Squamous Papilloma Research Articles

External Auditory Canal Squamous Papilloma Presenting with Otitis Externa and Severe Bony Erosion.

We present a case of a 68-year-old lady with an insidious progressive history of otorrhea, otalgia, and reduced hearing for 3months. She was treated for malignant otitis externa and was treated with systemic antibiotic but showed subtherapeutic response to treatment. She underwent examination under anaesthesia and biopsy with tumour debulking of the right ear via posterior auricular approach and histopathological examination revealed squamous papilloma of the external auditory canal. She recovered well after surgery and was asymptomatic during follow-up.

Systemic bevacizumab for treatment of recurrent respiratory papillomatosis.

To characterize treatment response of recurrent respiratory papillomatosis (RRP) including adult-onset RRP (AORRP) and juvenile-onset RRP (JORRP) to systemic bevacizumab (bev), and share our treatment regimen experience. Patients were enrolled in bev treatment based on a pathologically confirmed diagnosis of squamous papilloma. According to lesion characteristics and medical history, systemic bev was used as preoperative adjuvant therapy, postoperative adjuvant therapy, or primary therapy. The assessment of treatment response relied on the morphological changes of lesions. Vocalization and voice-related quality of life were evaluated using the voice handicap index-30 (VHI-30) for adults and the pediatric VHI (pVHI) for children. Adverse effect was monitored through patient self-reported symptoms and regular follow-ups. This study included 24 patients, comprising nine AORRP and 15 JORRP cases. In AORRP, all patients (100%) exhibited various degrees of response to systemic bev, with 5 (55.56%) achieving complete response (CR). Among JORRP patients, 14 (93.33%) showed a response to systemic bev, with 8 (53.33%) achieving CR and currently being followed up. No instances of aggravation were observed during systemic bev treatment. A total of 21 patients (21/24, 87.50%) reported voice improvement, accompanied by reduced VHI-30 or pVHI scores across all aspects, including total, functional, physical, and emotional dimensions. No grade 3 or higher adverse events occurred. The most common adverse events were grade 1 gum bleeding (n = 4, 16.67%) and grade 1 proteinuria (n = 4, 16.67%). Systemic bev can be used as a powerful therapy for both AORRP and JORRP. The findings provide a reference to the systemic bev treatment for RRP.

Сучасні аспекти клініки, діагностики та лікування ВПЛ-асоційованих доброякісних уражень ротової порожнини

Human papillomavirus (HPV) exhibits specific tropism for squamous epithelium and therefore contributes to the development of many benign, potentially malignant, and malignant epithelial lesions. The benign HPV-related lesions of the oral cavity comprise verruca vulgaris, squamous papilloma, condyloma acuminatum and multifocal epithelial hyperplasia. Oral squamous papilloma is most common in people of various ages. Purpose: To determine the structure, clinical features and morphological signs of oral squamous papilloma in patients of different sex and age. Materials and methods. For the period of 2020-2023, 18 people with oral papilloma (papillomatosis) aged 15 to 70 years were examined. In 12 patients, papilloma was removed by conventional surgery, in 6 patients – using a high power diode laser. Pathohistological evaluation of excisional biopsy and identification/genotyping of HPV DNA by REAL TIME PCR was carried out. Results. Squamous papilloma dominates in the structure of HPV-related benign oral lesions (88.8%). Among patients with papiloma, the majority are women (72.2%) with an average age of 29.3±4.0 years. The average age of men with papilloma is 52.2±5.8 years. By localization in the oral cavity, papillomas are most often found on the gingiva (43.75%), as well as on the tongue (25%), on the soft palate (18.75%), on the mucous membrane of the upper lip (6.25%) and cheek (6.25%). The average papilloma size by diameter was 0.71±0.06 cm. Pathomorphological confirmation of the impact of HPV on the development of oral squamous papilloma, namely the presence of coylocytes, was obtained in 31.3% of excision biopsies. Hyperkeratosis of the covering epithelium was found in 5 patients (27.7%), and this condition is defined as «keratopapiloma». In 6 women (33.3%), the presence of various types of HPV was detected by PCR, including high oncogenic risk (HPV-16, 18, 66, 68). Conclusion. Oral squamous papilloma, associated with high oncogenic risk HPV, as well as keratopapilloma in heavy smokers, should be considered a precancerous disease of the oral mucosa with a high risk of malignancy. Key words: human papillomavirus, papillomavirus infection, oral squamous papilloma, keratopapiloma, laboratory diagnostics, oral mucosa, risk of malignancy

Squamous Cell Papilloma of the Conjunctiva

Squamous Cell Papilloma of the Conjunctiva

THE HISTOPATHOLOGICAL STUDY OF TUMOR AND TUMOR-LIKE LESIONS OF ORAL CAVITY AND OROPHARYNX

Objective: The objective is the histopathological study of tumor and tumor-like lesions of the oral cavity and oropharynx. Methods: This study was conducted in the Department of Pathology, SBKS Medical Institute and Research Centre, Piparia, for 1 year. One hundred oral biopsies received from the ENT department were studied. Clinical details were obtained from the requisition form. Biopsies received were processed and stained with Hematoxylin and Eosin. Histopathological diagnosis regarding type and differentiation was made. Results: Among 100 cases of the oral cavity and oropharynx biopsies analyzed in the present study, malignant lesions were 90 (90%), premalignant lesions were 4 (4%), and benign lesions were 6 (6%). The study included 86 cases (86%) of squamous cell carcinoma, 2 cases (2%) of verrucous carcinoma, 1 case (1%) of adenosquamous carcinoma, 1 case (1%) of adenocarcinoma, 3 cases (3%) of leukoplakia, 1 case (1%) of severe dysplasia, 3 cases (3%) of pleomorphic adenoma, and 1 case (1%) each of pyogenic granuloma, squamous papilloma, ossifying fibroma. Maximum number of cases was of squamous cell carcinoma (86%). Maximum number of cases was seen inthe age group of 36–45 years, the youngest patient was 25 years old. There was a male preponderance for oral and oropharyngeal lesions (73%) as compared to females (27%). Male: Female ratio was 1:0.37. The most common site of the lesion was the tongue (41%) followed by buccal mucosa (30%). The majority of the tumors were well-differentiated. Conclusion: Males are more likely to develop lesions of the oral cavity and oropharynx than females. Typically, older age groups are affected. Drinking alcohol, smoking, and chewing tobacco can contribute to oral and oropharyngeal lesions. The most frequent place implicated is the tongue. The most prevalent histological variation is squamous cell carcinoma, and the majority of these tumors are well-differentiated.

S2719 An Unusual Case of Squamous Papilloma Masquerading as Esophageal Malignancy

S2719 An Unusual Case of Squamous Papilloma Masquerading as Esophageal Malignancy

A Rare Otological Presentation of Squamous Papilloma

Introduction:
 Squamous papillomas (SPs) are benign epithelial neoplastic lesions commonly found in skin, oral mucosa, upper aerodigestive tract and genitals. Involvement of external auditory canal (EAC) by SP is extremely rare and whatever scarce literature is available is in the form of case reports. The exact incidence of this entity is still unknown. Consequently, its etiology, histopathological features, differential diagnoses and optimal management merit a better understanding by the Otolaryngologists.
 Case report: We present a case of EAC SP in a 15 year old girl hailing from north-eastern India who presented to us with a mass in the EAC which was acutely painful. Contrast Enhanced Computed Tomography remained the gold standard and imaging study of choice for evaluation. However, the diagnosis was clinched only by histopathology. We also discuss our strategy of management along with a brief review of literature.
 Conclusion:
 Squamous papilloma has rarely been reported to affect the EAC. Human papilloma virus remains the most consistent etiological agent. Advanced imaging like contrast enhanced high resolution computed tomogram remains gold standard to evaluate any mass seen in EAC. Complete excision with cold steel technique or coblation with good post-operative care and follow up is the standard of care.

Detection of Human Papillomavirus in Squamous Papilloma of the Esophagus.

Introduction: The etiology of esophageal squamous papilloma (ESP) is largely unknown. Previous studies have shown a variable association with human papillomavirus (HPV) with conflicting data. The aim of this study was to further investigate the possible association of HPV in our ESP series using RNA in-situ hybridization (ISH) and compare study groups from the United States of America and China. Methods: Demographic and clinical data of patients with ESP were retrieved from the University of California Los Angeles (UCLA) (1/2016-3/2019) and Peking Union Medical College Hospital (PUMCH) (9/2014-3/2019) pathology databases. Hematoxylin and eosin slides were reexamined. Confirmed cases were examined by high- and low-risk HPV RNA ISH. Results: For the UCLA cohort, 13 429 upper endoscopies were performed and 78 biopsies from 72 patients were identified as ESP (F:M = 45:27, 66.7% > 45 years). Seventy-four (94.9%) biopsies were designated as polyps or nodules and 46.6% were located in the mid-esophagus. Other abnormal findings included gastroesophageal reflux disease (48.6%), hiatal hernia (38.9%), and esophagitis (36.1%). For the PUMCH cohort, 63 754 upper endoscopies were performed and 73 biopsies from 71 patients were identified as ESP (F:M = 48:23, 71.8% > 45 years). Sixty-four (87.7%) biopsies were designated as polyps or nodules and 57.5% were located in the mid-esophagus. Other abnormal findings included esophagitis (19.7%), and hiatal hernia (8.5%). No features of conventional cytologic dysplasia or viral cytopathic change were found. None of the cases was associated with squamous cell carcinoma, and none showed positive HPV RNA ISH results. Conclusions: No association was found between ESP and active HPV infection in our 2 cohorts. Other etiopathogenetic mechanisms, such as aging, might contribute to the development of these innocent lesions.

Esophageal squamous papilloma: Literature review and case-control retrospective study with histopathological exam of human papillomavirus.

Esophageal squamous papilloma (ESP) is a benign growth in the esophagus with unknown malignant potential. The mechanism underlying ESP formation is unknown, but human papillomavirus (HPV) infection has been proposed as a potential etiology. We sought to investigate the clinical characteristic of ESP in our population, review the current literature, and highlight the role of HPV. This is a retrospective case-control study conducted at two referral centers. We selected the ESP population by free-text search in the pathology department database and selected controls randomly from the general endoscopy population. Immunostains were used to evaluate ESP tissue for HPV. Between January 2016 and December 2021, we identified 66 patients with ESP, with a prevalence of 0.72%. ESP patients were younger, with a median age of 52 years (P = 0.021), and more likely African American (34.4 vs 7.5%, P < 0.001) compared to controls. On endoscopy images, the growth was predominantly solitary (92.5%) in the middle of the esophagus (39.4%), with sizes ranging from 0.2 to 2.3 cm. A total of 62 patients had available tissue for HPV immune staining, and none tested positive for HPV. Eighteen patients had a follow-up endoscopy with an average of 504.5 days follow-up period. One patient developed esophageal squamous cell carcinoma during follow-up. We observed a higher prevalence of ESP compared to previous studies. The formation of ESP is multifactorial and partially explained by HPV infection in selected populations. The malignant potential of ESP is low but not negligible.

Clinico-pathological Factors in Malignant Transformation of RRP.

Various clinico-pathological factors play role in the papilloma proliferation and pathogenesis of Recurrent respiratory papillomatosis (RRP). However, it is not known if they are directly responsible for malignant transformation of these papillomas or not. We did this study to elucidate any such association. The most recent debrided tissue of RRP in 20 patients was evaluated for p16 expression, VEGF estimation (tissue expression and serum levels), and tissue HPV DNA concentration. The final histopathology results were then correlated with these pathological factors and with clinical factors like duration of illness, age of onset of symptoms, extent of disease, etc. Squamous papilloma was seen in 60%, dysplasia in 25%, and squamous cell carcinoma (SCC) in 15% of the patients. Positive immunostaining for p16 (staining in ≥70% of tumor cells) was seen only in one case, which was SCC. There was no statistically significant difference between p16 expression, tissue VEGF expression, serum VEGF levels, and tissue HPV DNA in any of the histological groups. The mean age of disease onset was significantly higher in patients with SCC (p = 0.03). A significantly higher number of patients with dysplasia had tracheobronchial involvement (p = 0.022). We concluded that no single pathological factor is solely responsible for development of malignancy in RRP, whereas clinical factors like tracheobronchial involvement and age of onset may contribute to development of dysplasia or carcinoma.

Laryngeal papillomatosis in an adult patient: managed with micolaryngeal surgery and CO2 laser

The most prevalent benign laryngeal tumour, squamous papilloma, typically affects the vocal folds and/or epiglottis. It is often associated with human papillomavirus (HPV) infection and can present as a single or multiple lesions. We describe a case of a 24-year-old male who presented with hoarseness and dysphonia for six to eight months. Laryngoscopy revealed exophytic, papillary lesion on the right true vocal fold with creating contact lesion on opposite side. The lesion was excised using carbon dioxide (CO2) laser and histopathology confirmed the diagnosis of squamous papilloma. The patient had no recurrence or complications at six months follow-up. This case illustrates the clinical features, diagnosis, and management of squamous papilloma of the true vocal fold in an adult patient.

Approach to small biopsies in the larynx.

Small biopsies in the larynx can make a definitive diagnosis challenging due to the sampling or tangential sectioning. The differential diagnosis can be divided into mucosal lesions (squamous papillomas, intraepithelial dysplasia, and invasive squamous cell carcinoma) or submucosal lesions (vocal cord polyps/nodules, amyloidosis, granular cell tumor, rhabdomyoma, neuroendocrine neoplasms, salivary gland tumors, and cartilaginous tumors). Diagnostic criteria (both morphologic and immunohistochemical) are reviewed to arrive at a diagnosis even on small biopsy.

Analysis of the anatomical distribution of HPV genotypes in head and neck squamous papillomas.

Squamous papillomas (SPs) of the head and neck are usually benign lesions associated with human papilloma virus (HPV) infection. However, the reported HPV detection rates vary widely, especially with respect to anatomical distribution. The etiology of SPs in the head and neck remains unclear; analyzing HPV genotypes of SPs based on anatomical sites could assist in clarifying the pathogenesis of SPs in the head and neck. Therefore, the aim of this study was to review the prevalence, subtypes, and anatomical distribution of HPV in head and neck SPs at a hospital in China; we also investigated whether p16, a marker of HPV infection in oropharyngeal carcinoma, could serve as a surrogate marker for HPV in head and neck SPs. The presence of HPV DNA of 23 types (5 low-risk HPV and 18 high-risk HPV types) was detected via real-time PCR. p16 immunohistochemistry was performed using SP sections. Age, sex, anatomical location, and HPV subtype were recorded for each case. In total, 105 SPs were identified, including 47 in the larynx, 42 in the pharynx, 6 in the external auditory canal (EAC), 5 in the oral cavity, and 5 in the nasal cavity. HPV was found in 57 (54.3%) cases, with the highest positivity rate in the larynx (46/47; 97.9%). Only 5/42 (11.9%) patients showed HPV positivity in the pharynx. HPV incidence was highly dependent on the anatomical site. SPs in the larynx and EAC were more likely to carry HPV than those in other anatomical sites. High-risk HPV infections were rarely associated with SPs in the head and neck region. The sensitivity and specificity of p16 immunohistochemistry for HPV infection were 88% and 96%, respectively. There may be an association between p16 and HPV infection in head and neck SPs, but further studies are needed to validate this assertion.

Mixed squamous cell and glandular papilloma of the bronchus

Mixed squamous cell and glandular papilloma of the bronchus

Benign Squamous Papilloma of the Vulva

Benign Squamous Papilloma of the Vulva

GINGIVAL NEOPLASMS: A COLLABORATIVE STUDY OF 557 CASES FROM BRAZIL

Objective This study aimed to report a large series of gingival neoplasms in Brazil. Study Design Between 2000 and 2020, all cases of gingival neoplasms, both benign and malignant, diagnosed in four Brazilian oral pathology services, were retrieved for the study. Clinical and demographic data, such as age, gender, ethnicity location of the lesion (mandibular or maxillary, anterior or posterior), elementary lesion, type of biopsy performed, clinical diagnoses, and final diagnosis were collected from each laboratory's records. Results This study identified 557 cases of gingival neoplasms. There was a predilection for males (54%, n=300). Malignant tumors were more frequent, corresponding to 71% (n=398) of the cases. Squamous cell carcinoma (57%, n=317), sarcomas (5%, n=25), and lymphomas (4%, n=23) were the most prevalent malignant neoplasms. Benign tumors represented 29% (n=159) of diagnosed cases. Squamous cell papilloma (16%, n=91) was the most common benign tumor. Clinically, the gingival tumors usually appeared as a nodule (31%, n=170) or ulcer (25%, n=139). Conclusion Gingival nodules and ulcers may represent a malignant neoplasm. Detailed clinical, radiographic, and histopathological examinations are essential for the early and accurate diagnosis of gingival neoplasms. This study aimed to report a large series of gingival neoplasms in Brazil. Between 2000 and 2020, all cases of gingival neoplasms, both benign and malignant, diagnosed in four Brazilian oral pathology services, were retrieved for the study. Clinical and demographic data, such as age, gender, ethnicity location of the lesion (mandibular or maxillary, anterior or posterior), elementary lesion, type of biopsy performed, clinical diagnoses, and final diagnosis were collected from each laboratory's records. This study identified 557 cases of gingival neoplasms. There was a predilection for males (54%, n=300). Malignant tumors were more frequent, corresponding to 71% (n=398) of the cases. Squamous cell carcinoma (57%, n=317), sarcomas (5%, n=25), and lymphomas (4%, n=23) were the most prevalent malignant neoplasms. Benign tumors represented 29% (n=159) of diagnosed cases. Squamous cell papilloma (16%, n=91) was the most common benign tumor. Clinically, the gingival tumors usually appeared as a nodule (31%, n=170) or ulcer (25%, n=139). Gingival nodules and ulcers may represent a malignant neoplasm. Detailed clinical, radiographic, and histopathological examinations are essential for the early and accurate diagnosis of gingival neoplasms.

CORRELATION BETWEEN EPITHELIAL DYSPLASIA AND ORAL SQUAMOUS PAPILLOMA AS A RESULT OF MULTIPLE RISK FACTORS: A CLINICAL CASE

This study is a clinical case of a 64-year-old leukoderma female patient, smoker for more than 45 years, who, after being diagnosed with Hepatitis A and B in different periods, presented a single leukoplastic, verrucous, pedunculated nodule, of the "cauliflower" type, on the lower alveolar edge of the right side (lesion I). It also presented homogeneous leukoplastic plaque, with verrucous surface, in the region of the lateral border of the tongue on the left side (lesion II). Both lesions were asymptomatic, with an undefined onset. The probable diagnostic hypotheses were squamous papilloma (lesion I) and leukoplakia (lesion II), with a differential diagnosis of condyloma (lesion I) and lichen planus (lesion II). Biopsy was performed by excisional removal of lesion I and incisional removal of lesion II, with the diagnosis of oral squamous papilloma and moderate to severe oral epithelial dysplasia, respectively. There was no radiographic lesion. Patient is undergoing follow-up. This study is a clinical case of a 64-year-old leukoderma female patient, smoker for more than 45 years, who, after being diagnosed with Hepatitis A and B in different periods, presented a single leukoplastic, verrucous, pedunculated nodule, of the "cauliflower" type, on the lower alveolar edge of the right side (lesion I). It also presented homogeneous leukoplastic plaque, with verrucous surface, in the region of the lateral border of the tongue on the left side (lesion II). Both lesions were asymptomatic, with an undefined onset. The probable diagnostic hypotheses were squamous papilloma (lesion I) and leukoplakia (lesion II), with a differential diagnosis of condyloma (lesion I) and lichen planus (lesion II). Biopsy was performed by excisional removal of lesion I and incisional removal of lesion II, with the diagnosis of oral squamous papilloma and moderate to severe oral epithelial dysplasia, respectively. There was no radiographic lesion. Patient is undergoing follow-up.

ORAL VERRUCIFORM XANTHOMA: REPORT OF TWO CASES

Oral verruciform xanthoma (VX) is a benign lesion of unknown etiology, usually found in the gingiva and palate. This study reports on two cases of this uncommon lesion. The first is a nodule in the upper gingiva of an adult man, with the clinical diagnosis of squamous papilloma. The second is a white plaque on the tongue of a 64-year-old man, clinically diagnosed as leukoplakia or reactive hyperkeratosis. After excisional biopsy, both lesions presented a proliferation of squamous epithelium, with elongated rete ridges and numerous foamy macrophages (CD68+) within the connective tissue papillae, classified respectively as flat and verrucous. The first patient died during follow up, but the second showed no signs of recurrence one year after the biopsy. In a 60-year period, we have only 4 cases of VX (0.025%), a lesion that could be clinically misguided as other papillary or verrucous lesions. Oral verruciform xanthoma (VX) is a benign lesion of unknown etiology, usually found in the gingiva and palate. This study reports on two cases of this uncommon lesion. The first is a nodule in the upper gingiva of an adult man, with the clinical diagnosis of squamous papilloma. The second is a white plaque on the tongue of a 64-year-old man, clinically diagnosed as leukoplakia or reactive hyperkeratosis. After excisional biopsy, both lesions presented a proliferation of squamous epithelium, with elongated rete ridges and numerous foamy macrophages (CD68+) within the connective tissue papillae, classified respectively as flat and verrucous. The first patient died during follow up, but the second showed no signs of recurrence one year after the biopsy. In a 60-year period, we have only 4 cases of VX (0.025%), a lesion that could be clinically misguided as other papillary or verrucous lesions.

Histopathological Analysis of Tongue Lesions and Distribution by Age Groups

Aim: To retrospectively evaluate the histopathological characteristics of biopsies taken from tongue lesions and compare the results with current literature. Material and Methods: Histopathological results of biopsies taken from 163 patients with suspected tongue lesions between January 2017 and January 2022 were retrospectively reviewed. The results were evaluated in different age groups. Results: Seventy-two (44.2%) of the patients were male and 91 (55.8%) were female. The mean age of the patients was 47.76±17.33 years. The lesion was benign in 135 (82.8%) patients, precancerous in 4 (2.5%), and malignant in 24 (14.7%). Of the 135 patients with benign findings, squamous papilloma was detected in 33 (24.4%) patients and irritation fibroma in 19 (14.1%). Ulcer/inflammatory granulation tissue was detected in 18 (13.3%) patients, parakeratosis/acanthosis in 14 (10.4%), fibroepithelial polyp in 14 (10.4%), and pseudoepitheliomatous hyperplasia in 9 (6.7%). Less frequently, lymphoid hyperplasia, neurofibroma, mucocele, and verruca vulgaris were detected in 1 (0.7%) patient each. Squamous cell carcinoma was detected in all patients with malignancy. When evaluated according to age groups, it was found that the patients were most commonly in the 50–59 (27.6%) age group, followed by the 40–49 (19.6%) age group. Conclusion: The results show that most tongue lesions are benign. It should be noted that not every mass in the tongue is cancerous, but leukoplakic and ulcerated areas can be malignant. Due to the rapid metastasis of tongue lesions, early diagnosis and treatment may contribute significantly to the prognosis of patients.

Esophageal squamous cell papilloma in a child with cystic fibrosis: A rare incidental endoscopic finding

Esophageal squamous cell papilloma is an uncommon epithelial lesion of the esophagus. Epidemiological data regarding esophageal squamous cell papilloma in children is scarce and consists of few case reports. Although the etiology of esophageal squamous cell papilloma remains unclear, chemical/mechanical irritation induced hyper-regenerative response of esophageal mucosa and human papillomavirus infection have been suggested as most probable causes. A case of a 14-year-old girl with cystic fibrosis and chronic dyspepsia had a 0.5 x 0.5 cm sessile, multilobulated, whitish and verrucous polypoid mass close to the lower esophageal sphincter removed. Histologically, a benign squamous papilloma was confirmed. Her dyspeptic symptoms suggestive for gastroesophageal reflux resolved after papilloma removal and anti-acid treatment. Esophageal squamous cell papilloma is an incidental finding at upper endoscopy. Gastroesophageal reflux disease may be responsible for distally localized papillomas. Due to its rarity in childhood, there are not any well-established management and surveillance guidelines. Esophageal squamous cell papilloma should be removed, when possible, because of the ambiguity about its malignant potential.