A clinical and histopathological investigations on ten cases of the oral papillomatous lesions

Abstract

This paper describes the clinical and histopathological investigation of 10 cases of oral papillomatous lesions. Clinically the majority of cases occurred in older patients. The areas involved were the cheek mucosa, lower gingiva, palatal mucosa, tongue, and floor of the mouth. Tumour size was the most important clinical differention factor. Verrucous carcinomas tended to show a reddish thinge. Bony invasion was principally observed in verrucous carcinomas.
Histopathologically, 6 cases showed epithelial dysplastic changes identified as verrucous carcinoma. Those not showing epithelial dysplastic change included 3 cases of squamous cell papilloma and 1 case of leukoplakia verrucosa. The verrucous carcinomas showed not only epithelial dysplastic changes existing in the basal portion of the epithelium, such as increased number of mitotic figures, loss of polarity of the basal cells, the presence of more than a layer of cells having a basiloid appearance, but keratinization of single cells or cell groups in the prickle layer. Although they were strongly suspected to be carcinomas, their histopathologic findings were not so aggressive. The case of leukoplakia verrucosa was indistinguishable from a squamous cell papilloma associated with a leukoplakia.
Cases suitable for surgical excision showed a good clinical course. Malignant transformation was seen in 4 cases. Simultaneous squamous cell carcinoma at a second oral site was seen in 2 of 3 cases who died. 5 cases were complicated by hypertension which hampered effective surgical treatment.