Oral focal epithelial hyperplasia: report of five cases. Cristina Maria Borborema-SantosI; Maria Marta de CastroI; Paulo José Benevides dos SantosI,II; Sinésio. Focal epithelial hyperplasia is a rare contagious disease caused by human papilloma virus. Usually HPV involves either cutaneous or mucosal. Introduction: Focal epithelial hyperplasia (FEH), also known as Heck's disease, was described by Estrada in within a group of Colombian.


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These microscopic findings in conjunction with clinical presentation were sufficient to establish the accurate diagnosis of FEH. Clinicians must be aware of this rare oral disease, focal epithelial hyperplasia can even affect elderly patients, as we described here.


In the same year, Witkop and Niswander reported additional cases affecting Indians residing in Central and South America [ 2 ]. Furthermore, there were reports of the disease in other ethnic groups and individual cases worldwide [ ]. The concentration of FEH cases in some geographical areas with familial occurrence suggests environmental influences and genetic predisposition in its etiology.

It is focal epithelial hyperplasia known as Heck disease. Who gets focal epithelial hyperplasia?

Focal epithelial hyperplasia has been reported worldwide, but is particularly common in small native communities such as among North, Central and South American Focal epithelial hyperplasia and Inuit.

It is rare in Caucasian populations.

Heck's disease - Wikipedia

Risk factors for this condition include poor hygiene, poverty and communal lifestyles. It is most commonly seen in children and young adults.

Some authors report family clustering of cases. There is no difference between the sexes. Discussion Focal epithelial hyperplasia of the oral cavity was first reported among Navajo Indians focal epithelial hyperplasia multiple nodular elevations, similar focal epithelial hyperplasia those described in South American Indians and Eskimos of Greenland and Alaska [ 3 ].


The first case report was published by Dr. So far the literature reported less than 20 cases in humans [ 4 ]; hereby we present a rare case of multifocal epithelial hyperplasia expressing HPV 16 genotype.

Over the past few years HPV 13, 32, 1, 6, 11, and 16 were the common subtypes studied in association focal epithelial hyperplasia the disease. Although HPV is known to be the etiological agent, possibility of genetic predisposition, nutritional deficiencies and environmental factors like poverty and lack of hygiene, role of immunosuppression have been suggested as the other risk factors [ 45 ].

In the present case, genetic association was ruled out and focal epithelial hyperplasia positive history was revealed when enquired about other risk factors; however, factors like low socioeconomic profile and poor maintenance of hygiene can possibly be attributed to the disease manifestation.

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

Focal epithelial hyperplasia predominantly affects patients between the 1st and 2nd decades of life with a female predilection. The most frequent site was the lower lip [ 4 ]. In this case the lesion presented at an unusual age of 65 years involving multiple sites like gingiva, focal epithelial hyperplasia, tongue, and commissural areas of both right and left buccal mucosa.


Based upon the clinical findings, focal epithelial hyperplasia diagnosis of multifocal epithelial hyperplasia was given, whereas differential diagnosis included verrucous leukoplakia and verrucous carcinoma. The prominent microscopic features consist of parakeratin layering, extensive acanthosis, epithelial cells of the spinous layer with enlarged nucleus, degeneration of koilocytes, and mitosoid cells [ 6 ].

Our case demonstrated multiple papillary epithelial projections with fibrovascular connective tissue cores and presence of koilocytes in the spinous layer of the epithelium favouring the diagnosis.

Differential diagnosis includes condyloma acuminatum, verruca vulgaris, papilloma, irritation fibroma, and Cowden syndrome as they are known to have some clinical similarities like lesion type, color, and location.

Recent advancements in molecular biology techniques for HPV testing include light microscopy; electron microscopy; nonamplified molecular techniques like in situ hybridization, southern blot, and dot blot hybridization; target amplification using PCR; signal amplified techniques like hybrid capture technology; and gene expression using DNA microarrays [ 1 ].

In the present case the specific histopathologic features in conjunction with the clinical picture drove us towards molecular analysis, so as to rule out the possible association of human papilloma virus.

The PCR analysis of the biopsy sample isolated the HPV 16 genotype; however, other common strains associated with oral lesions were ruled out using type specific probes. A 7-year-old Caucasian girl was admitted to our clinic for investigation of multiple oral mucosal lesions focal epithelial hyperplasia the mouth.

Focal epithelial hyperplasia | DermNet New Zealand

Lesion was excised under local anesthesia without any complication. The lesion was diagnosed as focal epithelial hyperplasia according to both clinical and histopathological features.

Dental staff should be aware of these kind of lesions and histopathological examination together with a careful clinical observation focal epithelial hyperplasia be carried out for a definitive diagnosis. A site-specific predilection for keratinized and non-keratinized surfaces has been observed in these two types of HPV, respectively.

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