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Questions and Answers
What is the family of viruses to which HPV belongs?
What is the tropism of HPV?
What percentage of normal, healthy individuals have oral HPV infection?
What is the result of integrated HPV DNA in malignancies and high-grade premalignant lesions?
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Which HPV vaccine targets types 6, 11, 16, and 18?
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What is the result of HPV infection in normal-appearing skin or mucosa?
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What is the characteristic of squamous papilloma?
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How many HPV types are known to infect the oral mucosa?
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What is the virulence and infectivity rate of HPV types 6 and 11?
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What is the most common location for the soft tissue mass arising from the soft palate?
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What is the typical shape of the projections on the surface of the lesion?
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What is the color of the lesion depending on the amount of surface keratinization?
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What is the characteristic of the base of the pedunculated lesion?
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What is the typical arrangement of the keratinized stratified squamous epithelium in the lesion?
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What is the characteristic of the nuclei in koilocytes?
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What is the treatment for the lesion?
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Study Notes
Benign HPV-related Lesions
- Human papillomavirus (HPV) is a double-stranded DNA virus that infects skin or mucosa, exhibiting tropism for squamous epithelium.
- There are over 130 HPV types, with more than 30 types known to infect the oral mucosa.
- Most infected individuals are asymptomatic and lack clinically evident disease.
Low-Risk HPV Types
- HPV types 6, 11, 13, 32, 40, 42, 43, 44, 54, 55, 61, 62, 64, 67, 69, 70, 71, 72, and 81 are considered low-risk.
High-Risk HPV Types
- HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 73 are associated with malignant transformation.
HPV Vaccines
- Quadrivalent vaccine (Gardasil) targets HPV types 6, 11, 16, and 18.
- Bivalent vaccine (Cervarix) targets HPV types 16 and 18.
Oral HPV Infection
- Oral HPV infection is present in approximately 5% to 12% of normal, healthy individuals.
Pathogenesis of HPV
- In normal-appearing skin or mucosa, the virus may remain in a latent state within the nuclei of basal epithelial cells in low numbers.
- In lesional epithelium, the virus is present in increased copy numbers within various epithelial cell layers.
Squamous Papilloma
- Squamous papilloma is a benign papillary or verruciform mass resulting from HPV-induced proliferation of stratified squamous epithelium.
- HPV types 6 and 11 are associated with low virulence and infectivity rate, accounting for 3% of all oral lesions.
- Clinical features include:
- Soft, painless, usually pedunculated, exophytic nodule with numerous fingerlike surface projections.
- White, slightly red, or normal in color, depending on the amount of surface keratinization.
- Typically solitary, with a maximum size of about 0.5 cm, with little or no change thereafter.
- Histopathologic features include:
- Proliferation of keratinized stratified squamous epithelium arranged in fingerlike projections with fibrovascular connective tissue cores.
- Keratin layer is thickened in lesions with a white clinical appearance, and the epithelium typically exhibits a normal maturation pattern.
- Treatment and prognosis:
- Conservative surgical excision is recommended.
- No reported malignant transformation, continuous enlargement, or dissemination to other parts of the oral cavity.
Verruca Vulgaris (Common Wart)
- Verruca Vulgaris is a focal, benign, HPV-induced hyperplasia of stratified squamous epithelium.
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Description
This lecture covers benign HPV-related lesions, including squamous papilloma, verruca vulgaris, and condyloma acuminatum, as well as other epithelial pathology topics
