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CASE PRESENTATION

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CASE PRESENTATION

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  1. SPECIAL TYPE OF ORAL WART: FOCAL EPITHELIAL HYPERPLASIA (HECK’S DISEASE)TiberiuTebeică*, Sabina Zurac*, Răzvan Andrei*, FloricaStăniceanu*, Virginia Chițu*** Department of Pathology, Colentina University Hospital, Bucharest, Romania** Department of Dermatology, Colentina University Hospital, Bucharest, Romania • Focal epithelial hyperplasia (FEH) is a rare disorder described by Heck primarily as a disease of Native American children and adolescents, being extremely rare among the white population. • The disease is characterized by multiple, soft, circumscribed, sessile, nodular elevations of the oral mucosa. • This lesions may be single or clustered; in extreme cases, the confluent lesions may result in a ”cobblestoned” mucosa. • Convincing evidence assigned the etiologic role to HPV infection of squamous epithelia with subtypes 13 and 32. • There is a tendency toward multiple familial cases, suggesting genetic predisposition.

  2. CASE PRESENTATION Clinical features • 9-year young girl with multiple asymptomatic lesions of oral mucosa • 5-10 mm in diameter • soft rounded or nodular appearance • similar in color to the surrounding mucosa, with no inflammatory appearance • lasting for 7 months Clinical differential diagnosis • multiple squamouspapillomas • condylomataacuminata • neurofibromatosis • acanthosisnigricans • multiple hamartoma of Cowden’s syndrome => shave-biopsy and histological examinationof one lesion

  3. minimal parakeratosis • acanthotic epithelium with prominent clubbing and fusion of epithelial ridges • minimal connective tissue papillae without well-defined projetions of epithelium • special ballooning type of nuclear degeneration in some epithelial cells dispersed in all epithelium levels • typical koilocytic change • no epithelial dysplasia • coarse clumped heterochromatin with pseudomitotic appearance = ”mitosoid bodies”

  4. DISCUSSION • FEH is a benign asymptomatic condition, requiring only reassurance. • Ancillary studies for HPV detection are unnecessary in an appropriate clinical context. • A careful histopathological examination is essential in order to rule out sexually transmitted viral diseases with medico-legal implications, especially in areas with very low prevalence of Heck’s disease. Mitosoid body = the characteristic feature which enable the diagnosis of Focal Epithelial Hyperplasia with certainity.

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