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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2020  |  Volume : 38  |  Issue : 1  |  Page : 91-93
 

A case report of squamous papilloma of the hard palate in a pediatric patient


Department of Pedodontics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission09-Mar-2018
Date of Decision03-Oct-2018
Date of Acceptance13-Nov-2018
Date of Web Publication12-Mar-2020

Correspondence Address:
Dr. N Aishwarya
Department of Pedodontics, Rajarajeswari Dental College and Hospital, #14, Ramohalli Gate, Kumbalgudu, Mysore Road, Bengaluru - 560 074, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_71_18

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   Abstract 


Oral squamous papillomas are benign proliferating lesions induced by human papillomavirus. These lesions are painless and slowly-growing masses. As an oral lesion, it raises concern because of its clinical appearance. These lesions commonly occur between age 30 and 50 years, and sometimes can occur before the age of 10 years. Oral squamous papilloma accounts for 8% of all oral tumors in children. Common site predilection for the lesion is the tongue and palate and may occur on any other surface of the oral cavity such as the uvula and vermilion of the lip. Here, we are presenting a case of squamous papilloma on the palate in a 9-year-old child.


Keywords: Electrocautery, hard palate, squamous papilloma


How to cite this article:
JayaA, Nagarathna, Aishwarya N. A case report of squamous papilloma of the hard palate in a pediatric patient. J Indian Soc Pedod Prev Dent 2020;38:91-3

How to cite this URL:
JayaA, Nagarathna, Aishwarya N. A case report of squamous papilloma of the hard palate in a pediatric patient. J Indian Soc Pedod Prev Dent [serial online] 2020 [cited 2020 Apr 6];38:91-3. Available from: http://www.jisppd.com/text.asp?2020/38/1/91/280521





   Introduction Top


Oral squamous papilloma is a benign proliferation of parakeratinized stratified squamous epithelium, resulting in a papillary or verrucous exophytic mass induced by human papillomavirus (HPV) usually HPV-6 or HPV-1.[1] They are often asymptomatic slow-growing and occurs as single pedunculated masses with numerous finger-like projections most commonly seen on the tongue and soft palate, affecting mainly adults between the third to fifth decades rarely in the first decade of life.[2] They are categorized based on clinical appearance into isolated solitary and multiple recurring types and histologic appearance into exophytic, endophytic, and spiked. Oral squamous papilloma accounts for 8% of all tumor in children and should be differentiated from rare intraoral papillomatous lesions such as verruca vulgaris and condyloma acuminatum through histological examination.[2],[3] Surgical excision is the treatment of choice either by routine excision or laser ablation. Here, we present a case report of squamous papilloma of hard palate treated with surgical excision.


   Case Report Top


A 9 year old male patient reported to the Department of Pedodontics and Preventive Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru. He complained of the unerupted tooth in the upper front tooth region for 2 years and also complained of soft-tissue growth on the palate which feels leathery and increasing in size for 3 years and not associated with pain or discomfort. Tooth 62 was exfoliated 3 years ago. Family history was insignificant with no positive medical or dental history. A thorough clinical intraoral examination revealed a child with mixed dentition. Soft-tissue examination revealed a pink-colored small finger-like projection extending from labial attached gingiva extending up to the mid-palate in an irregular conical fashion in relation to 22 and was approximately 3.2 cm × 1.6 cm [Figure 1] and [Figure 2]. On palpation, the lesion was firm in consistency, irregular in shape, nontender, attached in the anterior region, and freely movable in the mid-palate region. Hard-tissue examination showed multiple dentinal caries suggestive of high caries risk patient. On extraoral examination, submandibular lymph nodes were soft, palpable, nontender. The case was discussed, and full-mouth rehabilitation was advised. In relation to soft-tissue lesion, incisional biopsy was advised and done under local anesthesia to derive at diagnosis and sent for histopathological examination which shows tissue lined by stratified squamous epithelium exhibiting papillomatosis and hyperplasia. Subepithelial stroma shows lymphoplasmacytic infiltrate which confirmed the lesion as squamous papilloma. The case was further discussed, and excision was chosen as the best treatment of choice. The parent and the child were informed, and consent was taken. The lesion was excised under local anesthesia [Figure 3] and [Figure 4] and follow-up was done at regular intervals [Figure 5]. The normal eruption of 22 was seen after 1 month and soft-tissue observation revealed healthy tissue with no recurrence.
Figure 1: Preoperative clinical photograph of squamous papilloma of the hard palate

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Figure 2: Preoperative clinical photograph of squamous papilloma in the labial surface of 22

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Figure 3: Postoperative clinical photograph of hard palate immediately after excision

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Figure 4: Excised squamous papilloma lesion

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Figure 5: Six months postoperative view of the hard palate

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   Discussion Top


Oral squamous papilloma is a generic term used for papillary and verrucous growth composed of benign epithelium and minor amounts of connective tissue and is associated with HPV-6 and HPV-11.[2],[4] They appear clinically as asymptomatic usually white but sometimes pink in color.[5] They are made up of numerous, small finger-like projections which result in a lesion with a roughened or cauliflower-like surface. These squamous papillomas can be divided into isolated-solitary and multiple-recurring type of which multiple recurring type occurs most commonly in children.[4] The most common sites of occurrence in the oral cavity are palate and tongue (34%), and least common affected sites are uvula, lips, and gingiva.[5],[6] Histologically, many long, thin, and finger-like projections extend above the surface of the mucosa. Each finger-like projection is lined by stratified squamous epithelium and contains a thin central connective tissue. The spinous cells proliferate in a papillary pattern. Koilocytes-HPV altered cells may or may not be seen. Upper-level epithelial cells demonstrate nuclei that are pyknotic and crenated, often surrounded by an edematous or optically clear zone, forming the so-called “koilocytic” cell. This cell is thought to be indicative of a virally-altered state. Chronic inflammatory cells are also seen.[2] These oral squamous papilloma should be clinically and histologically differentiated from fibroma, verruciform xanthoma, papillary hyperplasia, and condyloma acuminatum. Verruciform xanthoma has a distinct predilection for gingiva and the alveolar ridge.[7] A cause and effect relationship should be evident for inflammatory papillary hyperplasia. The condyloma would be larger than the papilloma, would have a broader base, and would appear pink to red as a result of less keratinization.[8] Treatment of choice for these lesions is surgical removal and also can be performed with electrocautery, cold steel excision, laser ablation, cryosurgery, or intralesional injections of interferon. In this case, surgical excision was performed with electrocautery as it a safe and effective method of hemostasis during surgery. It is known that the rate of recurrence in solitary lesions is low as compared to multiple lesion. In the present case, specimen displayed solitary lesion and there was no recurrence to date after resection of the lesion.


   Conclusion Top


Oral squamous papilloma is a benign proliferating lesion characterized by painless growth and is rare in children. Its pathogenesis is related to HPV. Early diagnosis and treatment should be performed to avoid further complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The authors are very grateful to Dr. Mamatha professor of the Department of Maxillofacial surgery for the helpful suggestions and treatment of the lesion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Misir AF, Demiriz L, Barut F. Laser treatment of an oral squamous papilloma in a pediatric patient: A case report. J Indian Soc Pedod Prev Dent 2013;31:279-81.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Babaji P, Singh V, Chaurasia VR, Masamatti VS, Sharma AM. Squamous papilloma of the hard palate. Indian J Dent 2014;5:211-3.  Back to cited text no. 2
  [Full text]  
3.
Alan H, Agacayak S, Kavak G, Ozcan A. Verrucous carcinoma and squamous cell papilloma of the oral cavity: Report of two cases and review of literature. Eur J Dent 2015;9:453-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Jaju PP, Suvarna PV, Desai RS. Squamous papilloma: Case report and review of literature. Int J Oral Sci 2010;2:222-5.  Back to cited text no. 4
    
5.
Abou-Elhamd KA, Yaquoby M. Soft palate papilloma: A report of 4 cases with review of literature. Saudi J Otorhinolaryngol Head Neck Surg 2010;12:26-8.  Back to cited text no. 5
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6.
Abbey LM, Page DG, Sawyer DR. The clinical and histopathologic features of a series of 464 oral squamous cell papillomas. Oral Surg Oral Med Oral Pathol 1980;49:419-28.  Back to cited text no. 6
    
7.
Rakhewar PS, Patil HP, Thorat M. Diode laser treatment of an oral squamous papilloma of soft palate. J Dent Lasers 2015;9:114-7.  Back to cited text no. 7
  [Full text]  
8.
Carneiro TE, Marinho SA, Verli FD, Mesquita AT, Lima NL, Miranda JL, et al. Oral squamous papilloma: Clinical, histologic and immunohistochemical analyses. J Oral Sci 2009;51:367-72.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
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