D I F F E R E N T I A L D I A G N O S I S O F H P V- R E L AT E D O R A L L E S I O N S
C a s e S e r i e s
1Masters in Dental Medicine; 2Assistant Lecturer of the Oral Surgery Medicine Clinic; 3Senior Professor, Chairman of the Oral Surgery and Medicine Clinic
Department of Surgery and Oral Medicine, Dental Medicine School, University of Lisbon
JOANA CABRITA
*, DIANA DE MACEDO
1, ANA LOURAÇO
2, FILIPE FREITAS
2, JOÃO CARAMÊS
3I N T R O D U C T I O N A N D O B J E C T I V E
D E S C R I P T I O N O F C L I N I C A L C A S E S
C L I N I C A L I M P L I C A T I O N S A N D C O N C L U S I O N S
R E F E R E N C E S
M a l e p a t i e n t , 5 4 y e a r s o l d . P r e s e n t e d w i t h m u l t i p l e e x o p h y t i c b i l a t e r a l l e s i o n s w i t h 2 0 m m i n t h e r e t r o - c o m m i s s u r a l z o n e s o f t h e
j u g a l m u c o s a .
M a l e p a t i e n t , 3 4 y e a r s o l d , w i t h a h i s t o r y o f a s t h m a a n d d e p r e s s i o n t r e a t e d w i t h e s c i t a l o p r a m .
P r e s e n t e d t h r e e e x o p h y t i c w a r t y l e s i o n s o n t h e l o w e r l a b i a l m u c o s a , g i n g i v a o f t h e r i g h t m a n d i b u l a r r e g i o n a n d a n t e r i o r z o n e o f t h e h a r d p a l a t e .
A n a t o m o p a t h o l o g i c a l e x a m i n a t i o n r e v e a l e d s q u a m o u s p a p i l l o m a w i t h o u t d y s p l a s i a a n d
e x f o l i a t i v e c y t o l o g y o f 3 2 H P V . T h e f i n a l d i a g n o s i s w a s m u l t i f o c a l e p i t h e l i a l h y p e r p l a s i a
S u r g i c a l e x c i s i o n a n d a n a t o m o p a t h o l o g i c a l e x a m i n a t i o n c o n f i r m e d t o b e s q u a m o u s p a p i l l o m a s o f v i r a l o r i g i n a n d H P V s e r o t y p i n g t h a t d e t e c t e d s u b t y p e 7 H P V . T h e p a t i e n t w a s
a d v i s e d t o b e v a c c i n a t e d .
S Q U A M O U S P A P I L L O M A
It is the most common oral papilloma4. It is characterized by a benign proliferation of stratified squamous epithelium. Intraorally its most common sites are tongue, lip mucosa and palate2,3. It is characterized by a soft, painless and
exophytic nodule3. It is induced by subtypes 6 and 112.
M a l e p a t i e n t , 5 0 y e a r s o l d , h o m o s e x u a l a n d c a r r y i n g t h e H u m a n I m m u n o d e f i c i e n c y V i r u s ( H I V ) .
P r e s e n t e d m u l t i p l e p a p u l e s , w i t h d i a m e t e r s b e t w e e n 2 t o 8 m m , i n t h e j u g a l , l a b i a l m u c o s a a n d o r a l f l o o r w i t h e v o l u t i o n o f 1 0 m o n t h s .
A n a t o m o p a t h o l o g i c a l e x a m i n a t i o n r e v e a l e d s q u a m o u s p a p i l l o m a a n d e x f o l i a t i v e c y t o l o g y o f
1 1 a n d 5 8 H P V .
T h e f i n a l d i a g n o s i s w a s m u l t i f o c a l e p i t h e l i a l h y p e r p l a s i a .
F e m a l e p a t i e n t , 6 6 y e a r s o l d , a l l e r g i c t o p e n i c i l l i n , w i t h n o o t h e r r e l e v a n t p e r s o n a l h i s t o r y . P r e s e n t e d v e r r u c o u s e x o p h y t i c l e s i o n s , w i t h a b o u t 2 m o n t h s o f e v o l u t i o n , i n t h e m u c o c u t a n e o u s t r a n s i t i o n n e a r t h e l e f t l a b i a l c o m m i s s u r e .
A n e x c i s i o n a l b i o p s y w a s p e r f o r m e d , w h o s e a n a t o m o p a t h o l o g i c a l e x a m i n a t i o n c o n f i r m e d a
v e r r u c a v u l g a r i s o f v i r a l o r i g i n .
V E R R U C A V U L G A R I S
Focal hyperplasia, benign and induced by subtypes 2 and 4 of HPV2,3,4. It presents as a painless papule or lump of pink color. Usually it does not reach
dimensions larger than 5 mm3. Its most frequent intraoral sites are the lip and anterior region of the tongue2,3.
F e m a l e p a t i e n t , 4 5 y e a r s o l d , h e a l t h y . I n n o n - s u r g i c a l p e r i o d o n t a l t r e a t m e n t , t h e p a t i e n t w a s r e f e r r e d d u e t o a u n i q u e e x o p h y t i c w h i t e l e s i o n w i t h p e d i c l e d b a s e o n t h e r i g h t b o r d e r o f t h e t o n g u e i n t h e p o s t e r i o r t h i r d .
A n e x c i s i o n a l b i o p s y w a s p e r f o r m e d , w h o s e a n a t o m o p a t h o l o g i c a l e x a m i n a t i o n r e v e a l e d f u l l y
e x c i s e d M a l p i g h i a n p a p i l l o m a .
F e m a l e p a t i e n t , 6 6 y e a r s o l d , o n s i m v a s t a t i n , r i s i d o n a n d p r e t e r a x . I t p r e s e n t e d a w h i t e l e s i o n o n p l a q u e i n t h e a d h e r e n t g i n g i v a b y v e s t i b u l a r o f t h e t o o t h 3 6 .
A n a t o m o p a t h o l o g i c a l e x a m i n a t i o n r e v e a l e d s q u a m o u s p a p i l l o m a . W h e n t h e e x c i s i o n a l
b i o p s y w a s p e r f o r m e d , s u b t y p i n g w a s s u g g e s t e d a n d t h e p a t i e n t d i d n o t w a n t t o
p e r f o r m i t .
T h e m o s t p r e v a l e n t b e n i g n o r a l l e s i o n s a s s o c i a t e d w i t h H u m a n P a p i l l o m a V i r u s ( H P V ) i n c l u d e : v e r r u c a v u l g a r i s , s q u a m o u s p a p i l l o m a , c o n d y l o m a a c u m i n a t u m a n d m u l t i f o c a l e p i t h e l i a l h y p e r p l a s i a1. T h e s e l e s i o n s s h a r e s i m i l a r c l i n i c a l a n d h i s t o l o g i c a l c h a r a c t e r i s t i c s a n d i t i s i m p o r t a n t t o r e c o g n i z e t h e m i n o r d e r t o d i s t i n g u i s h f r o m e a c h o t h e r a n d f r o m o t h e r p o t e n t i a l l y m a l i g n a n t a n d m a l i g n a n t l e s i o n s w i t h w h i c h t h e y a r e d i a g n o s e d2. T h e p u r p o s e o f t h i s c o m m u n i c a t i o n i s t o d e m o n s t r a t e , t h r o u g h c l i n i c a l c a s e s , t h e m o s t p r e v a l e n t b e n i g n l e s i o n s a s s o c i a t e d w i t h H P V p r e s e n t i n t h e o r a l c a v i t y .
1. Saulle R, Semyyonov L, Mannoci A, Careri A, Saburri F, Ottolenghi L, Guerra F e La Torre G. (2014). Human papillomavirus and cancerous diseases of the head and neck: a systematic review and meta-analysis. Oral Diseases; 2. Betz S. HPV-Related Papillary Lesions of the Oral Mucosa: A Review. Head and Neck Pathology; 3. Neville B., Damm D., Allen C. e Bouquot J (2009).
Patologia Oral e Maxilofacial. (Trad. 3ªEd.). Elsevier, Rio de Janeiro; Regezi, Sciubba e Jordan (2008). Patologia Oral – Correlações Clinicopatológicas (Trad. 5ª Ed.). Elsevier, Rio de Janeiro
H E C K ’ s D I S E A S E
M U L T I F O C A L E P I T H E L I A L
H Y P E R P L A S I A
It is induced by subtypes 13 and 32 and its most frequent intraoral sites are the oral and labial mucosa and tongue2,4. Characterized by the presence of
numerous nodular masses distributed in different locations. They are pink, discrete and asymptomatic papules4.
C O N D I L O M A A C U M I N A T U M
The lesions occur most frequently in the labial mucosa, soft palate and lingual frenum, presenting as an exophytic, sessile, pink and well-delimited
volume increase3. In general it is painless. Its average size is 1 to 1.5 cm and is induced by subtypes 6,11,16,182.
The knowledge of the pathophysiology of the disease and the careful clinical evaluation of the lesions are fundamental for the institution of the appropriate therapeutic approach. Some HPV subtypes are associated with an increased risk of developing cancer, especially the oropharynx. The Dentist plays an important role in the diagnosis and treatment of oral lesions.
