Inflammatory Papillary Hyperplasia of the Palatal Mucosa
Clinical Findings
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This occurs in adults wearing maxillary dentures and is occasionally seen in patients with high-arched palates and mouth-breathing habit. Patients may report sensitivity, especially if associated with candidiasis, and the denture may act as a fomite ( Fig. 3.1 ).
FIG 3.1 Inflammatory papillary hyperplasia of the palatal mucosa.(Courtesy Dr. Sadru Kabani, Boston, Mass.) - •
Pebbly excrescences occur on the palatal vault in a diffuse, symmetric distribution.
Etiopathogenesis and Histopathologic Features
Papillary hyperplasia of the palatal mucosa results from chronic irritation due to dentures or from mouth-breathing that leads to reactive hyperplasia of tissues.
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Proliferation of fibrovascular tissue occurs in nodules with a variable lymphoplasmacytic infiltrate. The overlying epithelium may be hyperplastic and exhibit spongiosis and leukocyte exocytosis. Pseudoepitheliomatous hyperplasia may be seen ( Figs. 3.2–3.4 ).
FIG 3.2 Inflammatory papillary hyperplasia of the palatal mucosa. (A) Papillary proliferation of fibrous tissue and epithelium. (B) Fibroepithelial and pseudoepitheliomatous hyperplasia with chronic inflammation. (C) Islands of benign epithelial cells.
FIG 3.3 Inflammatory papillary hyperplasia of the palate. (A) Papillary proliferation of fibrous tissue and epithelium. (B) Papillary structures, spongiosis, and chronic inflammation.
FIG 3.4 Inflammatory papillary hyperplasia composed of a benign papillary proliferation of fibrous tissue and epithelium with chronic inflammation (curetted specimen). - •
The presence of spongiotic pustules should always raise suspicion for candidiasis and periodic acid–Schiff staining with diastase should be performed.
Differential Diagnosis
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Inflamed squamous papilloma is usually solitary and pedunculated.
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Human papillomavirus–associated papillary lesions or condylomas contain koilocytes (see Chapter 4 ).
Management and Prognosis
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Excision or laser ablation of lesions must be accompanied by a denture reline or fabrication of new dentures. Lesions may recur if the denture continues to fit poorly.
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If present, candidiasis can be effectively treated with topical antifungals (eg, antifungal and steroid cream applied to the denture base [see Appendix B ]). The dentures should also be disinfected with chlorhexidine, nystatin, sodium benzoate, or other effective disinfectant.
References
Clinical Findings
- •
This occurs in adults wearing maxillary dentures and is occasionally seen in patients with high-arched palates and mouth-breathing habit. Patients may report sensitivity, especially if associated with candidiasis, and the denture may act as a fomite ( Fig. 3.1 ).
FIG 3.1 Inflammatory papillary hyperplasia of the palatal mucosa.(Courtesy Dr. Sadru Kabani, Boston, Mass.) - •
Pebbly excrescences occur on the palatal vault in a diffuse, symmetric distribution.
Etiopathogenesis and Histopathologic Features
Papillary hyperplasia of the palatal mucosa results from chronic irritation due to dentures or from mouth-breathing that leads to reactive hyperplasia of tissues.
- •
Proliferation of fibrovascular tissue occurs in nodules with a variable lymphoplasmacytic infiltrate. The overlying epithelium may be hyperplastic and exhibit spongiosis and leukocyte exocytosis. Pseudoepitheliomatous hyperplasia may be seen ( Figs. 3.2–3.4 ).
FIG 3.2 Inflammatory papillary hyperplasia of the palatal mucosa. (A) Papillary proliferation of fibrous tissue and epithelium. (B) Fibroepithelial and pseudoepitheliomatous hyperplasia with chronic inflammation. (C) Islands of benign epithelial cells.
FIG 3.3 Inflammatory papillary hyperplasia of the palate. (A) Papillary proliferation of fibrous tissue and epithelium. (B) Papillary structures, spongiosis, and chronic inflammation.
FIG 3.4 Inflammatory papillary hyperplasia composed of a benign papillary proliferation of fibrous tissue and epithelium with chronic inflammation (curetted specimen). - •
The presence of spongiotic pustules should always raise suspicion for candidiasis and periodic acid–Schiff staining with diastase should be performed.
Differential Diagnosis
- •
Inflamed squamous papilloma is usually solitary and pedunculated.
- •
Human papillomavirus–associated papillary lesions or condylomas contain koilocytes (see Chapter 4 ).
Management and Prognosis
- •
Excision or laser ablation of lesions must be accompanied by a denture reline or fabrication of new dentures. Lesions may recur if the denture continues to fit poorly.
- •
If present, candidiasis can be effectively treated with topical antifungals (eg, antifungal and steroid cream applied to the denture base [see Appendix B ]). The dentures should also be disinfected with chlorhexidine, nystatin, sodium benzoate, or other effective disinfectant.
References
Verruciform Xanthoma
Clinical Findings
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This occurs most frequently in the fifth and sixth decades of life with equal gender predilection. It occurs as a discrete, nontender, yellowish, or mucosa-colored plaque with a pebbly, warty appearance, although some are flat. Seventy-five percent are located on the keratinized tissues of the gingiva and hard palatal mucosa, with the tongue and buccal mucosa being the next most common sites ( Fig. 3.5 ).
FIG 3.5 Verruciform xanthoma. (A) Papillary nodule of the right lateral tongue.(Reprinted from Shahrabi Farahani S, Treister NS, Khan Z, Woo SB. Oral verruciform xanthoma associated with chronic graft-versus-host disease: a report of five cases and a review of the literature. Head Neck Pathol. 2011;5:193–198.)
Verruciform xanthoma. (A) Papillary nodule of the right lateral tongue.(Reprinted from Shahrabi Farahani S, Treister NS, Khan Z, Woo SB. Oral verruciform xanthoma associated with chronic graft-versus-host disease: a report of five cases and a review of the literature. Head Neck Pathol. 2011;5:193–198.)
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This may be seen in areas of mucosa or skin exhibiting damage to the epithelium, such as from trauma, and inflammatory conditions such as lichen planus, pemphigus vulgaris, epidermolysis bullosa, and chronic graft-versus-host disease. It is less commonly associated with carcinoma in situ, invasive carcinoma, chronic lymphedema, and congenital epidermal nevi.
Etiopathogenesis and Histopathologic Features
Verruciform xanthoma is a reactive lesion believed to be a histiocytic response to products of epithelial breakdown, although some believe that it is accumulation of lipid-laden macrophages that induces the epithelial proliferation. Resident and reparative macrophages are involved. A subset of cutaneous cases shows mutation of the 3β-hydroxysteroid dehydrogenase gene, which is important in cholesterol biosynthesis.
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There is a benign papillary proliferation of stratified squamous epithelium with elongated rete ridges, generally of the same length and confluent at the tips ( Figs. 3.6A and 3.7A ). Infrequently, lesions have a flat surface ( Fig. 3.8A ).
