The Spectrum Of Oral Lesions Presenting Clinically With Papillary- Verrucous Features

Publication date: Available online 24 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Whitefield Sara, Raiser Vadim, Shuster Amir, Kleinman Shlomi, Shlomi Benjamin, Kaplan Ilana
PurposeTo study the spectrum of oral pathologies presenting clinically with papillary-verrucous features.Materials and Methods10-year retrospective study (2007 to 2016) of oral papillary lesions was undertaken. All biopsies which included a clinical description of papillary or verrucous architecture were retrieved. The data collected included clinical features, size, color, location, histopathological diagnosis age and gender.ResultsThe study included 137 patients, with a total of 151 lesions. The ages ranged from 10 weeks to 84 years (mean 49). Histopathologically, 60% of cases were HPV related, 19% showed hyperplasia, 11% hyperplastic candidiasis, 7% dysplastic or malignant and 3% benign of unknown etiology. Of the 7% diagnosed with dysplasia or malignancy, only 60% were suspected for malignancy at the time of biopsy.HPV-related lesions and hyperplasia were most frequently found on the tongue (38% and 41%) and soft palate (21 and 14%), respectively. Hyperplastic candidiasis was most frequent on the buccal mucosa and tongue (35 and 24%, respectively).1.3% of total lesions were found to be squamous cell carcinoma (SCC) and 1.3% verrucous carcinoma. 50% of the verrucous/papillary malignant lesions were found on the gingiva. Most malignant lesions occurred in the 40-60 age group.ConclusionThe results of this study suggest, that due to the wide spectrum of entities presenting clinically as papillary-verrucous architecture, biopsy is necessary for diagnosis. The clinical presentations allowed for overall accurate diagnosis in only 47% of cases and 60% accuracy in dysplastic or malignant cases. It is of significant importance to correctly identify those lesions which are HPV-related, but at the same time to rule-out those lesions which are unrelated to HPV, to help alleviate a patient's anxiety. Most importantly, biopsy is mandatory for recognition of the malignant lesions with a papillary verrucous architecture, which may mimic other benign entities in the group of papillary verrucous lesions.



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