Inverted papilloma

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PAPILLOMA

of a Case

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HE: papilloma is a common benign csophytic growth cncount~cred in both oral and dermal structures. When seen in the oral cavity, it most commonl) appears as an innocuous, small, circumscribed, peduncnlated mass whose surface is verrucous or cauliflower-like iii tcst,ure. Papillomas can occur in practically any area of the mouth and hnvc no apparent predilection for a particular ag~t: group, since they arc encount,eretl not infrequently in young cl~ildrcn.l Levers has classified screral dermal lesions as being papillomatous in nature, but th(* Verruca vulgaris or common wart is the skin lesion most analogous t,o the oral p:~l~illoma. Jlicroscopicall:-, the oral papillonra consists of many fingerlike projections (Mcmtling above the mucosal surface on a stalklikc base. The projections contain a continuous layer of’ stratified squamous epithcliurn on a thin core of loost~ connective tissue. The cpitht~lium very often dcmonstratcs hypcrkcratosis: however, this may be relat,ed t,o the> irritational trauma to which they arc often snl)jtY?tt~d. Au atypical oral papillolnatous lesion demonstrating endophytic rathcl t,hall esophytie characteristics was rcportcd in 1939.” This lesion, which OF cutwd on the buccal mucosa, was termed a “ ccntripetal tlpithelial papillomit ” and exhibited leukokeratotic and dyskerat,otic changes. This is the only such In the cast reported hcrc an oral It&on described in the dental literature. lesion t~xhibited similar histopathologic qualit,ies. *Department **Department School of Dentistry,

of Oral Pathology. Sew York University of Periodontology and Oral Medicine, Tcaneck, New Jersr~y. 918

School of Dentistry. Fairleigh Dickinson

University

Volume IS Number 8

INVERTED

PAPILLOMA Fig.

919

1.

Fig. 2. Fig. l.--Clinical appearance of lesion on edentulous mandibular ridge. Note the raised white lesion on the attached gingiva. Irregular areas of ulceration appear on the posterior denture-bearing regions. Fig. S.--Low-power photomicrograph demonstrating endophytic nature of the papillomThe surface epithelium has a broad layer of keratosis, and the connective atous lesion. tissue directly below the epithelial proliferation shows marked inflltrabon with lymphocytes. (Magnification X70 : reduced %.)

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Volume I5 Number 8

lN\‘ERTEI)

I’APIT,I,OMX

Yntlrologist’s” h’eport.-A strip of mucosa, pearly \vhite in color and measuring 30 by 2.8 by 2 mm., was rwcired in formalin fixative. The surface epitholium showed a l)roacl layer of keratosis. \\‘ithin the stratum spinosum numerous dyskeratotic cells and scattcrcd mitotic figures were sew. rlI~crc was WC island which showc4 a do\vugrowth of crlls, and lwncxth it the stromn shon-(~1 markwl inRltl,ation 1)~ lyn~pho~~y~~~s, ~~ic~g~sosi.c: Tissue sulm~itt (~1 for rsnmination S~IOTVI~~ lcukoplakia and inverted papilloma showing markctl clyskcratosis. 11 was :tcIriwtl that the patient he kflpt under observation. l’ostoperativn healing was unwentful, ant1 tlrc patient 1,as OIPXWXYI periodically for a period of approximately one year, during which time no significant clinical changes could ho noted in the operate<1 area.

Fig. I.-Cellular detail in changes in the stratum spinosum. below

the

basal

layer.

(Magnification,

area

of

inverted

Note the heavy X500; reduced

papilloma demonstrating dyskeratotic accumulations of lymphocytes directly 1/4.)

The foregoing GWC bears a striking rcscnhlance to the lesion rcportcd in 1939 in the Archives of (Ural Yntho/oq?y.3 The latter Icsion was seen in a 3%J-WI+-old woman and tlp~~('ilYC'd clinicnlly ilS il flat, yellowish white lll~llll~~il~l~! 011 tllc huccal ~~UCOSBopposite a mandibular third nlolar. The lesion was homifirtl o11 pillpation, and the patient was cspericncin g no pain or disconifoi~t. Thch histopathologic report OF this lesion, hcausc~ of its similarity to ilic one tlwerihc~tl hew, is of interest: Microscopic t~xamination reveals the surface of the sp(~cinrcw to lw composed 0 f stratificsd squamous cpithelium. licneath the coriunl and subniuaosal c*onnwtive tissw arc’ striat(J The n~ucous meml)ranc~ proper manifcwts hypcrkcrat osis of motic~ratr~ d~grco muscle fil~crs. l’rojcxting from it into the corium is a with focal parakeratosis and hydropic dcyweration. circunx3xilvxl epith(~li:rl prolifcrntion of elongntcd and round retc peg expansions with l~sal layer and stratum spinosum iliffercntiating in the overlying m(lnll~ane. One part is less well defined ant1 prrsents degenerated hydropic cells with lobulatc~tl nuclei and prominwt, nucleoli. spintlle shape Mitotic figures are evident in hoth portions of the cpithelial mass. d fusiform is assumed by foci of atypical ~11s. Thc~ mcrnl~rane propria in swh areas is poorly d~finc~l. *I&l. Freund,

M.D.,

Pathologist,

New

York

Institute

of Clinical

Oral

Pathology.

CONCLUSIONS

An unusual case of an c&ophytic papilloma displa)Gg epithc~lial d>*splasia occurring on the mucous membrane of the oral cavitj- has bcc~n llresclrt ctl. In reviewing the literature, WC’i’ound t,his to 1~ the second such lesion rc’l)or.tcatl in the past thirty years. and

REFERENCES A Textbook of Oral Pathology, l’hila1. Schafer, W. G., Hine, M. K., and Levy, B. M.: delphia, 1960, W. B. Saunders Company. Histopathology of the Skin, cd. 2, Philadelphia, 1954, J. Ii. IZppincotf 2. Lever, W. F.: Compyy. Arch. Oral Path. 3: 62, l!l:i!). i. At;?“,’ l$qlloma of the Cheek ((:ase Report), , . .: The Skin, St. Louis, 1954, The C. \‘. Mosby Company.