Oral inverted ductal papilloma associated with condyloma acuminata and HPV in an HIV+ patient

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

“…The patient age at appearance of the lesion is usually between the fourth and fifth decade of life and no particular gender predilection has been observed (1,5). In our review of the literature, the mean age was found to be 44 years, with a range of 27-65 years.…”

“…The size of the lesion varies from 0.5-1.5 cm in diameter, and the most common location is in a minor salivary gland of the lip and lower cheek mucosa (2,3). The etiology is unknown, though some authors have related it to human papillomavirus (HPV) infection, due to the detection of HPV sequences (subtypes 6/11) within the lesion (4,5). Certain immunohistochemical and ultrastructural studies have suggested that IDPOC may originate in the transition zone between the distal extremity of the secretory duct of a salivary gland and the surface epithelium of the oral cavity (6).…”

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.…”

“…In particular, the epidermoid cells expressed high molecular weight cytokeratins,19 with most luminal cells being positive for cytokeratin 717,18,20 and EMA,19 although…”