PAIDEIA XXI
Vol. 9, Nº 2, Lima, julio-diciembre 2019, pp. 199-207
ISSN Versión Impresa: 2221-7770; ISSN Versión Electrónica: 2519-5700
ORIGINAL ARTICLE / ARTÍCULO ORIGINAL
MULTIPLE ORAL VULGAR WARTS: REPORT OF A
CLINICAL CASE
VERRUGAS VULGARES BUCALES MÚLTIPLES:
REPORTE DE UN CASO CLÍNICO
ABSTRACT
doi:10.31381/paideia.v9i2.2752
Thaináh Bruna Santos-Zambrano
1*
; Nataly Barreiro-Mendoza
1
; Noelia Alarcón-Barcia
1
;
Mirian Verónica Ramos-León
1
; Edison Junior Rodríguez-Álava
1
& Rigoberto Fimia-Duarte
2
1* Universidad San Gregorio de Portoviejo, Ecuador. E-mail: thainahbruna@gmail.com /
gnbarreiro@sangregorio.edu.ec / noeliaab91@hotmail.com/ mvramos@sangregorio.edu.ec
/ e.ejrodriguez@sangregorio.edu.ec
2 Facultad de Tecnología de la Salud y Enfermería. Universidad de Ciencias Médicas de Villa
Clara, Cuba. https://orcid: 0000-0001-5237-0810. E-mail: rigoberto.mia66@gmail.com
Author for correspondence: thainahbruna@gmail.com
The human papilloma virus constitutes a heterogeneous viral group capable
of producing hyperplastic, papillomatous and verrucous lesions in both skin
and mucosa, and in recent years it has been shown to play an important
role in carcinogenesis. Some authors have shown that high-risk HPV infection
may be a cofactor in oral carcinogenesis, although the presence of human
papillomavirus would not be sufcient to cause malignant transgression, it
probably requires additional genetic changes for progression to a neoplastic
stage. The incidence and prevalence of the infection are increasingly high,
hence the need to highlight the importance of making an early diagnosis of
benign lesions in the mouth which would allow adequate preventive treatment
of the lesion, preventing its transformation and progression to a premalignant
and/or malignant lesion. The aim of this work is to report a clinical case
of a female patient, forty-eight years old, who appeared at the Department
of Pathology in Saint Gregory University of Portoviejo presenting verrucous
growths on the upper lip. Considering the clinical characteristics of the lesion,
our diagnostic hypothesis was lesions by the Human Papilloma Virus, and
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the histopathological evaluation conrmed the
diagnostic hypothesis of a
squamous papilloma.
Key words: Oral mucosa – Verruca Vulgaris – Virus – HPV
El virus del papiloma humano constituye un grupo viral heterogéneo capaz
de producir lesiones hiperplásicas, papilomatosas y verrugosas en la piel y la
mucosa, y en los últimos años, se ha demostrado que juega un papel importante
en la carcinogénesis. Algunos autores han demostrado que la infección por
VPH de alto riesgo puede ser un cofactor en la carcinogénesis oral, aunque
la presencia del virus del papiloma humano no sería suciente para causar
transgresión maligna, probablemente requiera cambios genéticos adicionales
para la progresión a una etapa neoplásica. La incidencia y prevalencia de la
infección son cada vez más altas, de ahí la necesidad de resaltar la importancia
de hacer un diagnóstico precoz de lesiones benignas en la boca, lo que permitiría
un tratamiento preventivo adecuado de la lesión, evitando su transformación y
progresión a premalignas o lesión maligna. El objetivo de este trabajo es informar
un caso clínico de una paciente de cuarenta y ocho años que apareció en el
Departamento de Patología de la Universidad de Saint Gregory de Portoviejo
y que presenta crecimientos verrugosos en el labio superior. Considerando
las características clínicas de la lesión, nuestra hipótesis diagnóstica fue: las
lesiones por el virus del papiloma humano y la evaluación histopatológica
conrmaron la hipótesis diagnóstica de un papiloma escamoso.
Palabras clave: Mucosa bucal – Verruga Vulgar – Virus – VPH
RESUMEN
INTRODUCTION
Oral squamous papilloma (OSP) is
a benign proliferation of the stratied
squamous epithelium that results in
a papillary or verrucous exophytic
tumor, induced by the human
papillomavirus (HPV). The human
papillomavirus (HPV) is a virus from
the Papillomaviridae family. Almost all
infections occur transiently because
they are controlled by the body’s
immune response; only between 10
and 20% become chronic or persistent
and have greater oncogenic potential
(WHO, 2006; Ontañón et al., 2019).
This infectious agent can infect
the buccal, laryngeal and cervical
mucosa, as well as the genitals. HPV
is the most widespread sexually
transmitted disease in the United
States. Its prevalence varies between
14 and 90%, being more frequent in
women. There are approximately 150
different types of HPV that have been
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identied; however, 24 are associated
with oral lesions, of which types 16
and 18 have been associated in 85%
of cases with invasive squamous cell
carcinomas, dysplasias or carcinomas
in situ; while types 6, 11, 13 and 32
have been associated with benign
lesions (Soares et al., 2019).
The route of transmission of HPV
is diverse; it can occur in the perinatal
route, due to transplacental infection,
amniotic uid, blood, sexual contact,
autoinoculation, and some authors
suggest a possible transmission by
saliva. Some authors have shown
that high-risk HPV infection can be
a cofactor in oral carcinogenesis and
that the latent infection by the virus is
common. The presence of the human
papillomavirus would not be enough
to cause the malignant transgression,
probably being necessary additional
genetic changes for the progression
to a neoplastic stage (Jiménez et al.,
2001; Luckett & Feldman, 2016).
The oral cavity diagnosis of HPV
lesions is based on the clinical
characteristics of the lesion, such
as white or purple lesion depending
on the degree of keratinization of the
mucosa, rough surface, pronounced
and irregular edges, sessile or
pediculated, unique or multiple
and generally asymptomatic. The
clinical characteristics of most oral
papillomas are that they are small
and do not exceed one cm, although
sometimes larger lesions can reach 3
cm in size (Jiménez, 2002). They can
appear at any age between the third
and fth decade of life and can appear
anywhere in the oral cavity, being
the most frequent site of localization
the inner side of the lip, hard and
soft palate, uvula and lateral border
of the tongue. Lesions produced
by these viruses can be classied
into two large groups: benign
lesions (buccal papilloma, vulgar
wart, condyloma acuminatum and
multifocal epithelial hyperplasia) and
potentially cancerous or malignant
lesions (idiopathic leukoplakia and
squamous cell carcinoma) (WHO,
2006; Arreaga, 2014; Palacios-
Saucedo et al., 2019). The aim of this
work is to report a clinical case of a
female patient, forty-eight years old,
who appeared at the Department of
Pathology in Sanit Gregory University
of Portoviejo, Ecuador presenting
verrucous growths on the upper lip.
MATERIAL AN METHODS
We report the clinical case of a
female patient, forty-eight years old,
who appeared at the Department of
Pathology in Saint Gregory University
of Portoviejo due to a warty growth in
the upper lip (Figure 1). In the clinical
examination fragments of soft,
rough, irregular tissues that measure
between 0.2 to 0.3 cm, of a whitish
color, are observed.
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Figure 1. Clinical examination of labial mucosa.
Verrucous growth is observed.
Ethic aspects
The case study was presented and
approved by the institutional ethics
committee of the San Gregorio University
in Portoviejo, Ecuador. In addition,
the term consent was presented to the
patient informed.
RESULTS
The treatment was performed by
means of an excisional biopsy of the lesion
due to its size, in ltrative anesthesia was
placed around the lesion in 4 cardinal
points, (above, below, right and left,
Figure 2). The amount of anesthesia was
0.8ml to avoid edematizing activity of the
sample and thus be able to have accurate
limits of the injury.
Figure 2. In ltrative anesthesia
around the lesion.
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With scalpel n ° 12 a straight
incision was made on the tissue
(Figure 3). An additional cone-shaped
incision was made towards the depth
of the tissue to entirely remove the
affected gland (Figure 4). It was then
placed in a vial with 10% formalin
for histopathological study. Then
we proceeded to suture (silk thread
4-zeros) placing four points (Figure 5).
The corresponding pharmacotherapy
consisted of Betasun tablets of 25mg
every 12 h for 5 days and amoxicillin
tablets of 500mg every 8 h for 7 days.
Post-surgery indications included
a diet with nonirritating foods and
daily oral hygiene complemented with
mouth rinses.
Figure 3. Surgical Procedure.
Figure 4. Surgical Procedure
removal of verrucous tissue.
After 7 days, regression of the lesion
was veri ed and the suture thread was
removed. (Figures 5 and 6).
Figure 5. Suture.
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Figure 6. Regression of the lesion was veri ed 7 days after
surgical procedure.
DISCUSSION
Based on the results of the
microscopic study, it shows nodular
acanthosis with hyper and focal
parakeratosis, with hypergranulosis.
Keratinocytes in the basal stratum
show mild hyperplasia with slight
loss of polarity. The dermis has mild
congestion with dilated capillaries
with surgical edges and no histological
changes. With histopathological
evaluation, Squamous Papilloma was
con rmed. Squamous papilloma,
although more prevalent in women,
can occur in any gender and at any
age of the reproductive stage (Dos
Reis et al., 2009; Díaz et al., 2014).
The lesions of squamous papilloma,
according to the literature, have no
gender predilection, being observed
in the same prevalence for men and
women (Castro et al., 2004; Neville et
al., 2004; Esquenazi et al., 2010). In
the case reported, we found the lesion
in a 40-year-old patient. The age range
is consistent with that reported by the
authors indicating the appearance of
lesions in an age range that varies
from 30 to 50 years (Neville et al.,
2004; Cavalcanti & Carestiano, 2006;
Fakhry et al., 2019).
Some authors believe that
squamous papilloma lesions in the
oral mucosa are more frequent in the
dorsum of the tongue and, in the vast
majority of cases, are asymptomatic. In
the case reported, the lesion appeared
in soft, rough, and irregular whitish
tissues (Batista et al., 1996; Leite et
al., 2008; Esquenazi et al., 2010).
HPV is the causative agent of
cervical cancer and appears to be
involved in the etiology of oral cavity
cancer, which indicates the execution
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of studies on non-cancerous lesions,
but there is little evidence of molecular
tests performed on non-cancerous
lesions in the that its etiological factor
is the human papillomavirus, and
evidence is growing that indicates that
genotypes of high-risk squamous cell
carcinoma of this virus are detected,
which suggests that lesions that are
not cancerous and that are caused by
HPV can develop malignant lesions,
likewise in the present clinical case
(Pardo et al., 2018).
The dentist surgeon must have a
thorough clinical observation and a
careful history to favor the diagnosis,
treatment, guidance, and clarication
to the patient about the risks and
prophylactic measures that should be
taken for HPV infections and possible
related diseases (Medina et al., 2010;
Martínez-Martínez et al., 2018).
Considering the clinical
characteristics of the lesion, based
on the results of the histopathological
evaluation, this case study has
as conclusion the diagnosis of a
Squamous Papilloma associated with
the Human Papilloma Virus. Hence
the importance of an early diagnosis
based on clinical, histopathological
characteristics and ideally in the
immunohistochemically study.
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Received November 3, 2019.
Accepted December 20, 2019.
