3: Noninfectious Papillary Lesions

3 Noninfectious Papillary Lesions

Chapter Contents

Inflammatory Papillary Hyperplasia of the Palate

Verruciform Xanthoma

Juvenile Localized Spongiotic Gingival Hyperplasia

Inflammatory Papillary Hyperplasia of the Palate

Clinical Findings

• Papillary hyperplasia of the palate usually occurs in adults wearing dentures; it is occasionally seen in patients with high-arched palates and mouth-breathing habit (with adenoidal facies); may be sensitive, especially if associated with erythematous candidiasis, because denture may act as a fomite; dryness from mouth-breathing also predisposes to candidiasis (Fig. 3-1).

• Pebbly excrescences appear on the palatal vault in a diffuse, symmetric distribution.

• Papillary lesions associated with human papillomavirus infection are discussed in Chapter 4.

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FIGURE 3-1 Inflammatory papillary hyperplasia of the palate.

(Courtesy of Dr. Sadru Kabani, Boston, Mass.)

Etiopathogenesis and Histopathologic Features

Chronic irritation from the denture or from mouth-breathing leads to reactive hyperplasia of tissues.

• There is proliferation of fibrous tissue in nodules with variable lymphoplasmacytic infiltrate; overlying epithelium may be hyperplastic and exhibit spongiosis and leukocyte exocytosis; pseudoepitheliomatous hyperplasia may be seen (Figs. 3-2 to 3-4).

• Presence of spongiotic pustules should always raise suspicion for candidiasis and a periodic acid–Schiff (PAS) stain with diastase should be performed.

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FIGURE 3-2 Inflammatory papillary hyperplasia of palate. A, Papillary proliferation of fibrous tissue and epithelium. B, Fibroepithelial and pseudoepitheliomatous hyperplasia with chronic inflammation. C, Islands of benign epithelial cells.

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FIGURE 3-3 Inflammatory papillary hyperplasia of palate. A, Papillary proliferation of fibrous tissue and epithelium. B, Papillary structures, spongiosus, and chronic inflammation.

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FIGURE 3-4 Inflammatory papillary hyperplasia, curetted specimen.

Differential Diagnosis

• Inflamed squamous papilloma is usually single and pedunculated.

Management and Prognosis

• Excise or ablate lesions with scalpel or laser and reline or remake denture; lesions may recur if denture continues to fit poorly.

• Treat candidiasis with topical antifungals (e.g., nystatin or clotrimazole troches) or systemic therapy (e.g., fluconazole).

References

Canger EM, Celenk P, Kayipmaz S. Denture-related hyperplasia: a clinical study of a Turkish population group. Braz Dent J. 2009;20:243-248.

Kaplan I, Vered M, Moskona D, et al. An immunohistochemical study of p53 and PCNA in inflammatory papillary hyperplasia of the palate: a dilemma of interpretation. Oral Dis. 1998;4:194-199.

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  4. 6: Vascular, Neural, and Muscle Tumors
  5. 7: Ulcerative and Inflammatory Conditions
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Jan 12, 2015 | Posted by in Oral and Maxillofacial Pathology | Comments Off on 3: Noninfectious Papillary Lesions

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