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Unusual Length of Pedicle: Pedunculated Squamous Papilloma of Uvula Causing Unusual Dysphagia of Long Duration in a Child of 10 Years

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Case Reports in Dentistry
Authors:
Ramisetty Sabitha Devi
Ramisetty Sabitha Devi
Ramisetty Sabitha Devi
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B Rajsekhar
B Rajsekhar
B Rajsekhar
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G Vijay Srinivas
G Vijay Srinivas
G Vijay Srinivas
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Ninad Moon at RKDF Medical College Hospital and Research Center
Ninad Moon
  • RKDF Medical College Hospital and Research Center
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Abstract and Figures

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).
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Case Report
Unusual Length of Pedicle: Pedunculated Squamous
Papilloma of Uvula Causing Unusual Dysphagia of Long
Duration in a Child of 10 Years
Ramisetty Sabitha Devi,1B. Rajsekhar,2G. Vijay Srinivas,3and Ninad J. Moon4
1Department of Oral Pathology, St. Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India
2GEMS Medical College, Srikakulam, Andhra Prodesh, India
3OralPathology,St.JosephDentalCollege,Eluru,AndhraProdesh,India
4Department of Periodontics & Implantology, RKDF Dental College & Research Centre Bhopal, Madhya Pradesh, India
Correspondence should be addressed to Ramisetty Sabitha Devi; sabitha mds@yahoo.co.in
Received  November ; Accepted  December ; Published  January 
Academic Editors: K. Luna-Ortiz, K. Nakamori, and K. Yamagata
Copyright ©  Ramisetty Sabitha Devi et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
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 oen asymptomatic and
benign. Pedunculated squamous papillomas usually arise from the so palate, tonsil, or the epiglottis. ese 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. e narrow base of the pedicle made the intraoral excision possible. But
here, we present a case of a -year-old boy who had history of dysphagia of -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 (. inches).
1. Introduction
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
oen asymptomatic and benign []. Pedunculated squamous
papillomas usually arise from the so palate, tonsil, or the
epiglottis. ese 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. e narrow base
of the pedicle made the intraoral excision possible.
2. Case Report
A -year old boy presented with  years of unusual dyspha-
gia. He also reported choking sensation while eating solid
food and was comfortable only in squatting position. He
had a history of elongated pedunculated lesion. e patient
had diculty in swallowing food for  years because of local
irritation in throat and dry cough. ere was no relevant
history of throat pain, fever, and any other infection. On
throat examination extending from uvular tip a ne strand
of tissue over . inches in length ending in a small disc-like
mass-pedunculated ( ×cms)basal partofuvulaappeared
to be normal. is caused diculty in swallowing (in the
laryngeal region). Excision was simple (see Figure ).
Grossly. On examination the disc-like mass revealed rough
and papillary projections giving a provisional diagnosis of
papilloma (see Figure ).
Histopathological Examination.Squamouspapillomaisclas-
sically an exophytic lesion showing a complex pattern
of nger-like projections with a central vascular zone
Hindawi Publishing Corporation
Case Reports in Dentistry
Volume 2014, Article ID 313506, 3 pages
http://dx.doi.org/10.1155/2014/313506
Case Reports in Dentistry
F : Clinical photo: arrow showing pedunculated squamous
papilloma of uvula.
F : Macroscopic view of pedunculated squamous papilloma
uvula.
surrounded by stratied squamous epithelium. Multiple
papillary folds are hyperparakeratotic and epithelium also
revealed plenty of koilocytes (see Figure ).
3. Discussion
Pedunculated squamous papillomas usually arise from the
so palate, tonsil, or the epiglottis. ese lesions can some-
times 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
werequiteunusual.enarrowbaseofthepediclemadethe
intraoral excision possible [].
Oral squamous papilloma (OSP) is a benign proliferation
of the stratied squamous epithelium, which results in a
papillary or verrucous exophytic mass. e lesions were so-
ened/accid in .% of cases and a pedunculated attachment
was seen in % of the lesions [].
Male to female ratio is  : .. e mean age was  years,
with the majority in the nd, rd, and th decades. e sites
commonly aected by benign neoplasms were the palate,
tongue, upper lip, and buccal mucosa, in a descending order.
% of squamous papilloma was common benign oral so
tissue masses. e most common location for squamous
papilloma was the palate and tongue [].
F : Microscopic view of pedunculated squamous papilloma
uvula.
Malignant oropharyngeal tumors are far more common
comparedto benign tumors. Oropharyngeal papilloma is typ-
ically present in adults. Benign oropharyngeal tumors are far
less common compared to malignant tumors. Oropharyngeal
papilloma is typically diagnosed most oen in adults. e
papilloma is usually solitary and enlarges to a maximum size
of about . cm []. But in our case papilloma is in rare
site-uvula, big in size ( × cms), long pedunculated strand
measured . inches in length and unusual cause of dysphagia
makes it sound rare.
In  oral squamous cell papillomas, .% of cases were
located on the palatal complex (hard, so, and uvula), but
only .% of cases were located on the uvula. Papilloma was
greater than one cm in length, which occurs in less than %
of cases of oral papillomas. erefore, it is probable that the
greater the length of the uvular lesion, the rarely [].
ey are most oen benign and asymptomatic. But in our
case the patient presented with dysphagia-irritation of throat-
atypical []. Squamous cell papilloma arose from the uvula,
which presented as unusual. But in our case it arose from
uvula causing unusual dysphagia. Both support rarity [].
Pathogenesis is related to human papilloma virus, but
there is controversy regarding its viral origin. In our case
section shows koilocytes [].Averagesizeislessthancms
and only % were  cms and many are  to  mms []. ere
is a ne strand of tissue more than  inches terminating disc-
like papilloma. In our case also it matches parallel.
4. Conclusion
Squamous cell papilloma is a benign tumor with a rare
entity arising on uvula which caused unusual dysphagia
(symptomatic) of long duration, and patient was comfortable
only in squatting position; it revealed ne strand of tissue
measuring . inches terminating with a mass measuring  ×
cms, papilloma, and on section it revealed presence of
koilocytes. Hence with the above features it is a rare entity.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
Case Reports in Dentistry
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... Papilloma is a benign epithelial mass which comprises fingerlike projections involving squamous epithelium. Squamous papilloma is an exophytic mass which involves soft palate, tonsils [16] or uvula. ...
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Background. Oral squamous papillomas are benign pedunculated masses that grow most commonly on the palate. These benign lesions rarely cause symptoms. Methods. Here we present the case of a large, elongated squamous papilloma of the uvula causing dysphagia. We also review pertinent literature related to these lesions. Results. This patient underwent surgical excision of her atypically symptomatic oral lesion, with complete resolution of symptoms. Conclusion. Oral squamous papillomas are benign lesions which are usually asymptomatic. Dysphagia due to a squamous papilloma of the uvula has only been reported once in the literature previously. The development of symptoms such as dysphagia due to squamous papilloma of the uvula is uncommon; however this may be more likely in the presence of particularly large lesions.
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Article
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The aim of this study was to evaluate the relative frequencies, types and distribution of benign oral masses in North Jordanians. The records of the Department of Pathology at Jordan University of Science & Technology were reviewed and analyzed for patients with benign oral soft tissue masses, received during an 11-year period (1991-2001). The main outcome measures were patients' age and sex, and the mass type and location. A sum of 818 benign oral soft tissue masses (4% neoplastic and 96% non-neoplastic) was analyzed. Common benign neoplasms were salivary pleomorphic adenoma and lipoma. Non-neoplastic lesions consisted of traumatic (43%) inflammatory/ infective (33%), cystic (14%) and developmental (9%) lesions. Common non-neoplastic lesions were fibroepithelial polyp, pyogenic granuloma, mucoceles, hemangioma and squamous papilloma, in a descending order. There were 330 (40%) males and 488 (60%) females with a male to female ratio of 1: 1.5. The mean age was 33 years, with the majority in the 2(nd), 3(rd) and 4(th) decades. The sites commonly affected by benign neoplasms were the palate, tongue, upper lip and buccal mucosa, in a descending order and the sites commonly affected by non-neoplastic lesions were the gingiva, buccal mucosa, lower lip and tongue in a descending order. It is concluded that some of the features of benign oral masses in north Jordanians published in this paper are similar to those from other countries, and some are different. Further nationwide population-based surveys are needed to further define the epidemiology of benign oral masses among Jordanians.
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The clinical and histopathologic features of a series of 464 oral squamous cell papillomas
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