Papillary lesions

Verrucal-Papillary Lesions
• Reactive lesions:
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Papillary hyperplasia
Condyloma Latum
Squamous Papilloma
Condyloma Acuminatum
Focal epithelial hyperplasia

• Neoplasms:

• Keratoacanthoma
• Verrucous carcinoma

• Unknown etiology:

• Pyostomatitis vegetans
• Verruciform xanthoma
Verrucous leukoplakia

• Etiology

 Removable dentures

 Hard palate and trauma
 Microorganisms (Candida A)

• Clinical features

 Site: Palate
 Erythematous, papillary cobblestone
 Ulceration is rare

 Histopathology
 Small papillary projections covered with SSE
 Stroma is well vascularized

 Epithelium is hyperplastic with pseudoepitheliomatous features
 No evidence of dysplasia
Pseudoepitheliomatous
epithelium
Epithelial dysplasia
Mild, moderate and
severe

Malignant invasion of
epithelium

 Differential diagnosis:
 Nicotine stomatitis
 Multiple squamous papillomas
 Acanthosis nigricans

 Cowden syndrome

 Treatment and prognosis:
 mild: soft tissue agents and liners
 Surgical removal

Condyloma Latum
 Etiology: Secondary syphilis
 Clinically: Most common in the perianal area

 Orally: Smooth, lobulated or mushroom-like mass
 HP: Acanthosis, intra- and intercellular edema,
inflammatory cell infiltration

 Treatment: It will regress after the treatment of syphilis

Intracellular

intercellular

Squamous Papilloma
Oral Verruca Vulgaris

Etiology
 HPV [2, 6, 11, 57]
 2, 4 & 40

Cutaneous verruca

 3 & 10

Flat warts

 13 & 32


 Transmission might be through direct contact

Squamous Papilloma
Clinical features
 Most common papillary lesion of the oral mucosa
 Palate, lip and vermilion and other parts of oral mucosa
 Generally single and less than 1 cm.
 Cauliflower-like surface

Squamous Papilloma
Histopathology
 Growth of keratinized squamous epithelium

 Well vascularized stroma
 Inflammatory cell infiltration

Squamous Papilloma
Differential diagnosis

 Verruciform xanthoma [gingiva, skin, Langerhans cells]
 Condyloma acuminatum [larger with broader base]
 Darier’s disease [multiple]

Squamous Papilloma
Treatment

 Remove by surgery or Laser

• Etiology
Cauliflower

 HPV 6 & 11
 Infectious lesion
 Frequent in HIV-infected persons

• Clinical features

 Common in the anogenital region and
may involve oral mucosa
Early stage: multiple pink nodules
 Later it grows and coalesce to become:
 Soft, broad-base papillary growth

• Histopathology
 Papillary projections covered by hyperplastic SSE
 Might be keratinized or non-keratinized
 Upper level of epithelium demonstrate perinuclear
cellular vacuolization [koilocytic cells]
 Vascularized stroma with inflammatory infiltration

Koilocytic cells

• Treatment

 Surgical excision:

 Scalpel
 Laser CO2
 Cryosurgery

Heck’s disease

 Etiology:
 - Common among Americans
 - Irritation
 - Vitamin deficiency
 - HPV 13 and possibly 32

 - Multi-focal epithelial hyperplasia

Heck’s disease
 Clinical features:

 - Multiple nodular soft tissue masses
 - Buccal, labial mucosa and tongue
 - Whitish to pinky in color

Heck’s disease

 Histopathology:
 - Acanthosis
 - Parakeratosis
 - Ballooning spinous cells

Heck’s disease

 Treatment:

 - Regress spontaneously
 - Surgical removal

Keratoacanthoma
Etiology
 Benign lesion

 Common at sun exposed skin and less on the
vermilion
 Rarely on oral mucosa in such case it may
originate from Fordyce’s granules
 Other etiologic agents:
 Viral infection
 trauma
 Chemical irritation …etc.

Keratoacanthoma
Clinical features
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Solitary or multiple
Rapid enlargement of the papule within 4-8 weeks
Asymptomatic nodules with central plug of keratin

Keratoacanthoma
Histopathology
 Central keratin plug
 Marginal buttress of epithelium
 Pseudoepitheliomatous hyperplasia

 Intense mixed inflammatory infiltration
 No malignancy

Keratoacanthoma
 SCC
 Verruca vulgaris

Treatment
 Careful follow-up
 It may regress spontaneously if no
 Surgical removal and HP examination

Verrucous carcinoma
Etiology

o The use of tobacco [smoking or smokeless]
o HPV

Verrucous carcinoma
Clinical features
5% of oral SCC
Common sites: buccal mucosa and gingiva
Early stage [verrucous hyperplasia] is benign or may
arise from leukoplakia
• Indurate firm with invasion to the subjacent tissue
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Verrucous carcinoma
Histopathology
Papillary surface, acanthotic and highly
keratinized epithelium
 Submucosal invasion by bulbous well
differentiated epithelium

 Minimal atypia

Verrucous carcinoma
 SCC
 Proliferative verrucous leukoplakia

Treatment
 Surgery followed by radiotherapy

Pyostomatitis vegetans
Etiology

• Benign chronic mucocutaneous disease
• Unknown etiology
• Many cases are associated with
gastrointestinal disturbances

Clinical features

 Erythematous and edematous oral
mucosa
 Multiple yellow pustules 2-3 mm
 Papillary projections of oral mucosa
 male are more affected than female with
mean age of 34 years

Histopathology

 Acanthosis

 Hyperkeratosis
 Pseudoepitheliomatous hyperplasia
 Inflammatory infiltration

 Ulceration and superficial epithelial necrosis

Treatment
 Controlling the associated diseases if present
 Topical corticosteroids may be used
 Additional antibiotic and multivitamins may be
employed

Verruciform xanthoma
Etiology

• Unknown
• Immunologic disorder

Clinical features
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Well circumscribed
Papillary surface
Size: vary from 2mm. To 2cm.
May appear on the skin
Mean age 45 years

Histopathology

 Parakeratinized papillomatous epithelium

 Elongated rete ridges
 Presence of xanthoma [foam] cells in the
lamina propria
 Langerhans cells

Treatment
 Conservative surgical excision

Condyloma latum
Oral squamous papilloma
Condyloma acuminatum
Keratoakanthoma
Verrucous carcinoma


Condyloma latum
Keratoakanthoma
Verrucous carcinoma



Condyloma latum
Keratoakanthoma
Verrucous carcinoma




Because there’s no histopathology

Papillary lesions

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Papillary lesions