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Focal Epithelial Hyperplasia

Heck disease

Subject: Patomorphology

Author: Renata Jażdżewska-Baran

Focal epithelial hyperplasia

(Heck's disease)

Heck disease

Focal epithelial hyperplasia - overview

Overview

- also known as Heck’s disease,

- infrequent asymptomatic condition,

- caused by human papilloma virus- HPV infection in the mouth,

- histopathologic assessment and clinical observation are necessary to establish the diagnosis,

- is more common among younger age groups.

Prevalence

- has been reported worldwide,

- particularly common in small native communities (North, Central and South American Indians and Inuit)

- Incidence 30% has been reported among Inuit and children from some communities in Venezuela,

- it’s rare among Caucasian populations.

Clinical features

Clinical features:

The most common sites of involvement include:

  • labial, buccal, and lingual mucosa,
  • gingival, palatal, tonsilar lesions also have been reported.

  • This disease normally manifests as multiple soft, flattened or rounded papules, which are usually clustered and the color of normal mucosa.

  • They may be scattered, pale, or rarely white.

  • The lesions have a tendency to disappear on their own.

Clinical features

Multiple lesions on buccal and labial mucosa.

Pictures source: Ghalayani P,, Tavakoli P,, Eftekhari M,, et al. Oral focal epithelial hyperplasia: Report of three cases/oral fokal epitel hiperplazisi: Üç Olgu Sunumu. Turk J Pathol. 2015;31((1):):60-–63.

Etiology

  • The human papillomavirus (HPV) is associated with proliferations of squamous mucosa.
  • HPV type 13 and 32 has been detected with polymerase chain reaction.
  • HPV 6,11 and 18 have been found as well.
  • Human-to-human transmission of HPV has been assumed to be the most important mode of contact. However, the virus can be transmitted from mother to child.

HPV

Source: Scully C., Scully's Medical Problems in Dentistry, Churchill Livingstone, 2014.

Risk factors

- living conditions (communal lifestyles)

- malnutrition,

- poor hygiene,

- genetic factors

- associated with HIV infection/AIDS.

Diagnosis

  • biopsy from a lesion in the mouth for histopathological examination,

  • diagnosis can be confirmed by the detection of HPV 12 or 32 DNA,
  • following PCR on scraping taken from a lesion, or by in situ hybridization of biopsy specimens.

Histological features

  • epithelium is very thickened and raised above the mucosa,

  • typical „mitosoid” cells - collapsed nucleus that resembles a mitotic figure,

  • squamous epithelium with regional parakeratosis, acanthosis,

  • basal cell hyperplasia, vacuolization of numerous epithelial cells (koilocytosis),

  • occasional binucleation and nuclear irregularity.

1

Acanthosis of the epithelium with broad and elongated rete ridges.

2

Isolated perinuclear cellular vacuolization.

3

Mitosoid cell

Treatment

  • excisions biopsy, CO2 laser,
  • topical imiquimod 5% cream
  • enhancing oral and general hygiene,
  • application of local cryotherapy,
  • application of vitamin A and sulfamides.

Sources:

Sources

1. Scully C., Scully's Medical Problems in Dentistry, Churchill Livingstone, 2014.

2. Ghalayani P,, Tavakoli P,, Eftekhari M,, et al. Oral focal epithelial hyperplasia: Report of three cases/oral fokal epitel hiperplazisi: Üç Olgu Sunumu. Turk J Pathol. 2015;31((1):):60-–63.

4. Durso BC, Pinto JMV, Jorge J Jr, de Almeida OP. Extensive focal epithelial hyperplasia: Case report. J Can Dent Assoc 2005; 71: 769–771.

3. Website: https://dermnetnz.org/topics/focal-epithelial-hyperplasia/

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