A Rare Nonvenereal Presentation of Oral Condyloma Acuminatum

Sir,

A 29-year-old female reported with a complaint of growth in her mouth of 3 months duration. A cauliflower-shaped growth measuring 1 cm × 1.5 cm was found on the left buccal mucosa overlying the distal surface of upper left third-molar [Figure 1]. The growth had a smooth surface, firm, noncompressible, nonreducible, and nontender. Routine hematological investigations showed all the parameters within normal limits. Excisional biopsy and removal of the offending tooth showed presence of hyperplastic stratified squamous epithelium with underlying acanthosis, basal cell hyperplasia, koilocytes, dilated blood capillaries, and chronic inflammatory cell infiltrates, features, suggestive of condyloma acuminatum (CA) [Figure 2]. During follow-up, satisfactory healing was noted. Considering the nature of the lesion, patient was enquired about her sexual exposure history and it was negative. Examination of the genitals and the vaginal culture were normal. Both VDRL (Venereal Disease Research Laboratory test) and HIV-ELISA (Human immuno deficiency virus- Enzyme linked immunosorbent assay) test were negative.

Figure 1.

Intraoral photograph showing the proliferative mass

Figure 2.

Histopathology showing koilocytes (H and E, ×400)

CA caused by human papilloma virus (HPV) is commonly found on the skin, anogenital tract, and rarely on oral mucosa. Transmission in adults can be the result of orogenital contact, autoinoculation, casual social contact, and fomite transmission.[1,2] In children, it may spread during parturition, nonsexual contact from infected caregivers, and direct sexual contacts.[2,3] Cases of CA with no history of sexual contact and genital lesions were also reported. In such instances, it is hypothesized that the virus responsible could be a variant of genital virus or a mutant strain.[4] Investigation regimen of CA includes genital examination, HIV-ELISA, and VDRL test.[4] In the present case, all examination and tests reported negative. Routine microscopic evaluation and PCR (Polymerase chain reaction) can be used to identify the virus. However, nondetection of HPV-DNA (Human papilloma virus- Deoxyribonucleic acid) cannot be considered as absence of infection, as small number of copies can go undetected.[5]

Although CA can rarely resolve spontaneously, conservative excision, electrocautery, or cryosurgery is the treatment of choice.[1,3,4] Few suggest usage of podophyllin, trichloroacetic acid, 5-flurouracil, and imiquimod.[5] Considering the oncogenic nature of HPV, patients should be educated about the preventive methods and HPV vaccination should also be advocated.[5] The present case is a classical evidence of nonvenereal type of condyloma acuminatum and the lesion resolved spontaneously after removal of the mass and the offending tooth.

Declaration of patient consent

The authors certify that they have obtained the appropriate patient consent form. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her names and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.