Benign Epithelial Pathology

Etiology: Human Papilloma Virus 6 and 11

Clinical Features:

› Any age – 30 to 50 years

› On tongue, lips and soft palate

› Soft , painless, pedunculated, exophytic

nodule with projections

› Cauliflower or wartlike appearance

Histopathologic Features:

› Proliferation of keratinised stratified

squamous epithelium

› Fibrovascular tissue cores

Squamous

papilloma on

lateral border of

tongue

Koilocytes – virus altered epithelial cellls

with pyknotic nuclei

Treatment : Conservative surgical

excision

Known as common wart

Etiology : HPV 2,4,6 and 40

Clinical Features:

› Contagious

› Commmon in children and on skin

› Painless nodule with papillary projections

› Rough pebbly surface

› Extreme accumulation lead to keratin horn


› Hyperkeratotic stratified squamous

epithelium in finger like projections

› Koilocytes are present in epithelium

Treatment:

› Liquid nitrogen cryotherapy

› Surgical excision or curettage

› Laser

› Keratinolytic agents – salicylic acid

Known as self healing carcinoma

Etiology:

› Trauma

› Sunlight

› HPV 9,11,13,16,18,24,33,37,57

› Immunocompromised state

Clinical Features:

› More in men

› On sun exposed area of face- vermillion

border of lips

› Dome shaped nodules with keratin plug

projecting like a horn

› Painful


› Hyperplastic squamous proliferation

› Dyskeratosis

› Epithelium at the base proliferate

downwards

› Produces chronic inflammatory response

Treatment :

› Surgical excision

Known as snuff dipper’s lesion

Etiology:

› Chewing or holding finely ground tobacco

leaves in vestibule

Clinical Features:

› Painless loss of gingival and periodontium in

area of contact

› Destruction of alveolar bone

› Brown-black stains

Wear of incisal and occlusal surfaces

Thin gray or gray-white plaque

Velvety feel of mucosa

Stretched mucosa appears fissured


› Intracellular vacuolization of superficial cells

› Parakeratin chevrons as pointed projections

› Hyperkeratosis and acanthosis

Treatment:

› Cessation of habit leads to normal mucosa

appearance

› Takes 2 to 6 weeks to regress

Known as farmer’s lip and sailor’s lip

Etiology:

› Long term exposure to UV light

› Light skinned people

Clinical Features:

› Males more

› Lower lip vermillion

› Smooth surface and blotchy pale areas

Progress to rough scaly areas

Chronic focal ulceration at places of

trauma


› Atrophic stratified squamous epithelium

› Connective tissue shows band of

amorphous, acellular basophilic change

(solar elastosis)

Treatment :

› Use lip balms with

sunscreen

› Vermillionectomy

› CO2 laser ablation

› Electrodessication

Known as Heck’s disease

Etiology :

› HPV 13 and 32

Clinical Features:

› Primarily in children

› Papillary lesion

› Smooth surfaced flat topped lesion

› Well demarcated

Cluster to form cobblestone

appearance or fissured appearance


› Focal acanthosis

› Epithelial show koilocytic change

› Cells with collapsed nuclei – mitosoid cells

› Lack of connective tissue cores in surface

projections

Treatment :

› Excision

Known as smoker’s palate

Etiology:

› Cigar and pipe smoking

› Reverse smoking

Clinical Features:

› More in men

› Palatal mucosa – diffusely gray or white

› Elevated papules with punctate red centers

Fissured or dried mud appearance

Brown or black stain on teeth


› Hyperkeratosis and acanthosis

› Inflammation of connective tissue

› Metaplasia of excretory ducts

Treatment :

› Smoking cessation

leads to regression

WHO - “a white patch or plaque that

cannot be characterised clinically or

pathologically as any other disease”

Premalignant lesion – benign

morphologically altered tissue that has a

greater than normal risk of malignant

transformation

Etiology:› Tobacco smoking

› Alcohol consumption

› UV radiation

› Sanguinaria – toothpaste containing herbal extract

› Microorganism - treponema pallidum

› Trauma

Clinical features:› Older people - 40 years

› On lip vermillion , buccal mucosa, gingiva , tongue

Slightly elevated gray or gray white

plaques

Plaques are fissured, wrinkled and

sharply demarcated

Maybe be intermixed red-and-white

lesion-erythroplakia


› Thickened surface keratin layer or thickened

spinous layer which masks redness of

underlying connective tissue

› Hyperkeratosis with acanthosis

› Dysplastic features

Treatment:

› Surgical excision

› Electrocautery

› Cryosurgery

› Laser ablation

› Cessation of smoking

› Retinoids

It is a red patch that cannot be clinically

or pathologically diagnosed as any

other condition

Clinical Features:

› Well demarcated

erythematous macule

or papule

› Soft velvety texture


› Epithelial dysplasia

› Epithelium show lack of keratin production

› Atrophic epithelium

› Thus red color

Treatment:

› Irritation source removed

› Biopsy to confirm diagnosis

Education

Benign Epithelial Pathology