Multiple Papillary Lesions, Generalized, Oral Cavity
Dolphine Oda, BDS, MSc
Dr. Michael Martin
Department of Oral Medicine, University of Washington, Seattle
Case Summary and Diagnostic Information
This is a 44-year-old white male with numerous pink/white papillary lesions, some of which are exophytic and many of which are flat and spongy.
Diagnostic Information Available
History of present Illness
Figure 1 Photograph represents the typical appearance of the oral cavity at multiple visits of the University of Washington Oral Medicine Clinic. Note the multiple, variable size pink/white papillary lesions of the buccal mucosa and spongy flat pink/red lesions of the gingiva (upper and lower).
Figure 2 Photograph represents the typical appearance of the oral cavity at multiple visits of the University of Washington Oral Medicine Clinic. Note the generalized spongy flat pink/red lesions of the palatal gingiva and hard palate.
Clinical and Radiographic Findings
Histologic examination reveals multiple pieces of soft tissue composed of papillary surface epithelium (Figure 3) with an underlying fibrous connective tissue core. The latter was loose and vascular and was focally infiltrated by lymphocytes. The papillary projections ranged from blunt to elongated and were all covered by parakeratin of variable thickness. The keratin layer of some of the specimens was infiltrated by fungal hyphae and spores. The spinous layer showed evidence of cells with empty-looking cytoplasm and small nuclei consistent with koilocytes (Figure 4). The immunohistochemistry stain with antibody to human papilloma virus types 6/11, 16, etc (Figure 5) was strongly positive.
Figure 3 Low power (x40) H & E histology shows papillary epithelium covered by parakeratin and supported by fibrous connective tissue core.
Figure 4 Low power (x100) H & E histology demonstrating spinous layer cells with mitosoid cells and koilocytes.
Figure 5 Low power (x100) Immunohistochemistry stain with antibody to HPV types 6/11, 16, demonstrating strong positive nuclear staining at the superficial spinous layer.
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