dental and medical histories were insignificant. All the vital signs were within the normal range. The extraoral examination did not reveal any abnormality. On the alveolar mucosa an exophytic, solitary, sessile growth was present over the left upper alveolar mucosa measuring 1.5 × 1.5 cm in diameter, which appeared to be whitish in color with an irregular surface. All the inspectory findings were confirmed on palpation. The growth was nontender and soft to slightly firm in consistency. The lesion was totally asymptomatic and was gradually increasing in size [Figure 3]. On the basis of clinical examination, a provisional diagnosis of verruca vulgaris was made. An excisional biopsy of the lesion was done and the histopathological examination showed similar features as seen in the first case [Figure 4].
Figure 3: Exophytic growth present at left upper alveolar ridge

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Figure 4: Histopathological picture in case-2

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   Discussion Top


OSP is a benign entity presenting itself as an exophytic lesion, with a rugose red or white surface having a sessile or pedunculated base.[2],[3] It can be granular, finger-like and may be asymptomatic.[6] The average size is <1.0 cm with palate as the most common site of occurrence followed by uvula area, tongue, and lips. The mean age of patients presenting with oral mucosal papilloma is 36.4 years with a range of 2–9 years without any sexual predilection. The duration ranges from weeks to 10 years; most of the lesions have been reported to be of 2–7 months duration.[7] Our cases showed all the features reported in literature except the age of the patient in the first case which did not correlate with the age reported in literature. The exception in the first case can be attributed to the fact that lesion might have been gone unnoticed by the patient. The differential diagnosis of OSP, when solitary, includes verruciform xanthoma, papillary hyperplasia, and condyloma acuminatum. Verruciform xanthoma has a distinct predilection for the gingiva and the alveolar ridge. A cause-and-effect relationship (e.g., lesion appearing under an ill-fitting denture) should be evident for inflammatory papillary hyperplasia. The condyloma would be larger than the papilloma, would have a broader base, and would appear pink-to-red as a result of less keratinization. In addition, clustered or multiple squamous papillomas would suggest focal epithelial hyperplasia (Heck disease).[8] Histological features are associated with epithelial hyperplasia with fibrovascular cores. Papillary projections seen may be sharp to blunt.[9] The exophytic finger like projections are lined by stratified squamous epithelium and contains a thin central connective tissue.[10] The spinous cells proliferate in a papillary pattern. Koilocytes, HPV altered cells may or may not be seen. Upper-level epithelial cells demonstrate nuclei that are pyknotic and crenated, often surrounded by an edematous or optically-clear zone, forming the so-called “koilocytic” cell. This cell is thought to be indicative of a virally-altered state. Chronic inflammatory cells are also seen.[8]

The solitary, simple squamous papilloma has not been considered to be a sexually transmitted lesion and when these lesions occur in children, sexual abuse is not to be suspected.[10] Owing to the association of this clinical entity with low-risk HPV type 6 and health status of both the patients, tests for HPV were not advised. As a treatment approach lesions <1 cm in diameter should be excised and examined histopathologically for changes associated with dysplasia or frank malignancy. In our case, an excisional biopsy of both lesions was considered for diagnosis as well as from treatment point of view.


   Conclusion Top


Two cases of squamous papilloma one in a 55-year-old male and other in a 33-year-old female patient were reported along with a discussion on etiology, clinical features, histopathological appearance, and differential diagnosis. An early clinical diagnosis as well as histopathological examination of these lesions is important because of their association with oral dysplasias and carcinomas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Terai M, Hashimoto K, Yoda K, Sata T. High prevalence of human papillomaviruses in the normal oral cavity of adults. Oral Microbiol Immunol 1999;14:201-5.  Back to cited text no. 1
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2.
Varnai AD, Bollmann M, Bankfalvi A, Kovacs K, Heller H, Schmitt C, et al. The prevalence and distribution of human papillomavirus genotypes in oral epithelial hyperplasia: Proposal of a concept. J Oral Pathol Med 2009;38:181-7.  Back to cited text no. 2
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3.
Kojima A, Maeda H, Kurahashi N, Sakagami G, Kubo K, Yoshimoto H, et al. Human papillomaviruses in the normal oral cavity of children in Japan. Oral Oncol 2003;39:821-8.  Back to cited text no. 3
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4.
Miller CS, Johnstone BM. Human papillomavirus as a risk factor for oral squamous cell carcinoma: A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:622-35.  Back to cited text no. 4
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5.
Bouda M, Gorgoulis VG, Kastrinakis NG, Giannoudis A, Tsoli E, Danassi-Afentaki, et al. “High risk” HPV types are frequently detected in potentially malignant and malignant oral lesions, but not in normal oral mucosa. Mod Pathol 2000;13:644-53.  Back to cited text no. 5
    
6.
Chang F, Syrjänen S, Kellokoski J, Syrjänen K. Human papillomavirus (HPV) infections and their associations with oral disease. J Oral Pathol Med 1991;20:305-17.  Back to cited text no. 6
    
7.
Carneiro TE, Marinho SA, Verli FD, Mesquita AT, Lima NL, Miranda JL. Oral squamous papilloma: Clinical, histologic and immunohistochemical analyses. J Oral Sci 2009;51:367-72.  Back to cited text no. 7
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8.
Jaju PP, Suvarna PV, Desai RS. Squamous papilloma: Case report and review of literature. Int J Oral 2010;2:222-5.  Back to cited text no. 8
    
9.
Ongole R, Praveen BN. Tumors of orofacial region. In: The Textbook of Oral Medicine, Oral Diagnosis and Oral Radiology. New Delhi: Elsevier; 2013. p. 345-6.  Back to cited text no. 9
    
10.
Eversole LR, Laipis PJ. Oral squamous papilloma: Detection of HPV DNA by in situ hybridization. Oral Surg Oral Med Oral Pathol 1988;65:545-50.  Back to cited text no. 10
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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