Inverted ductal papilloma of the oral cavity secondary to lower lip trauma. A case report and literature review.

Abstract

Inverted ductal papilloma of the oral cavity is an infrequent benign neoplasm of papillary appearance that originates in the secretory duct of a salivary gland. The etiology is unknown, though some authors have related it to human papillomavirus (HPV) infection. We present the case of a 40-year-old woman with a tumor of the lower lip mucosa. Histopathological study of the lesion diagnosed inverted ductal papilloma of the oral cavity. Human papillomavirus DNA detection and typing based on tumor lesion DNA amplification and posterior hybridization, revealed no presence of viral DNA. The antecedents of trauma reported by the patient could have played an important role in the development of this tumor. Key words:Inverted ductal papilloma, intraductal papilloma, oral papilloma, papillary epidermoid adenoma.

Buccal mass excreting pus-like material

“…14,15,17,19,20 A small orifice may be seen on the tumor surface, representing the ductal opening connecting the tumor lumen with the overlying surface 15,17 and occasionally, as in the present case, outflow of fluid may be observed from the orifice. 12,19 Maximum dimension ranges between 0.5-2.0 cm.…”

“…Infection from the human papillomavirus (HPV) has been considered as a possible factor 15,17 and HPV6/11 DNA has been detected in 3 out of 6 cases of IDP by in situ hybridization (ISH), 28 while HPV11 DNA was found in a case arising in an HIV-positive patient by polymerase chain reaction (PCR). 20 However, no HPV DNA was detected in three additional cases, by ISH 29 or PCR, 15,16 while other authors consider the absence of koilocytes and binucleated keratinocytes in the lining epithelium as inconsistent with HPV infection. 17 Vargas, et al 18 suggested that chronic trauma could be another likely causative factor, but our patient could not recall an injury in the area before the lesion's presentation.…”

“…14 IDP is a rare entity. 15,16 Combining the data from the most recent reviews on IDP by Epivatianos, et al 17 and Sala-Pérez, et al 15 15,17 There is no remarkable gender predilection.…”

“…12,19 Maximum dimension ranges between 0.5-2.0 cm. 15,17,18 Clinical differential diagnosis includes mucocele, fibroma, lipoma, salivary gland tumors and squamous papilloma. 12,17 In the present case, the microscopic differential diagnosis included mainly IDP, IP and papillary cystadenoma, while the coexistence of epidermoid cells with mucous cells required differentiation from mucoepidermoid carcinoma (MEC).…”

Other Adenomas

“…Other reports, on the other hand, have indicated the presence of HPV 6/11 in inverted ductal papilloma as well as in inverted ductal papilloma associated with condyloma acuminatum [ 63 , 78 ]. A more recent study from 2013 revealed no presence of HPV viral DNA in a lip inverted ductal papilloma but the patient had a previous history of trauma [ 142 ].…”