Outline

After reading this post you will learn the following about Squamous Papilloma :-

  • Introduction & Etiology
  • Clinical Features
  • Histopathologic Features
  • Treatment & Prognosis

Introduction

  • Squamous papilloma is the fourth most common oral mucosal mass
  • Associated with papillomavirus (HPV); commonly caused by HPV types 6 and 11
  • Although all HPV lesions are infective, squamous papilloma has low virulence and infectivity, and is not very contagious
  • Clinically and microscopically indistinguishable from verruca vulgaris (common wart), which is a virus-induced focal papillary hyperplasia of the epidermis

Clinical Features

  • Exophytic growth with numerous small finger-like projections, resulting in a roughened, verrucous, or ‘cauliflower-like’ surface
  • Nearly always a well-circumscribed pedunculated tumor, occasionally sessile
  • Painless; usually white but sometimes pink in color
  • Common intraoral sites include tongue, lips, buccal mucosa, gingiva, and palate, particularly near the uvula
  • Majority are small, measuring a few millimeters in diameter, but can reach several centimeters
  • Occur at any age, including young children

COMMON WART/VERRUCA VULGARIS:

  • Frequent tumor of the skin, analogous to oral papilloma
  • Uncommon on oral mucous membranes but extremely common on the skin
  • Associated viruses include HPV-2, HPV-4, and HPV-40
  • Clinically similar to oral papilloma; contagious and capable of spreading via autoinoculation

Cowden’s Syndrome:

  • Papilloma-like or papillomatous lesions, as well as ‘pebbly’ lesions and fibromas, are recognized as manifestations of this syndrome in the oral cavity

Histopathologic Features :-

  • Consists of many long, thin, finger-like projections extending above the surface of the mucosa
  • Each projection is made up of a continuous layer of stratified squamous epithelium with a central connective tissue core supporting nutrient blood vessels
  • Some papillomas exhibit hyperkeratosis, likely due to location and frictional irritation
  • Essential feature is a proliferation of spinous cells in a papillary pattern; connective tissue is supportive stroma and not neoplastic
  • Occasional papillomas show basilar hyperplasia and mild mitotic activity, often mistaken for mild epithelial dysplasia
  • Koilocytes (HPV-altered epithelial cells with perinuclear clear spaces and nuclear pyknosis) may or may not be found in superficial epithelial layers
  • Presence of chronic inflammatory cells may vary in the connective tissue
Squamous Papilloma Low Magnification
Squamous Papilloma High Magnification
Squamous Papilloma – H & E Diagram

Treatment & Prognosis :-

  • Excision involves removing the tumor, including the base of the mucosa where the pedicle or stalk inserts
  • Proper excision typically results in rare recurrence of the tumor

References :-

  • Shafer’s Textbook Of Oral Pathology
  • Neville – Oral & Maxillofacial Pathology
  • Image – Wikipedia & Wikimedia Commons