Cases reported • Palatal Neoplasms

11/19. A squamous cell papilloma as a cause of dysphagia and vomiting.

Squamous cell papillomas occur relatively commonly intra-orally. patients are usually unaware of their presence. A case is described of a squamous cell papilloma arising from the uvula, which presented as an unusual cause of dysphagia and vomiting.

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12/19. Inverted papilloma--a modified surgical approach to reconstruction of the palate.

A case of inverted papilloma (Ringertz tumour), which presented as a palatal swelling, is reported. The tumour involved the antral and nasoethmoidal complex. An approach to reconstruction of the palate after removal of the tumour is described.

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13/19. Massive oropharyngeal papillomatosis causing obstructive sleep apnea in a child.

Obstructive sleep apnea in children is most often secondary to severe adenotonsillar hypertrophy. A 5 1/2-year-old boy presented with loud snoring, increasing dysphagia, nocturnal choking, and apnea. Extensive papillomatosis of the uvula, soft palate, and nasopharynx was found to be causing the obstruction. Although multiple papillomas of the larynx and tracheobronchial tree are well known, the occurrence of extensive papillomas of the oral cavity is rare. The unusual clinical presentation and pathologic significance are discussed.

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14/19. Flattened papillary mass on the posterior hard palate.

An unusually large, asymptomatic, exophytic mass of the palate with a papillary surface architecture--characteristic of an oral squamous papilloma--has been presented. The cause of the squamous papilloma is unknown. Surgical excision, with microscopic examination of removed tissue, is the preferred treatment. recurrence or malignant change, or both, are unusual.

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15/19. The utilization of the carbon dioxide laser in the treatment of recurrent papillomatosis: report of case.

The carbon dioxide laser is a relatively new mode of therapy in the treatment of oral lesions. In our experience, when the laser has been used, bleeding, scarring, and edema have been minimal. With the development of hand-held instrumentation, this useful tool can be added to the oral surgeon's armamentarium.

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16/19. Intraoral papillary squamous cell tumor of the soft palate with features of sialadenoma papilliferum-? malignant sialadenoma papilliferum.

An unusual, recurring, squamous papillary tumor involving and possibly arising from minor salivary gland excretory ducts in the palate is presented. Similarity to sialadenoma papilliferum and upper respiratory tract papillomatosis is noted. A paraglandular cystic mass with some resemblance to the palatal lesion, and a solitary lymph node with papillary squamous epithelial deposits was found in a radical neck dissection. We suggest that the lymph node lesion represents a metastasis which may have arisen from the palatal lesion, and therefore propose the concept of a possible malignant analogue of sialadenoma papilliferum.

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17/19. Oral florid papillomatosis.

A case of oral florid papillomatosis involving the superior and inferior alveolar ridges, the palate and the tongue in a young woman is presented. Histological examination showed papillary hyperplasia with marked acanthosis. The basement membrane remained intact. The patient was treated with a combination of recombinant-alpha 2a interferon and carbon dioxide laser surgery.

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18/19. Low malignant intraductal carcinoma on the hard palate: a variant of salivary duct carcinoma?

A rare, minor salivary gland tumour of the hard palate in a middle-aged woman was presented. The small (1.0 X 0.5 cm in diameter) hemispherical tumour was well circumscribed with a fine papillomatous surface. Histopathologically, tumour cells with eosinophilic cytoplasm and a large nucleus were single-strand cuboidal and columnar cells, which showed intraductal growth exhibiting a cribriform pattern. The histological features were distinct from adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma because the tumour lacked the neurotropic infiltration, cord-like proliferation and targetoid arrangement. The tumour could not be identified as a typical salivary-duct carcinoma because Roman bridging, papillary projection, and severe cell atypia were not found. Tumour cells were negative for PAS, alcian blue, mucicarmine, p53, c-erbB-2, CEA, S-100 protein, alpha-smooth muscle actin, lactoferrin or vimentin. About 5% of the tumour cells were positive for proliferating cell nuclear antigen. Taking these factors into account, together with the clinical features, the name low malignant intraductal carcinoma seems appropriate.

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19/19. Atypical palatal papillomatosis treated by excision and full-thickness grafting.

Papillary lesions of the oral cavity are extremely common, and inflammatory palatal hyperplasia is well known to dental practitioners. Advanced sophistication in viral laboratory technologies makes it apparent that various forms of the human papilloma virus are often causative. However, this is not true for inflammatory palatal hyperplasia. This article describes a patient with anatomically well-demarcated, multiple squamous cell papillomas of the palate that could not be classified as inflammatory palatal hyperplasia, nor could a viral etiology be ascertained, despite exhaustive laboratory studies. The lesion recurred despite numerous surgical ablation attempts. Eradication was achieved only after applying free soft-tissue grafts over the areas of excision. The differential diagnosis of papillary lesions with an emphasis on viral etiology, laboratory studies associated with their identification, and a hypothesis that explains why grafting was the only successful means of treatment are also discussed.

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