|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 3 | Page : 778-780
Human papilloma virus: A diagnostic dilemma for dentist
Saurabh Goel1, Himanshu Gupta2, Barkha Makhijani3
1 Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
2 Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
3 Department of Periodontics, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
|Date of Web Publication||14-Oct-2014|
Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Airport Road, Debari, Udaipur - 313 024, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goel S, Gupta H, Makhijani B. Human papilloma virus: A diagnostic dilemma for dentist. J Can Res Ther 2014;10:778-80
Granulomatous lesions of the oral and orophrayngeal tissue present a diagnostic dilemma to the dentist due to the wide variety of possible etiologic factors. Hence, we encountered a rare case of oral squamous papilloma (OSP) caused by human papilloma virus (HPV) in a 14 year - old young male patient, which clinically mimicked granulomatous lesion of the palate.
OSP is a benign proliferation of the stratified squamous epithelium, which results in a papillary or verrucous exophytic mass induced by HPV. This tumor is of low virulence i.e. it is not contagious. HPV is a deoxyribonucleic acid virus of the papilloma viridae family that cannot be cultivated. , The viruses considered to be of high oncogenic potential include HPVs 16, 18, 31, 33, 35, 39, 45, 51, 55, 56, 58, 59, 66 and 68  and these have been associated with oral lesions such as squamous papilloma (SP), condyloma acuminatum (CA), squamous cell carcinoma (SCC) and verrucose carcinoma (VC).  The route of transmission of the virus is unknown for oral lesions.
A 14-year-old male patient [Figure 1]a and b had reported with painless soft - tissue growth in palatal region from last 7 months. The growth being initially small enlarged gradually in last 6 months and produced difficulty in chewing food. There was no apparent history of trauma, pain in the teeth, allergy to any substance, pus discharge, fever or any other history of systemic ailment.
|Figure 1: (a and b) Front and lateral view (c and d) A solitary reddish, pink, exophytic corrugated mass around 3 × 6 cm in size with intact overlying mucosa and ill-defined margins present on hard palate. (e) Intact lamina dura and normal periodontal ligament space width with no gross pathology evident. (f and g) Long, thin and finger-like projections lined by stratified squamous epithelium with koilocytosis as a result of perinuclear cytoplasmic vacuolization of cells of the spinous layer of the epithelium. Connective tissue shows lots of proliferating blood vessels and inflammatory cells like lymphocytes, plasma cells and macrophages. (h) Surgical removal of the lesion. (i) After 6 months of follow-up|
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Intraoral examination revealed a solitary, reddish pink, exophytic, cauliflower shaped mass around 3 × 6 cm in size, occupying right side of the hard palate extend anteriorly right and left central incisors and posteriorly until first molar. The enlargement was sessile, firm, non-tender with intact overlying mucosa and ill-defined margins [Figure 1]c and d.
Patient history and clinical examination led to a provisional diagnosis of chronic idiopathic granulomatous lesion of the palatal mucosa.
The differential diagnosis included pyogenic granuloma, peripheral giant cell granuloma, fibroma, peripheral ossifying fibroma, giant cell fibroma, papilloma, hemangioma, exophytic carcinoma, verrucous carcinoma and SCC.
Vitality test and routine blood investigations were found to be normal. Intraoral periapical and orthopantomograph revealed intact lamina dura and normal periodontal ligament space width with no gross pathology evident [Figure 1]e.
After clinical evaluation, surgical excision of the lesion was performed [Figure 1]f and post-operative instructions were given.
Histopathological examination revealed [Figure 1]g and h finger-like projection lined by stratified squamous epithelium. Koilocytosis as a result of perinuclear cytoplasmic vacuolization of cells producing perinuclear pale/clear halos and pyknosis. Connective tissue shows lots of proliferating blood vessels and inflammatory cells like lymphocytes, plasma cells and macrophages.
The findings were suggestive of SP of hard palate due to HPV.
There was no evidence of recurrence of the lesion in 6 months follow-up [Figure 1]i.
This case is reported for its rarity and it raises concern due to its multiple causes and clinical appearance, which may mimic with SCC, VC or CA and often create a confusing maze, through which the clinician must carefully proceed in order to develop an accurate diagnosis and provide an effective treatment.
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