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Soft palate papilloma: A report of 4 cases with review of literature.
Abstract
Papillomas appear as pedunculated or sessile, white or normal colored cauliflower like projections that arise from the mucosal surface. The most common site is the palate uvula area followed by tongue and lips. Of all sites, the soft palate is the most common and accounted for 20% of the lesions. The etiology remains unknown. Viral origin has always been suspect but studies are still inconclusive. Conservative
surgical excision is the treatment of choice with rare recurrence. There is no evidence that papillomas are premalignant.
This is a report of four cases of soft palate papilloma in patients of different Asian nationalities.
In conclusion, soft palate papilloma is more common than it is supposed
... [2,4] They appear clinically as asymptomatic usually white but sometimes pink in color. [5] They are made up of numerous, small finger-like projections which result in a lesion with a roughened or cauliflower-like surface. These squamous papillomas can be divided into isolated-solitary and multiple-recurring type of which multiple recurring type occurs most commonly in children. ...
... [4] The most common sites of occurrence in the oral cavity are palate and tongue (34%), and least common affected sites are uvula, lips, and gingiva. [5,6] Histologically, many long, thin, and finger-like projections extend above the surface of the mucosa. Each finger-like projection is lined by stratified squamous epithelium and contains a thin central connective tissue. ...
Oral squamous papillomas are benign proliferating lesions induced by human papillomavirus. These lesions are painless and slowly-growing masses. As an oral lesion, it raises concern because of its clinical appearance. These lesions commonly occur between age 30 and 50 years, and sometimes can occur before the age of 10 years. Oral squamous papilloma accounts for 8% of all oral tumors in children. Common site predilection for the lesion is the tongue and palate and may occur on any other surface of the oral cavity such as the uvula and vermilion of the lip. Here, we are presenting a case of squamous papilloma on the palate in a 9-year-old child.
... [2,4] They appear clinically as asymptomatic usually white but sometimes pink in color. [5] They are made up of numerous, small finger-like projections which result in a lesion with a roughened or cauliflower-like surface. These squamous papillomas can be divided into isolated-solitary and multiple-recurring type of which multiple recurring type occurs most commonly in children. ...
... [4] The most common sites of occurrence in the oral cavity are palate and tongue (34%), and least common affected sites are uvula, lips, and gingiva. [5,6] Histologically, many long, thin, and finger-like projections extend above the surface of the mucosa. Each finger-like projection is lined by stratified squamous epithelium and contains a thin central connective tissue. ...
Oral squamous papillomas are benign proliferating lesions induced by human papillomavirus. These lesions are painless and slowly-growing masses. As an oral lesion, it raises concern because of its clinical appearance. These lesions commonly occur between age 30 and 50 years, and sometimes can occur before the age of 10 years. Oral squamous papilloma accounts for 8% of all oral tumors in children. Common site predilection for the lesion is the tongue and palate and may occur on any other surface of the oral cavity such as the uvula and vermilion of the lip. Here, we are presenting a case of squamous papilloma on the palate in a 9-year-old child.
... In our case section shows koilocytes [8]. Average size is less than 1 cms and only 8% were 2 cms and many are 3 to 4 mms [9]. There is a fine strand of tissue more than 2 inches terminating disclike papilloma. ...
Benign oropharyngeal tumors are far less common compared to malignant tumors. Oropharyngeal papilloma is present in adults. Squamous papillomas are exophytic masses of oral cavity. When they occur on the palate they are most often asymptomatic and benign. Pedunculated squamous papillomas usually arise from the soft palate, tonsil, or the epiglottis. These lesions can sometimes prove to be fatal. A case of pedunculated squamous papilloma, arising from the laryngopharynx, the clinical presentation, the site of origin, and the size of the lesion were quite unusual. The narrow base of the pedicle made the intraoral excision possible. But here, we present a case of a 10-year-old boy who had history of dysphagia of 3-year duration for solid food and he was comfortable only in squatting position the reason being squamous papilloma of uvula (unusual site) atypically because of astonishing length of pedicle (2.3 inches).
To date, more than 100 types of human papillomavirus (HPV) have been identified. In the past 20 years, there has been an increasing interest in HPVs because of their potential role in the pathogenesis of malignant tumors. HPV infections are known to affect predominantly adult, sexually active age groups, whereas skin warts, at various anatomic sites, are usually associated with younger individuals. The modes of viral transmission in children remain controversial, including perinatal transmission, auto- and hetero-inoculation, sexual abuse, and, possibly, indirect transmission via fomites. Recent studies on perinatal infection with HPV have been inconclusive. It is still unclear how frequently perinatal infection progresses to clinical lesions, whether genital, laryngeal, or oral. Conflicting reports have been published on the prevalence of HPV infections in children. The current consensus is, however, that newborn babies can be exposed to cervical HPV infection of the mother. The detection rate of HPV DNA in oral swabs of newborn babies varies from 4% to 87%. The concordance of HPV types detected in newborn babies and their mothers is in the range of 57% to 69%, indicating that the infants might acquire the HPV infection post-natally from a variety of sources. HPV antibodies have been detected in 10% to 57% of the children, and there is usually no correlation between seropositivity and the detection of HPV DNA in either the oral or the genital mucosa. There is also evidence that transmission in utero or post-natal acquisition is possible. The mode of in utero transmission remains unknown, but theoretically the virus could be acquired hematogenously, by semen at fertilization, or as an ascending infection in the mother. The understanding of viral transmission routes is important, particularly because several vaccination programs are being planned worldwide. The serologic response to HPV detected in different populations of young women or women at risk of cervical cancer might be due to genital infections, but the possibility that HPV infection has been acquired earlier in life through the oral mucosa or respiratory tract cannot be ruled out.
This study evaluates the types and distribution of oral and maxillofacial tumours in north Jordanian children and adolescents. The records of the Department of Pathology at Jordan University of Science & Technology, during the period 1991-2000, were reviewed for patients younger than 19 years with oral and maxillofacial tumours. The tumours were analysed for age, sex, site and type. Out of all maxillofacial tumours, 23% occurred in children and adolescents, of these 10% were malignant and 90% were benign. 73% of the latter were soft tissue tumours and 17% were jaw tumours (58% odontogenic and 42% non-odontogenic). The most common benign soft tissue and jaw tumours were haemangioma and odontoma, respectively. 58% of malignant tumours were sarcomas and 42% were carcinomas. The mean age was 11 years with a female to male ratio of 1:1.2. The intraoral and extraoral sites most commonly affected by benign soft tissue tumours were the lower lip and face, respectively. While the total number of benign jaw tumours was slightly larger in the maxilla than the mandible, odontogenic tumours were more in the maxilla, and nonodontogenic tumours were more in the mandible. Differences found in this study between Jordanian children and adolescents and those from other countries may be attributable to genetic and geographic differences. The majority of benign tumours in the young are probably developmental rather than true neoplasms.
Genital human papillomavirus (HPV) infections are one of the most common sexually transmitted disease of viral origin. HPV is associated with a spectrum of diseases, ranging from benign verruca vulgaris and condylomata acuminate, to malignant cervical, vulvar, vaginal, anal or penile cancer. Men are usually the reservoir of the virus, which lives in latent or subclinical form on genital mucosa, and these asymptomatic infections can be oncogenic factor(s) in the development of cervical cancer. The examination of genital region in men, after application of 3-5% acetic acid, and use of colposcope is a reliable method for identification of subclinical HPV infections. The diagnosis and therapy of HPV infection in men is a potential benefit, because eradication of penile HPV infection may decrease the reservoir of the virus.
A case of oral inverted ductal papilloma that appeared on the lower lip of a 44-year-old man is described. A literature review and discussion of the histopathologic features and histogenesis of this uncommon lesion of minor salivary gland origin are also presented.
A clinical and histopathologic analysis of 464 oral squamous cell papillomas is presented. Data on age, sex, race, location, clinical appearance, duration, recurrence, and clinical diagnosis are reviewed. One hundred seventy-six of the 464 specimens were examined for hyperkeratosis, character and amount of inflammatory infiltrate, and evidence of cellular atypia. The trends seen in this study support claims made by previous authors regarding incidence and inflammatory involvement. The data support a slightly higher occurrence rate in males than in females and in white as opposed to black patients. Papillomas were most abundant on the palatal complex, dorsum and lateral tongue borders, and lower lips, respectively. Confusion of papilloma for fibroma in the clinical diagnosis was less common than expected. Recurrence rate and incidence of multiple papillomas were low. Histologic study revealed a tendency for hyperkeratotic lesions to arise from nonkeratinized oral sites. Cellular atypia was found, but it is still unclear whether these changes are preneoplastic or due to an increased growth rate.
Laryngeal and oral papilloma in pediatric patients are generally considered transmitted by maternal fetal transmission. In adults and immunocompromised patients, it is well documented that human papilloma virus (HPV) of the oropharynx is sexually transmitted. The possibility of sexual transmission of oral and laryngeal papilloma in children by oral genital contact is discussed.
The purpose of this study was to determine the potential for human papillomavirus to be transmitted vertically.
We started a systematic study of children 0.3 to 11.6 years old born to mothers included in the cohort of 530 women prospectively followed up for genital human papillomavirus infections in Kuopio since 1981. So far 98 children have been examined. The examinations included medical history, clinical examination of the oral cavity and hand warts, and cytologic samples from the oral mucosa for detection of human papillomavirus deoxyribonucleic acid with polymerase chain reaction with subsequent Southern blot hybridization.
Human papillomavirus deoxyribonucleic acid was found in 31 of the 98 (31.6%) oral scrapings. with MY09 and MY11 human papillomavirus primers, 12 of the 98 were positive for human papillomavirus deoxyribonucleic acid in the electrophoresis gel and in subsequent hybridization. Nineteen of the positive samples were not visible in the gel but become positive when hybridized. At delivery, 5 mothers had genital human papillomavirus infection with the same virus type found in her child. In the additional 11 mothers genital human papillomavirus infection with the same virus type as in the child was diagnosed a few months before or after delivery. Mothers of the 25 children shown to be negative for oral human papillomavirus were also human papillomavirus deoxyribonucleic acid negative at delivery. Minor hyperplastic growths of the oral mucosa were found in 21 of the 98 children (21%). One child had a papilloma where human papillomavirus 16 deoxyribonucleic acid was detected, as was also found in her mother's genital area at delivery.
Our results support the concept that an infected mother can transmit human papillomavirus to her child.
Human papillomaviruses are a group of genetically related organisms that infect stratified squamous epithelium. Unlike many other viruses that infect oral epithelium and induce lysis of the cells they penetrate, HPVs induce proliferative changes in these cells that result in both benign and malignant tumors. The common skin wart (verruca vulgaris) is induced by HPV 2 and 4. Genital warts (condylomas) and the common solitary oral papilloma are associated with HPV 6 and 11. Either HPV 13 or 32 causes focal epithelial hyperplasia. All of these wart-like lesions are benign growths of the stratified squamous lining of the oral cavity and lips and can be treated by surgical excision or laser ablation. HPV 16 and other less frequently encountered genotypes are associated with uterine cervix cancer in 95 percent to 98 percent of cases, and the evidence for a causal role is robust. There are emerging data that implicate HPV in certain subsets of oral cancer, particularly those that arise in the oropharynx/tonsillar region. Some instances of the various histologic subtypes subsumed under proliferative verrucous leukoplakia and verrucous carcinoma also harbor HPV.
Oral cavity benign and malign tumors In: A textbook of oral pathology
- Wg Shafer
- Kh Hine
- Levy
Shafer WG, Hine KH, Levy BM. Oral cavity benign and malign tumors. In: A textbook of oral pathology. Philadelphia: Saunders, 1983, P: 80-2.