Multifocal Epithelial Hyperplasia of Oral Cavity Expressing HPV 16 Gene: A Rare Entity

Focal epithelial hyperplasia is a rare contagious disease caused by human papilloma virus. Usually HPV involves either cutaneous or mucosal surfaces, whereas concomitant mucocutaneous involvement is extremely rare. We report such a unique case of multifocal epithelial hyperplasia involving multiple sites of oral cavity along with skin lesions in a 65-year-old female. We also discuss the probable multifactorial etiology and variable clinical presentations of the lesions, including evidence of HPV 16 expression, as detected by polymerase chain reaction. The present report illustrates the need for careful examination and prompt diagnosis of the disease, as it might be associated with high risk genotypes such as HPV 16 and 18. 1. Introduction Human papilloma virus (HPV) infection is known to induce proliferative lesions on the skin and mucosa which may be benign or malignant. Over 120 genotypes have been identified in the HPV family, among which HPV 16 and 18 are considered to be high risk genotypes owing to their malignant potential. Benign oral lesions associated with HPV include squamous papilloma, verruca vulgaris, condyloma acuminatum, focal epithelial hyperplasia, and malignant variants like verrucous carcinoma and squamous cell carcinoma [1]. Focal epithelial hyperplasia of the oral cavity is a benign infectious disease caused by HPV, clinically presenting as multiple, well circumscribed papules on the oral mucosa, primarily involving gingiva, buccal, or labial mucosa [2]. The lack of sufficient literature and the asymptomatic nature of the condition make the clinical diagnosis difficult. We hereby report a unique case that presented clinically as multifocal epithelial hyperplasia of the oral mucosa in concurrence with the skin lesions. 2. Case Report A 65-year-old female patient presented with complaint of sensitivity of teeth since 2 months. Her past medical, dental, and personal histories were noncontributory. On extra oral examination multiple warts were seen involving face, scalp (Figures 1 and 2), and trunk. Intraoral examination showed multiple coalescent papillary projections, involving oral mucosa. The lesion was seen involving the labial gingiva of anterior teeth encroaching through the interdental papilla and involving palate (Figures 3 and 4). Predominant lesion was seen on palate extending bilaterally involving marginal gingiva of all the maxillary teeth and mid-palatine raphe and posteriorly till maxillary tuberosity region (Figure 4). Similar papillary lesions were seen involving labial gingiva of lower anterior teeth (Figure 3),