Abstract
The multifocal epithelial hyperplasia (Heck’s disease) is characterized by a proliferation of stratified squamous epithelium and is usually attributed to human papillomavirus (HPV) types 13 and 32. Current studies have found a broad ethnic incidence of the disease. Its risk factors are associated with low socioeconomic status and HPV infection. Clinical appearance may include smooth surface nodules and/or papules, generally involving buccal and labial mucosa. An 83-year-old female patient was referred for evaluation of 3 painless nodular lesions in the upper and lower lip mucosa (up to 1 cm diameter) with 10-year evolution. After incisional biopsy, the microscopic examination revealed fragments of mucosa coated by a squamous epithelium displaying regional parakeratosis, acanthosis, basal cell hyperplasia, vacuolization of epithelial cells (koilocytosis), and the presence of mitosoid cells. With clinical and microscopic associations, the definitive diagnosis was multifocal epithelial hyperplasia. The treatment options include surgical excision, CO2 laser, cryotherapy, topic or systemic medicaments, and others.
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