Heck's Disease Research Articles

Heck's Disease: Diagnosis and Susceptibility

Focal epithelial hyperplasia, or Heck's disease, is an uncommon proliferation of oral mucosa that presents primarily in Native Central and South American populations. It presents as asymptomatic papules or nodules on the oral mucosa, gingiva, tongue, and lips. In the majority of cases, human papilloma virus 13 or 32 is detected. Factors that determine disease susceptibility are unclear, but genetics, and having the human lymphocytic antigen-DR4 (DRB1*0404) allele in particular, are thought to play a major role in disease vulnerability. We report another case of focal epithelial hyperplasia, hypothesize on disease susceptibility, and review the current understanding of this uncommon disorder.

Hiperplasia epitelial focal (doença de Heck) em descendente de índios brasileiros: relato de caso

A hiperplasia epitelial focal, ou doenca de Heck, e uma enfermidade rara, benigna, que afeta a mucosa oral de criancas e adultos jovens de diversas regioes do mundo e em diferentes grupos etnicos, como indigenas e esquimos. Apresenta correlacao com o papilomavirus humano (HPV) no qual os tipos 13 e 32 tem sido consistentemente detectados nessas lesoes. Este artigo relata um caso de uma paciente de 18 anos de idade, descendente de indios potiguares, que compareceu ao servico de estomatologia da Universidade Federal do Rio Grande do Norte (UFRN), exibindo lesoes bem definidas, arredondadas, planas, localizadas em cavidade oral, com tempo de evolucao de aproximadamente dois anos. As lesoes foram submetidas a biopsias incisionais, constatado-se no exame histopatologico alteracoes epiteliais, como acantose, cristas epiteliais em forma de taco de golfe alem de celulas mitosoides. Esses achados histopatologicos foram compativeis com a hipotese clinica de hiperplasia epitelial focal (doenca de Heck).

Focal Epithelial Hyperplasia (Heck Disease) in a Black Child

We describe a 3-year-old African male child with focal epithelial hyperplasia (Heck disease). The clinical diagnosis was confirmed histologically and by the finding of human papillomavirus type 32.

Focal epithelial hyperplasia of the oral mucosa

A case of focal epithelial hyperplasia of the oral mucosa (Heck's disease) is presented, which appears to be the first to be described in the United Kingdom. Virus particles were found in tissue from the lesions studied by electron microscopy, and identified as belonging to the papilloma virus sub-group of the family of papovaviruses.

Oral focal epithelial hyperplasia: report of five cases

Focal epithelial hyperplasia or Heck's disease is a rare contagious disease caused by human papillomavirus types 13 or 32, initially described among Native American populations. This condition is characterized by the occurrence of multiple small papules or nodules in oral cavity, especially on labial and buccal mucosa and tongue. This report describes the diagnosis of focal epithelial hyperplasia in five Central Amazonian Indians who sought treatment at the Amazonas State Foundation of Tropical Medicine (FMT-AM), using clinical criteria, polymerase chain reaction (PCR) and DNA sequencing.

Focal epithelial hyperplasia (Heck's disease): report of a case in a girl of Brazilian Indian descent

Summary. Background. This report describes the case of a patient with focal epithelial hyperplasia (FEH), a rare but distinctive entity of viral aetiology with characteristic clinical and histopathological features. Case report. The condition is usually seen in children and adolescents of American Indian and Eskimo background. Surgical removal of papillomatous lesions is the treatment of choice, either for aesthetic reasons, or when the lesions interfere with function or are readily traumatized. Recurrence and the site of new lesions are unpredictable, and continued review of the patient is often necessary. The patient described here has been followed for 24 months without recurrences or changes in the aspect of the remaining lesions. Conclusion. This case highlights a possible genetic predilection for FEH, since the patient is a descent of a Brazilian Xavante Indian.

Multifocal papilloma virus epithelial hyperplasia

Multifocal papilloma virus epithelial hyperplasia is an infection of the oral mucosa produced by human papilloma virus types 13 and 32, which primarily bilaterally affects lips, lateral borders of tongue, and buccal mucosa. The attached oral mucosa, floor of mouth, soft palate, and oropharynx are sites that appear not to be affected. This study comprises 110 patients with multifocal papilloma virus epithelial hyperplasia identified over a period of 3 years in Guatemala City and neighboring rural areas. All but four patients were younger than 18 years of age. More than one affected patient was observed in several families. All but three cases occurred in patients living in extreme poverty (annual family income less than $1,200 in U.S. dollars). Biopsies of 60 lesions demonstrated acanthosis and nuclear degeneration within the epithelium. We suggest that the eponym Heck's disease be abandoned because this disease was described in the Latin-American literature before the initial description in the American literature. We propose the term multifocal papilloma virus epithelial hyperplasia, which best describes the nature and multifocality of this disease.

Heck's disease (focal epithelial hyperplasia): a longitudinal study.

A 3-year longitudinal study on Heck's disease among school children was undertaken in 2 communities which are similar geographically, socioeconomically and ethnically. The variations in the annual prevalence rates (7% to 13%), the incidence rates per 1000 (38 to 68), the female to male ratios (1:0.4 to 1:1) and the average ages of the affected pupils did not differ between communities and from year to year. Lesions varied in number, size and duration. Some were seen only at one of the examinations, while others remained during the whole study. The majority were situated on the mucosae of the lower lips and cheeks. The prevalence of lesions amongst school children in these two communities was noticeably higher than that of another community of similar ethnicity studied earlier. The clinical behaviour of the lesions is in keeping with what is expected of some HPV infections. The relatively high prevalence rate and the anatomical distribution of the lesions indicate the infectious nature of the disease, which we believe is influenced to a large extent by the lifestyle in these communities.

Multiple oral papules in a native South American girl. Focal epithelial hyperplasia (Heck's disease)

Multiple oral papules in a native South American girl. Focal epithelial hyperplasia (Heck's disease)

Focal Epithelial Hyperplasia (Heck's Disease): The First Reported Case from Italy

A case of focal epithelial hyperplasia (Heck's disease) of the oral mucosa observed for the first time in Italy is reported. The patient was of Italian extraction. The lesions, represented by soft nodules, were multiple and located on the vestibular and labial mucosa. Biopsy tissues were studied for the presence of human papilloma virus (HPV) by electron microscopy, in situ hybridization and immunoperoxidase staining to HPV group antigens. No viral particles consistent with HPV were found in the epithelial cells. The tissues were positive for HPV antigen by immunoperoxidase staining and hybridized to the HPV 13 probe. In situ hybridization to the HPV 6, HPV 11, HPV 16, HPV 18 and 32 probes was negative. Our study substantiates that focal epithelial hyperplasia, although rare, may be observed in Whites and that HPV 13 in associated with the disease.

Heck's disease

The clinical and histological findings in two adult caucasians with focal epithelial hyperplasia (Heck's disease) are described. The literature concerning this rare condition is reviewed.

In situ detection of human papillomavirus Types 13 and 32 in focal epithelial hyperplasia of the oral mucosa

17 cases of focal epithelial hyperplasia of the oral mucosa (FEH, Heck's disease) were investigated for the presence of human papillomavirus (HPV) nucleic acid sequences by means of in situ DNA hybridization using biotinylated DNA probes of HPV types 1, 6, 11, 13, 16, 18, and 32. Ten of 17 cases were positive for HPV 13 DNA in contrast to 6 of 17 positive cases obtained after application of the HPV 32 probe, with a double infection in one case. The results of our study suggest, that HPV 13 and HPV 32 are very specifically found in lesions of FEH and can be detected in a high percentage of cases using in situ hybridization.

Human papillomavirus type 13 and focal epithelial hyperplasia of the oral mucosa: DNA hybridization on paraffin-embedded specimens.

16 cases of focal epithelial hyperplasia (Heck's disease) were studied for the presence of human papillomavirus DNA by means of nucleic acid hybridization. Hybridization was carried out in situ with biotin-labelled probes of HPV 1, 6, 11, 13, 16, and 18 DNA under stringent and non-stringent conditions. Under non-stringent conditions, 6 of 16 cases (38%) hybridized to a mixture of HPV 1, 6, 11, 16, and 18 DNA. When these probes were applied under stringent conditions, only one case could be shown to be weakly positive for HPV 6/11 DNA. Further stringent hybridizations, which were conducted with a HPV 13 probe on 12 of our 16 cases, revealed a positive result in 9 of 12 cases (75%). The results of our study strongly substantiate the concept that HPV 13 or a closely related HPV type is associated with lesions morphologically presenting as focal epithelial hyperplasia.

Focal epithelial hyperplasia: report of two cases and review of literature

Two cases of focal epithelial hyperplasia were observed in Tehran, Iran. No cases had been reported previously in the literature in Iran. The patients whose cases are presented were both white females. Multiple nodular lesions were seen on the upper and lower labial and buccal mucosa. The lesions were clinically and histologically consistent with focal epithelial hyperplasia (Heck's disease). No further treatment was undertaken as the lesions usually regress spontaneously.

A human papillomavirus closely related to HPV 13 found in a focal epithelial hyperplasia lesion (Heck disease).

A human papillomavirus closely related to HPV 13 found in a focal epithelial hyperplasia lesion (Heck disease).

Heck's disease (focal epithelial hyperplasia)

A patient and his mother noted the insidious appearance of a distinctive benign papular eruption confined to the mucosa of the lips. The clinical pattern and histologic findings fulfill the criteria of a recently described entity, focal epithelial hyperplasia. An electron microscopic search for viral particles was negative. Arguments for both a viral and a hereditary pathogenesis have been put forth, but the etiology of the condition remains controversial. This disorder may be more frequently reported as dermatologists become increasingly aware of its existence.

Multiple fibroepithelial hyperplasias of the oral mucosa

Reported is a rare case of multiple fibroepithelial hyperplasias of the oral cavity, and the suggestion is made that several previous authors may have confused this lesion with focal epithelial hyperplasia (Heck's disease). The differential diagnosis of multiple fibroepithelial hyperplasias is discussed in order to elucidate some of the confusions in the diagnosis of cases of multiple papules and nodules of the oral mucosa.

Focal epithelial hyperplasia in Israeli families of Libyan origin

The occurrence of focal epithelial hyperplasia (Heck's disease) in seven Israeli families is reported. All the cases involved children and young adults whose parents had immigrated to Israel from Libya. The familial occurrence and possible etiologic factors of the condition are discussed. A genetic predisposition for the disease is suggested.

Focal epithelial hyperplasia (Heck's disease)

Multiple labial, buccal, gingival, and lingual papular lesions were noted in a 35-year-old Egyptian man with focal epithelial hyperplasia. The papillomatous pattern of the lesions on the lower lip was a rather striking feature. The clinical and histopathologic appearance of the lesions led to a diagnosis of focal epithelial hyperplasia. Surgical removal seems to be the best method of treating such lesions. In the present case, surgical removal of the papillomatous surface of the lower lip was not followed by recurrence over a 15-month postoperative period.

Focal epithelial hyperplasia (Heck's disease)

Focal epithelial hyperplasia is a benign disease of unknown aetiology, characterised by multiple small, symptomless, elevated nodules on the oral mucosa. It has previously only been reported in the New World.