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Tian X, Li Z, Dan H, Zeng X, Chen Q, Wang J. Photodynamic therapy in focal epithelial hyperplasia. Photodiagnosis Photodyn Ther 2023; 44:103757. [PMID: 37604219 DOI: 10.1016/j.pdpdt.2023.103757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
Focal epithelial hyperplasia (FEH) is an uncommon benign disorder affecting the oral mucosa. It is primarily associated with human papillomavirus (HPV) infection and presents as multiple white or pink soft papules or nodules. Typically, FEH is asymptomatic. Conventional treatment approaches for FEH include topical medication, surgical excision, CO2 laser ablation, cryotherapy, etc., but their efficacy varies. Photodynamic therapy (PDT) is a non-invasive and selective photochemotherapy method widely utilized in clinical practice. By employing specific light wavelengths to activate photosensitizers and induce the generation of reactive oxygen, PDT exerts cytotoxic effects. However, the application of PDT in treating FEH has not been previously documented. In this study, we present a case demonstrating the complete remission of FEH lesions using PDT, with no recurrence observed over a period of 9 months. This compelling outcome suggests that PDT may be a preferred treatment modality for FEH.
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Affiliation(s)
- Xin Tian
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan 610041, China
| | - Zhenglei Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan 610041, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan 610041, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan 610041, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan 610041, China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan 610041, China.
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Santana-Gutierrez A, Pérez-Garza DM, Ocampo-Candiani J, Alba-Rojas E. Intralesional immunotherapy with MMR vaccine in a paediatric case of focal epithelial hyperplasia. Australas J Dermatol 2023; 64:e290-e291. [PMID: 37228245 DOI: 10.1111/ajd.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Adalberto Santana-Gutierrez
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Daniela Michelle Pérez-Garza
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Erika Alba-Rojas
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Arbelo-Ramos N, Anderson K, Joshi A, Wieland C, Tyring S, Rady P, Tollefson M. Heck's disease occurring after Epstein-Barr virus-associated smooth muscle tumors in an immunosuppressed child. Pediatr Dermatol 2021; 38:257-259. [PMID: 33275301 DOI: 10.1111/pde.14463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
A 10-year-old Guatemalan girl with past medical history of Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) and combined immunodeficiency presented for evaluation of painful intraoral lesions. On examination, she was noted to have multiple, white to flesh-colored, soft, flat-topped papules, and plaques on the buccal and labial mucosa. Human papillomavirus type 13 was detected on PCR with PGMY primers of previously biopsied buccal tissue, confirming a diagnosis of Heck's disease (multifocal epithelial hyperplasia). We present an immunosuppressed, pediatric patient with two rare, virus-associated neoplastic disorders that have not been previously reported to occur in the same individual.
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Affiliation(s)
- Natasha Arbelo-Ramos
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Avni Joshi
- Department of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephen Tyring
- Department of Dermatology, University of Texas Health Science Center, Houston, TX, USA
| | - Peter Rady
- Department of Dermatology, University of Texas Health Science Center, Houston, TX, USA
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Chompunud Na Ayudhya C, Alawi F, Akintoye SO. Unusual oral multifocal epithelial hyperplasia in an adult African-American lung transplant patient. Transpl Infect Dis 2020; 23:e13497. [PMID: 33095955 DOI: 10.1111/tid.13497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 01/10/2023]
Abstract
Oral multifocal epithelial hyperplasia (MEH), or Heck's disease, is a rare benign proliferation of the oral mucosa associated with human papillomavirus (HPV). It clinically presents as multiple asymptomatic papules and nodules that mostly affect the lips, buccal mucosa, and tongue. MEH is predominantly found in children and young adults while relatively few cases have been reported in the elderly population. Here, we report a case of oral MEH in a 65-year-old man with history of lung transplantation. This case highlights the potential susceptibility of organ transplant recipients to the development of MEH. Since MEH that does not require treatment unless the lesion bothers the patient, clinicians should promptly establish a definitive diagnosis to rule out other HPV-related precancerous lesions.
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Affiliation(s)
- Chalatip Chompunud Na Ayudhya
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.,Department of Basic and Translational Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Faizan Alawi
- Department of Basic and Translational Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Sunday O Akintoye
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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Conde-Ferráez L, Ek-Hernández GE, Canché-Pech JR, Gómez-Carballo JG, Kantún-Moreno NE, González-Losa MDR. Genomic characterization of human papillomavirus type 13, associated to multifocal epithelial hyperplasia, in a Mayan community. Infect Genet Evol 2020; 91:104595. [PMID: 33096300 DOI: 10.1016/j.meegid.2020.104595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
Human papillomavirus type 13 (HPV13) is a low-risk HPV type associated with Multifocal Epithelial Hyperplasia (MEH). It is considered a rare pathology of oral mucosa, more prevalent in certain ethnical groups, such as the Maya from Yucatan in Mexico. As for 2020 only two complete genomes of HPV13 are publicly available in Genbank database (one from Turkey one from the Amazonian). We aimed to obtain the complete genome sequence of HPV13 associated to MEH, obtained from a community in the Mayan area from Mexico. A bank of oral swabs from children with MEH were used. To enrich the sample, a Rolling Cycle Amplification (RCA) method was performed followed by overlapping end-point PCR of 500 bp fragments, Sanger sequencing and assembly. Eight open reading frames (ORFs) were annotated (E1, E2, E4, E5, E6, E7, L1 and L2 genes). When compared with the other two previously reported genomes the identity at nucleotide level is high 98.9% and 99.6%, respectively. The phylogenetic tree shows that Yucatan HPV13 is more closely related to HPV13 obtained from the Amazonian. Most changes identified at amino acid level are substitutions derived from nucleotide variations or SNPs in coding regions. Amino-acid changes were observed in E2 and E1 proteins (n ≥ 8), and in L1, L2, E6 and E5 proteins (n ≤ 5). E7 protein from Yucatan has 100% identity with the reported from Amazonian and differs (94.1% identity) with the one from Turkey due to 3 substitutions and three missing amino acids. In conclusion, the genome from HPV13 (7831 bp, 49 nt missing) associated to MEH in the Mayan area from Yucatan was obtained from stored swabs; this is the first effort in Mexico, the second in Latin America, and the third of the world. More research that contributes to the knowledge of the determinants underlying this neglected pathology are urged.
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Affiliation(s)
- Laura Conde-Ferráez
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales, Dr. Hideyo Noguchi, Laboratorio de Virología, Calle 43 No. 613 x calle 90, Col. Inalámbrica, CP. 97069, Mérida, Yucatán, Mexico.
| | - Gemaly Elisama Ek-Hernández
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales, Dr. Hideyo Noguchi, Laboratorio de Virología, Calle 43 No. 613 x calle 90, Col. Inalámbrica, CP. 97069, Mérida, Yucatán, Mexico.
| | - José Reyes Canché-Pech
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales, Dr. Hideyo Noguchi, Laboratorio de Virología, Calle 43 No. 613 x calle 90, Col. Inalámbrica, CP. 97069, Mérida, Yucatán, Mexico
| | - Jesús Gilberto Gómez-Carballo
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales, Dr. Hideyo Noguchi, Laboratorio de Virología, Calle 43 No. 613 x calle 90, Col. Inalámbrica, CP. 97069, Mérida, Yucatán, Mexico.
| | - Nuvia Eugenia Kantún-Moreno
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales, Dr. Hideyo Noguchi, Laboratorio de Virología, Calle 43 No. 613 x calle 90, Col. Inalámbrica, CP. 97069, Mérida, Yucatán, Mexico.
| | - María Del Refugio González-Losa
- Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales, Dr. Hideyo Noguchi, Laboratorio de Virología, Calle 43 No. 613 x calle 90, Col. Inalámbrica, CP. 97069, Mérida, Yucatán, Mexico.
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Jiménez Aguilar SM, Rodríguez DL, Muñoz Estrada VF, Cázarez Salazar SG, Velarde Félix JS, Méndez Martínez RS. Great diversity of oncogenic human papillomaviruses is revealed in an outbreak of multifocal epithelial hyperplasia. J Am Acad Dermatol 2019:S0190-9622(19)33318-3. [PMID: 31881297 DOI: 10.1016/j.jaad.2019.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 11/20/2022]
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Patil K, Guledgud MV, Sanjay CJ, Penumatsa B. Oral Multifocal Epithelial Hyperplasia: An Unusual Entity. Int J Appl Basic Med Res 2019; 9:253-255. [PMID: 31681555 PMCID: PMC6822326 DOI: 10.4103/ijabmr.ijabmr_252_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 03/30/2019] [Accepted: 08/17/2019] [Indexed: 11/09/2022] Open
Abstract
Multifocal epithelial hyperplasia (Heck's disease) is a rare, contagious, asymptomatic, and benign disease affecting the oral mucosa. It is usually seen in childhood and adolescence and is noted only in specific groups in certain geographical regions. The lesion is clinically characterized by the presence of multiple small papules or nodules in the oral cavity, especially on the labial mucosa, buccal mucosa, and tongue. Histopathology is necessary to confirm the diagnosis. Treatment remains unspecific, although surgical excision, CO2 laser therapy, and topical antivirals are in use. We present a clinical case of a 65-year-old Indian male with multiple oral lesions that clinically and histologically resemble Heck's disease.
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Affiliation(s)
- Karthikeya Patil
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Mahima V Guledgud
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - C J Sanjay
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Bharathi Penumatsa
- Department of Oral Medicine and Radiology, Care Dental College and Hospital, Guntur, Andhra Pradesh, India
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Schwartz Z, Magro C, Nuovo G. The molecular-based differentiation of Heck's disease from its mimics including oral condyloma and white sponge nevus. Ann Diagn Pathol 2019; 43:151402. [PMID: 31473371 DOI: 10.1016/j.anndiagpath.2019.151402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
Heck's disease (focal or multifocal epithelial hyperplasia) is a benign, rare condition of the skin and mucous membranes induced by human papillomavirus (HPV) infection. Other entities that can induce large papillomatous lesions that involve the mucous membranes and skin include condyloma acuminatum, which is sexually transmitted, and white sponge nevus, often due to a mutation of cytokeratin 4 or 13. Six cases diagnosed as either Heck's disease (n = 2) or white sponge nevus (n = 4) and 6 oral condyloma were compared on histologic grounds and analyzed in situ for HPV DNA, including HPVs 6,11, and 13, as well as cytokeratins 4 and 13. Each case showed marked acanthosis, and para/hyperkeratosis. More variable histologic findings included rete ridge elongation, keratinocyte degeneration, and perinuclear halos. High copy HPV 13 DNA was evident in the squamous cells towards the surface in the two cases diagnosed as Heck's disease and in two cases diagnosed as white sponge nevus on clinical grounds. HPV 6/11 was found in each of the six condyloma. Marked decrease in either cytokeratin 4 or 13 was evident in the two cases diagnosed as white sponge nevus that were HPV DNA negative. It is concluded that in situ hybridization analyses including HPVs 6, 11, and 13 as well as immunohistochemistry for cytokeratins 4 and 13 can differentiate Heck's disease from condyloma and white sponge nevus, which can be difficult to differentiate on clinical and histologic grounds.
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Affiliation(s)
- Ziv Schwartz
- Weill Cornell Medicine, New York, NY, United States of America
| | - Cynthia Magro
- Weill Cornell Medicine, New York, NY, United States of America
| | - Gerard Nuovo
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America; Discovery Life Sciences, Powell, OH, United States of America.
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Abstract
Heck's disease or focal epithelial hyperplasia is a rare, benign and asymptomatic lesion of oral mucosa that is characterized by the presence of soft, sessile papules, white to pinkish in colour that occur diffusely in oral cavity. Prevalence rate of this disease greatly varies from one geographic region to another. It is found to be closely associated with human papilloma virus (HPV). This paper reports an Indian case of focal epithelial hyperplasia in a 5-year-old boy that is diagnosed according to both clinical and histopathological features, where human poillomavirus (HPV) subtype 32 was found associated with disease through polymerase chain reaction analyses. A dental practitioner should be aware of this disease and must perform a careful evaluation both clinically and histopathologically for setting the diagnosis with other diseases.
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Affiliation(s)
- Srinivas Nallanchakrava
- Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Naga Sreebala
- Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Basavaraj
- Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Farheena Sindgi
- Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
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