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Inverted oral papilloma
400
Cheer
Oral September,
Surg. 1973
The patients described by Bhaskar and Lilly ranged in age from 12 to 59 years, and any lesion not excised in their entirety were reported to have regressed spontaneously within 2 months. The cases presented here fell into this age range but failed to show evidence of spontaneous healing. SUMMARY
This article has presented a review of the literature, as well as two additional cases of traumatic granuloma of the tongue. This lesion is of traumatic origin and reportedly heals spontaneously. The two cases reported herein, however, were of 9 and 18 months’ duration, respectively, with no evidence of regression. The reason for the prompt surgical excision in our cases was the duration of the lesions which, along with their clinical appearance, suggested the possibility of malignancy and the need for microscopic diagnosis. It should be emphasized, however, that both lesions were benign in spite of their histologic pseudoinvasive characteristics. REFERENCES
1. Bhaskar, 8. N., and Lilly, G. E.: Traumatic perimental), ORAL BURG. 18: 206, 1964. 2. Hansen, E. H., and Schmidt, H.: Ulcerated Tongue Report of a Case, Acta Derm. Venereol. Repriltt
reqztests
Granuloma
of the
Tongue
Granuloma Eosinophilicum 41: 235, 1961.
(Human Diutinum
and
Ex-
of
the
to:
Dr. Steven R. Snyder 1578 Northway Mall Pittsburgh, Pa. 15237
Inverted oral papilloma Robert 0. Greer, D.L).S.,* Boston, Mass. BOSTON
UNIVERSITY
SCHOOL
OF GRADUATE
DENTISTRY
A rare case of inverted papilloma of the oral cavity is presented. The lesion behaves in a benign manner, unlike similar lesions in the nasal cavity and paranasal sinuses which may undergo malignant change. The pathologist should be well aware of its occurrence.
T
he papilloma is a common benign epithelial tumor of unknown origin which can occur in any area of the mouth and has no age-group predilection. It com-
This investigation was supported in part by Special from the National Institute of Dental Research, National Public Health Service. *Special Research Fellow in Oral Pathology.
Research Institutes
Grant 5 F03 DE 51834-02 of Health, United States
Inverted
Fig. epithelium 40.)
1. Low-power penetrating
oral
photomicrograph showing well-circumscribed the lamina propria. (Hematoxylin and eosin
Fig. 8. Note acantholytic Magnification, x 130.)
nature
of squamous
maturation.
“nests” stain,
(Hematoxylin
401
papilbma
of keratinizing Magnification,
and
eosin
x
stain.
monly extends above the mucosal surface on a narrow mucosal stalk or pedicle and presents as a cauliflower-like exophytic growth. Microscopically, the typical oral papilloma demonstrates a pattern of multiple fingerlike projections of stratified squamous epithelium surrounding a central connective tissue c0re.l Papillomas which histologically demonstrate endophytic (inverted) rather than exophytic growth characteristics are rare,2* 3 although dermatologic,’ bladder,5* 6 and nasal and paranasal sinus inverted papillomas’-I1 have been documented in the literature. Inverted papillomas of the oral cavity are benign lesions. It is important to recognize this fact, since similar lesions presenting elsewhere in the body, particularly lesions of the nasal and paranasal sinuses, have demonstrated malignant alteration.ll
Oral surg. September,
Pig. 3. Higher-power photomicrogrnph and eosin stain. Magnification, x 310.)
CASE
showing
considerable
acantholysis.
1973
(Hematoxylin
REPORT
A 40-year-old man with chronic periodontal disease was noted to haye a small white polypoid lesion of the labial mucosa of the lower lip. He had been aware of the lesion for several months and stated that at one time it had ulcerated. The lesion was painless. The patient’s medical history was essentially noncontributory, and systemic finrlings were negative. He admitted to smoking two packs of cigarettes daily. The patient was referred to an oral surgeon, and the lesion was completely excised at its base. Pathologic
findings
A gray-white polypoid piece of soft tissue measuring 4 by 3 mm. was received in formalin. Microscopic examination revealed a tumor with an epithelial surface of hyperkeratotic squamous epithelium. Circumscribed “nests” of squamous epithelium were present in the lamina proprin (Fig. 1). They were composed of cells which were regular in size, shape, staining reaction, and nuclear character; however, considerable acantholysis was noted (Figs. 2 and 3). Mitotic activity was absent, and there was moderate chronic inflammation; no disruption of the basement membrane was obwrved. The patient’s postoperative course was uneventful, and there has been no recurrence.
SUMMARY
An unusual case of endophytic (inverted) oral papilloma displaying acantholysis and hyperkeratosis has been presented. A review of the literature indicates that this is only the third such (we reported in the past 40 years. REFERENCES
1. Thoma, K. H.: Oral Pathology, ed. 6, St. Louis, 1970, The C. V. Mosby Company, p. 803. 2. Moskow, R., and Moskow, B. S.: Inverted Pnpilloma; Report of a Case, OWL SURG. 15: 918-922, 1966. 3. Gettinger, R. : Atypical Papilloma of the Cheek: Case Report, Arch. Clin. Oral Pathol. 3: 62,1939. 4. Lever, W. F.: Histopathology of the skin, ed. 4, Philadelphia, 1967. J. B. Lippincott Company, p. 490. 5. Potts, I. F., and Hirst, E.: Inverted Papilloma of the Bladder, J. Urol. 90: 175-179, 1963. 6. Trites, A. E. W.: Inverted Urothelial Papilloma; Report of Two Cases, J. Urol. 101: 216-219, 1969.
Inverted
oral papilloma
403
7. Bradford, J. L., Trail, M. L., Lyons, G. D., and Dulitz, L.: Inverted Papillomas of the Nose and Paranasal Sinuses, South. Med. J. 65: 29-32 1972. 8. Trible, W. M., and Salyaveth, L.: Inverting Papilloma of the Nose and Paranasal Sinuses: Report of 30 Cases, Laryngoscope 81:.663-668, 1971. 9. Cody, C. C.: Inverting Papilloma of the Nose and Sinuses, Laryngoscope 77: 584598, 1967. 10. Skalnik, E. M., Loeary, A., and Friedmann, J. E.: Inverted Papilloma of the Nasal Cavity, Arch. Otolarygol. 84: 61-67, 1966. 11. Snyder, R. N., and Perzin, K. H.: Papillomatosis of Nasal Cavity and Paranasal Sinuses (Inverted Papilloma, Squamous Papilloma) : A Clinicopathologic Study, Cancer 30: 66% 690, 1972. Reprint requests to : Dr. Robert 0. Greer Department of Oral Pathology Boston University School of Graduate 100 East Newton St. Boston, Mass. 02118
Dentistry
Cheer
Oral September,
Surg. 1973
The patients described by Bhaskar and Lilly ranged in age from 12 to 59 years, and any lesion not excised in their entirety were reported to have regressed spontaneously within 2 months. The cases presented here fell into this age range but failed to show evidence of spontaneous healing. SUMMARY
This article has presented a review of the literature, as well as two additional cases of traumatic granuloma of the tongue. This lesion is of traumatic origin and reportedly heals spontaneously. The two cases reported herein, however, were of 9 and 18 months’ duration, respectively, with no evidence of regression. The reason for the prompt surgical excision in our cases was the duration of the lesions which, along with their clinical appearance, suggested the possibility of malignancy and the need for microscopic diagnosis. It should be emphasized, however, that both lesions were benign in spite of their histologic pseudoinvasive characteristics. REFERENCES
1. Bhaskar, 8. N., and Lilly, G. E.: Traumatic perimental), ORAL BURG. 18: 206, 1964. 2. Hansen, E. H., and Schmidt, H.: Ulcerated Tongue Report of a Case, Acta Derm. Venereol. Repriltt
reqztests
Granuloma
of the
Tongue
Granuloma Eosinophilicum 41: 235, 1961.
(Human Diutinum
and
Ex-
of
the
to:
Dr. Steven R. Snyder 1578 Northway Mall Pittsburgh, Pa. 15237
Inverted oral papilloma Robert 0. Greer, D.L).S.,* Boston, Mass. BOSTON
UNIVERSITY
SCHOOL
OF GRADUATE
DENTISTRY
A rare case of inverted papilloma of the oral cavity is presented. The lesion behaves in a benign manner, unlike similar lesions in the nasal cavity and paranasal sinuses which may undergo malignant change. The pathologist should be well aware of its occurrence.
T
he papilloma is a common benign epithelial tumor of unknown origin which can occur in any area of the mouth and has no age-group predilection. It com-
This investigation was supported in part by Special from the National Institute of Dental Research, National Public Health Service. *Special Research Fellow in Oral Pathology.
Research Institutes
Grant 5 F03 DE 51834-02 of Health, United States
Inverted
Fig. epithelium 40.)
1. Low-power penetrating
oral
photomicrograph showing well-circumscribed the lamina propria. (Hematoxylin and eosin
Fig. 8. Note acantholytic Magnification, x 130.)
nature
of squamous
maturation.
“nests” stain,
(Hematoxylin
401
papilbma
of keratinizing Magnification,
and
eosin
x
stain.
monly extends above the mucosal surface on a narrow mucosal stalk or pedicle and presents as a cauliflower-like exophytic growth. Microscopically, the typical oral papilloma demonstrates a pattern of multiple fingerlike projections of stratified squamous epithelium surrounding a central connective tissue c0re.l Papillomas which histologically demonstrate endophytic (inverted) rather than exophytic growth characteristics are rare,2* 3 although dermatologic,’ bladder,5* 6 and nasal and paranasal sinus inverted papillomas’-I1 have been documented in the literature. Inverted papillomas of the oral cavity are benign lesions. It is important to recognize this fact, since similar lesions presenting elsewhere in the body, particularly lesions of the nasal and paranasal sinuses, have demonstrated malignant alteration.ll
Oral surg. September,
Pig. 3. Higher-power photomicrogrnph and eosin stain. Magnification, x 310.)
CASE
showing
considerable
acantholysis.
1973
(Hematoxylin
REPORT
A 40-year-old man with chronic periodontal disease was noted to haye a small white polypoid lesion of the labial mucosa of the lower lip. He had been aware of the lesion for several months and stated that at one time it had ulcerated. The lesion was painless. The patient’s medical history was essentially noncontributory, and systemic finrlings were negative. He admitted to smoking two packs of cigarettes daily. The patient was referred to an oral surgeon, and the lesion was completely excised at its base. Pathologic
findings
A gray-white polypoid piece of soft tissue measuring 4 by 3 mm. was received in formalin. Microscopic examination revealed a tumor with an epithelial surface of hyperkeratotic squamous epithelium. Circumscribed “nests” of squamous epithelium were present in the lamina proprin (Fig. 1). They were composed of cells which were regular in size, shape, staining reaction, and nuclear character; however, considerable acantholysis was noted (Figs. 2 and 3). Mitotic activity was absent, and there was moderate chronic inflammation; no disruption of the basement membrane was obwrved. The patient’s postoperative course was uneventful, and there has been no recurrence.
SUMMARY
An unusual case of endophytic (inverted) oral papilloma displaying acantholysis and hyperkeratosis has been presented. A review of the literature indicates that this is only the third such (we reported in the past 40 years. REFERENCES
1. Thoma, K. H.: Oral Pathology, ed. 6, St. Louis, 1970, The C. V. Mosby Company, p. 803. 2. Moskow, R., and Moskow, B. S.: Inverted Pnpilloma; Report of a Case, OWL SURG. 15: 918-922, 1966. 3. Gettinger, R. : Atypical Papilloma of the Cheek: Case Report, Arch. Clin. Oral Pathol. 3: 62,1939. 4. Lever, W. F.: Histopathology of the skin, ed. 4, Philadelphia, 1967. J. B. Lippincott Company, p. 490. 5. Potts, I. F., and Hirst, E.: Inverted Papilloma of the Bladder, J. Urol. 90: 175-179, 1963. 6. Trites, A. E. W.: Inverted Urothelial Papilloma; Report of Two Cases, J. Urol. 101: 216-219, 1969.
Inverted
oral papilloma
403
7. Bradford, J. L., Trail, M. L., Lyons, G. D., and Dulitz, L.: Inverted Papillomas of the Nose and Paranasal Sinuses, South. Med. J. 65: 29-32 1972. 8. Trible, W. M., and Salyaveth, L.: Inverting Papilloma of the Nose and Paranasal Sinuses: Report of 30 Cases, Laryngoscope 81:.663-668, 1971. 9. Cody, C. C.: Inverting Papilloma of the Nose and Sinuses, Laryngoscope 77: 584598, 1967. 10. Skalnik, E. M., Loeary, A., and Friedmann, J. E.: Inverted Papilloma of the Nasal Cavity, Arch. Otolarygol. 84: 61-67, 1966. 11. Snyder, R. N., and Perzin, K. H.: Papillomatosis of Nasal Cavity and Paranasal Sinuses (Inverted Papilloma, Squamous Papilloma) : A Clinicopathologic Study, Cancer 30: 66% 690, 1972. Reprint requests to : Dr. Robert 0. Greer Department of Oral Pathology Boston University School of Graduate 100 East Newton St. Boston, Mass. 02118
Dentistry