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Squamous Papilloma and Verruciform Xanthoma

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Squamous Papilloma and Verruciform Xanthoma

  1. 1. Squamous Papilloma/ (Oral Wart) Verruciform xanthoma Verruca-Papillary Lesions
  2. 2. Contents Clinical feature Etiology and Pathogenesis Histopathology Differential Diagnosis
  3. 3. Squamous Papilloma (Oral Wart) • Oral squamous papilloma is a generic term that used to include papillary and verrucous growths composed of benign epithelium and minor amounts supporting connective tissue
  4. 4. Etiology and Pathogenesis • HPV types and their known associations • DNA virus 1- benign 2- malignant • Specifically infect basal epithelia cells and establishes a productive infection only on stratified squamous epithelium
  5. 5. Clinical feature less than 1 cm Lateral tongue (granular)
  6. 6. Clinical feature Floor of mouth
  7. 7. Clinical feature • Oral wart , Palate (cauliflower like)
  8. 8. Histopathology
  9. 9. Papilloma Exophytic Finger like extension of epithelium supported by well vascularized connective tissue
  10. 10. Oral wart
  11. 11. Koilocytic cell Epithelial nuclei that are pyknotic and centered surrounded by edematous or optically clear zone
  12. 12. Oral wart • Positive brown staining nuclei are seen In upper level keratinocytes
  13. 13. Dysplastic oral warts
  14. 14. Dysplastic oral warts • A, Note normal epithelium at far right • B, stain for proliferation marker [PCNA] showing positive nuclear staining (red) in most keratinocytes
  15. 15. Differential Diagnosis Verruciform xanthoma Papillary hyperplasia Condyloma
  16. 16. Verruciform xanthoma • Uncommon benine oral mocusal lesion that occasionally may be found on the skin typically on the genitalia
  17. 17. Etiology and Pathogenesis The cause is Unknown (NSDHL)
  18. 18. Clinical feature: “whites” granular and papillary (2 mm to 2 cm)
  19. 19. Histopathology • Elongated epithelial ridge extend into the lamina propria at a uniform depth • Note the uniformly invaginated crypts alternate with papillary extension
  20. 20. Histopathology • Note Xanthoma cells (foamy macrophages) in the lamina propria or connective tissue papillae • Foam? (PAS) • No evidence of dysplasia and atypia
  21. 21. Differential Diagnosis Squamous papilloma Papillary squamous carcinoma Condyloma acuminatum
  22. 22. References Diz Dios, P., 2016. Oral medicine and Pathology at a glance. 2nd ed. West Sussex: WILEY Blackwell. Eversole, L.R., 2000. Papillary lesions of the oral cavity: relationship to human papillomaviruses. Journal of the California Dental Association, 28(12), pp.922-927. Regezi, J., 2012. Oral Pathology clinical pathological correlation. 6th ed. Missoury: Elsevier.