Squamous cell papilloma-like presentation of multiple neurovascular hamartomas of the oral cavity

Significance Statement: Neurovascular hamartomas (NVH) is an uncommon tumor-like developmental anomaly. We hereby report the case of a 28-year-old woman presenting with multiple millimetric excrescences in the oral cavity that were clinically interpreted as squamous cell papilloma and histologically consistent with NVHs. Neurovascular hamartomas is rare in the oral cavity. To the best of our knowledge, multiple NVHs have never been reported at this site.

HPV-Associated Benign Squamous Cell Papillomas in the Upper Aero-Digestive Tract and Their Malignant Potential

Squamous cell papilloma (SCP) in the upper aero-digestive tract is a rare disease entity with bimodal age presentation both at childhood and in adults. It originates from stratified squamous and/or respiratory epithelium. Traditionally, SCPs have been linked to chemical or mechanical irritation but, since the 1980s, they have also been associated with human papillomavirus (HPV) infection. Approximately 30% of the head and neck SCPs are associated with HPV infection, with this association being highest for laryngeal papillomas (76–94%), followed by oral (27–48%), sinonasal (25–40%), and oropharyngeal papillomas (6–7%). There is, however, a wide variation in HPV prevalence, the highest being in esophageal SCPs (11–57%). HPV6 and HPV11 are the two main HPV genotypes present, but these are also high-risk HPVs as they are infrequently detected. Some 20% of the oral and oropharyngeal papillomas also contain cutaneous HPV genotypes. Despite their benign morphology, some SCPs tend to recur and even undergo malignant transformation. The highest malignant potential is associated with sinonasal inverted papillomas (7–11%). This review discusses the evidence regarding HPV etiology of benign SCPs in the upper aero-digestive tract and their HPV-related malignant transformation. In addition, studies on HPV exposure at an early age are discussed, as are the animal models shedding light on HPV transmission, viral latency, and its reactivation.

Higher Number of EBI3 Cells in Mucosal Chronic Hyperplastic Candidiasis May Serve to Regulate IL-17-Producing Cells

Previous research into the inflammatory cell infiltrate of chronic hyperplastic candidosis (CHC) determined that the immune response is primarily composed of T cells, the majority of which are T helper (CD4+) cells. This present investigation used immunohistochemistry to further delineate the inflammatory cell infiltrate in CHC. Cells profiled were those expressing IL-17A cytokine, EBI3 and IL-12A subunits of the IL-35 cytokine, and FoxP3+ cells. Squamous cell papilloma (with Candida infection) and oral lichen planus tissues served as comparative controls to understand the local immune responses to Candida infection. The results demonstrated that Candida-induced inflammation and immune regulation co-exist in the oral mucosa of CHC and that high prevalence of cells expressing the EBI3 cytokine subunit may play an important role in this regulation. This balance between inflammation and immune tolerance toward invading Candida in the oral mucosa may be critical in determining progress of infection.

Laryngofissure in comorbid patient under ultrasound-guided regional anesthesia of the neck

Background Major neck surgery is done typically under general anesthesia (GA). The neural blocks of the neck include blocking of the cervical plexus, superior laryngeal nerve, trans-laryngeal, block of the glossopharyngeal nerve, and local anesthetic infiltration. In patients with a high risk of GA, including those with pulmonary dysfunction, and prior myocardial ischemia or infarction, regional anesthesia is mainly indicated. Case presentation We record a case of a comorbid geriatric patient with dysphonia and left glottic mass that was diagnosed as squamous cell papilloma by transoral biopsy using curved biopsy forceps under local spray anesthesia, and after 6 months, this patient developed stridor for which tracheostomy, laryngofissure, and left cordectomy were then performed solely under neck blocks. Surgery was performed while the patient remained pain-free and stable without any morbidity throughout the operation. Conclusions In high-risk patients and low-resource health systems, regional anesthesia in neck surgery can be a reasonable and cheap alternate to general anesthetics.

Squamous Cell Papilloma of the Esophagus: A Case Series Highlighting Endoscopic and Histologic Features

Esophageal squamous papillomas are rare epithelial lesions typically discovered incidentally during EGD. Their prevalence is estimated to be less than 0.01% in the general population. We present three cases of esophageal squamous papillomas identified histologically. It may be possible to identify these lesions macroscopically. One study provided a positive predictive value of 88% for squamous papilloma utilizing the triad of exophytic growth, wart-like projections, and surface vessel crossing seen on narrow band imaging during endoscopy. The etiology is unclear. Chronic mucosal irritation from GERD or esophagitis is the prevailing theory of pathogenesis, but HPV has been detected in some lesions. The malignant potential of these lesions is considered controversial. There are documented cases demonstrating complications with squamous cell carcinoma, so we recommend removal of all esophageal squamous papillomas; however, the small absolute number of cases documented in the literature makes drawing any associations or conclusions between esophageal squamous papillomas and squamous cell carcinoma difficult. Further research is needed regarding treatment and surveillance. This case series helps contribute to the small but growing literature of this rare finding.

Primary Tracheal Papilloma: A Case Report

Solitary papilloma in the respiratory tract is a rare benign epithelial tumor which is complete surgical excision of the current standard treatment for this type of tumor. Here a case of solitary tracheal papilloma treated by surgical resection is reported. Due to rarity and non-specific symptoms, tracheal papilloma always subjected to misdiagnosed and suffer from delayed treatment. In this case, a forty two years male has been presented with a recurrent non-productive irritative cough, a progressive shortness of breath, expiratory stridor and occasional hemoptysis. The patient was previously diagnosed as a case of bronchial asthma by a Pulmonologist and wrongly treated as well. CT scan revealed an intraluminal tracheal mass arises from the right side of the tracheal wall opposite c6-c7 vertebrae. The tumour was removed by endoscopic excision. The histopathological result confirms the diagnosis of squamous cell papilloma. No complications occur during surgery and no recurrence was observed in six months after surgery on followup. Bangladesh Med J. 2020 May; 49(2) : 44-47