Path 7: Verruco-Papillary Lesions

Front 1

Papilloma:

1) What is it?
2) Presumably induced by what virus? What 2 main ones induce up to 50% of papillomas?
3) What ages does it mostly affect? Gender?
4) What does it look like clinically?
5) Most commonly found where?
6) Solitary or multiple?
7) Enlarge?
8) D/D
9) Histologically, how does it look?
10) Tx?

Back 1

1) Benign proliferation of stratified squamous epithelium
2) HPV - 6&11
3) 30-50 years old, M=F
4) Soft, painless, pedunculated exophytic finger-like surface projection, "cauliflower" or wart-like appearance. White, red, or normal in color.
5) Tongue and soft palate
6) Solitary
7) Enlarge rapidly to size of ~0.5 cm (distinguishes from condyloma)
8) Papilloma, verruca, or condyloma
9) Hyperkeratotic, parakeratin
10) Conservative surgical excision, including the base of the lesion

Front 2

Verruca vulgaris:

1) What is it?
2) What is it induced by?
3) T or F: it is contagious
4) Where is it mostly found? What do oral lesions look like and where do they mostly affect the mouth?
5) Histologically, what defines it?
6) What age does it mostly affect?
7) What does it look like?
8) Tx and prognosis?

Back 2

1) Common wart
2) Virus induced (HPV-2, 4, 40)
3) T - can be autoninoculated
4) Skin of hands - very uncommon on oral mucosa (but is white - lip vermillion, labial mucosa, anterior tongue)
5) Orthokeratin
6) Children
7) Painless papules or nodules with papillary projections, may occur in clusters
8) Oral lesions surgically excised, 2/3rds disappear spontaneously within 2 years, especially in children

Front 3

Condyloma Acuminatum

1) Also known as a...
2) What is it?
3) Associated with what virus?
4) Where do lesions develop
5) Makes up ___% of all STDs diagnosed in STD clinics
6) Age it usually affects?
7) Where do oral lessions occur and what do they look like? What is characteristic about their growth pattern?
8) How do they compare to the size of a papilloma?

Back 3

1) Venereal wart
2) Sexually transmitted lesion of the genitalia, perianal region, mouth, larynx
3) HPV 6, 11, 16, 18
4) Site of sexual contact or trauma
5) 20%
6) Larger (avg size is 1-1.5 cm vs papilloma's 0.5 cm)
7) Labial mucosa, soft palate, lingual frenum, sessile/pink/well-demarcated, nontender exophytic w/ short surface projections. Multiple and clustered.

Front 4

Oral florid papillomatosis:

1) What is it really?

Back 4

1) Verrucous carcinoma or proliferation verrucous leukoplakia

Front 5

Keratoacanthoma:

1) What is it? What is it similar to?
2) What is it now called?
3) Age it affects?
4) Gender?
5) 95% found on what part?
6) 8% found where?
7) Frequency of upper lip vs. lower lip?
8) T or F: these do NOT occur intraorally
9) What does it look like?
10) Size?
11) Regression?
12) Histopathologically, how does it look?
13) Tx and prognosis? What is mandatory

Back 5

1) Self-limiting, epithelial proliferation with a strong clinical/histologic similarity to well-differentiated SCC - represents an extremely well differentiated form of SCC
2) Squamous cell carcinoma - keratoacanthoma type
3) 45 and older
4) Males
5) Sun exposed skin
6) Outer edge of vermillion of lips
7) Same
8) T
9) Firm, nontender, well-demarcated, sessile, dome-shaped nodule w/ central plug of keratin
10) Rapid enlargement, reaches 1-2 cm within 6 weeks
11) Most regress spontaneously within 6-12 months of onset, frequently leaving a depressed scar in the area
12) Surface epithelium @ lateral edges looks normal, @ lip of central crater, acute angle formed between overlying epithelium and lesion. Proliferation of epithelium exhibiting a downward growth pattern
13) Surgical excision usually adequate, low recurrence, biopsy mandatory

Front 6

Pyostomatitis vegetans:

1) What does it represent?
2) Oral lesions often precede?
3) What do they look like clinically?
4) Tx and prognosis?

Back 6

1) Unusual oral expression of inflammatory bower disease, ie ulcerative colitis, Crohn's disease. 25% not related to bowel disease
2) GI symptoms
3) Yellowish, slightly elevated liner serpentine pustules set on an erythematous oral mucosa - affects buccal mucosa, "snail track ulcers"
4) Intestinal disease is of most concern, tx underlying bowel problems and oral lesions will usually regress

Front 7

Verruciform xanthoma?

1) Etiology?
2) Characterized by what kind of cells?
3) What are they similar to?
4) T or F: associated with diabetes, hyperlipidemia, or other metabolic disorder
5) Typically in what ethnicity? Age? Gender?
6) Where is it usually found int he mouth?
7) What does it look like?
8) Tx and prognosis?

Back 7

1) Hyperplastic condition of unknown etiology
2) Xanthoma cells - lipid-laden histiocytes
3) Other dermal xanthomas
4) F
5) 40-70 y/o white female
6) Gingiva and alveolar mucosa
7) Well demarcated, soft, painless, sessile, slightly elevated white/yellow-white/red with papillary verruci-form surface
8) Conservative surgical excision, rarely recur

Front 8

Focal epithelial hyperplasia (Heck's disease)

1) What individuals are most commonly affected?
2) T or F: common
3) Caused by what?
4) What does it look like?
5) Course of disease?

Back 8

1) Native Americans + Africans
2) T
3) HPV 13, 31
4) Multiple mucosal colored lesions on buccal + labial mucosa, tongue and gingiva
5) *Self limiting*

Front 9

Verrucous carcinoma:

1) What is it?
2) What does it look like histologically?
3) Often misdiagnosed as?
4) 80-90% seen where?
5) Growth pattern?
6) 20% have co-existing ___
7) Risk factors
8) Some think that removing ____ removes the cancer because it can't propagate

Back 9

1) Well differentiated squamous cell carcinoma
2) Exophytic papillary with parakeratin clefting. No dysplasia seen, epithelium is well oriented
3) B-9 hyperplasia
4) Gingiva or buccal mucosa
5) Slow growing, doesn't metastasize
6) SCC
7) Snuff dippers/smokers, HPV
8) Gingiva