Oral squamous papilloma: report of a clinical rarity

Description

Oral squamous papilloma is a benign proliferation of the stratified squamous epithelium, which results in a papillary or verrucous exophytic mass induced by human papilloma virus (HPV).^{1 2}

A 51-year-old, healthy steel plant male worker reported with complaint of growth on lower lip near the left corner of mouth since 2 years. His medical, dental and personal history was non-contributory. The left submandibular lymph nodes were palpable and tender. The lesion appears as a small, non-tender papule 2 years back and gradually increases up to its present appearance as exophytic, pedunculated, cauliflower-like appearance with white coloured finger-like projections of size 1×1 cm and asymptomatic (figure 1).

Figure 1.

Photograph showing the lesion.

Blood investigation ELISA and PCR tests were under the normal limits. Surgical excision was done and the biopsy specimen was sent for histopathological examination which revealed proliferation of the spinous layer cells, following a digitiform pattern with a delicate core of fibrous connective tissue constituting the supporting stroma suggestive of squamous papilloma (figure 2). A 1-year follow-up was performed, and there was no evidence of recurrence of the lesion.

Figure 2.

H&E-stained section.

The association of HPV was considered as its pathogenesis especially HPV-6, 11, 16, which have already been identified in these lesions, but recent literature suggests that presence of HPV is an incidental finding and is unrelated to the development of a squamous papilloma.³

The presence of virus can be confirmed by PCR and by in situ hybridisation using radioisotope-labelled specific probes. However, hybridisation is less sensitive than PCR, which is considered the most suitable method for the detection of HPV.²

Learning points.

• The purpose of this report is to make the health community aware of this rare group of verrucous exophytic mass, which may mimic exophytic carcinoma, verrucous carcinoma or condyloma acuminatum. Even, the lesion is benign in nature but also has a small risk of malignant transformation.

• The presence of HPV is an incidental finding and is unrelated to the development of a squamous papilloma. Treatment modalities include laser ablation, cryotherapy, electrocautery, intralesional injections of interferon, salicylic acid application and conservative surgical excision.