Hyperplasia, focal epithelial B07

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Focal epithelial hyperplasia; focal epithelial hyperplasia (e); Heck`s disease; Heck's disease; Hyperplasia multilocularis mucosae oris Heck; Multifocal epithelial hyperplasia; oral focal epithelial hyperplasia; Stern M.

History
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Heck, 1963; Archard, Heck and Stanley, 1965

Definition
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Rare warty, mucosa-coloured papules and plaques of the oral mucosa caused by human papilloma viruses ( HPV types 13 and 32; rare detection of HPV types 1, 6, 11). The disease is commonly found in Eskimos and the Indian population in South America. In children: comorbidity with HIV infection is known.

Occurrence/Epidemiology
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Especially Indians and South Americans, Asians. Less so among Europeans. Occasionally a family cluster has also been described.

Etiopathogenesis
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In larger studies > 85% of patients were HPV positive. HPV32 was detected in 50%, HPV6 in 30% and HPV40 in 5%. HPV32 but not HPV6 was detected in HIV infected patients.

Manifestation
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Especially among children and young people, less frequently among adults (then often from Mediterranean countries).

Localization
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Oral mucosa; mainly lip red (here on the mucosal side of the lower lip); corner of the mouth; cheek mucosa (about 65 % of patients); more rarely the floor of the mouth or the palate is affected.

Clinical features
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Multiple wart-like, oral mucosa-coloured to whitish, persistent over months and years, broadly seated on the base, soft papules with a tendency to confluence. Size: 0,5-1,0 cm. Aggregation of the growths may result in larger, humpy beds.

Histology
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Acanthosis with large ballooned cells in the stratum spinosum, papillomatosis. The retellions are extended and partly anastomosed. Mitosis figures in the stratum basale.

Therapy
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If necessary, excision or cauterization with subsequent curettage. Spontaneous healing possible. Successful local therapy with solutions containing vit. A-acid has been reported. A high spontaneous remission is guaranteed!

Literature
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  1. Archard HO, Heck JW, Stanley HR (1965) Focal epithelial hyperplasia: an unusual and mucosal lesion found in Indian children. Oral Surg Oral Med Oral Catholic 20: 201-212
  2. Feller L et al (2010) Focal epithelial hyperplasia (Heck disease) related to highly active antiretroviral therapy in an HIV-seropositive child. A report of a case, and a review of the literature. SADJ 65:172-175Gökahmetoğlu
    S et al(2015)Focal epithelial hyperplasia in a Turkish family. Infez Med 22:322-325
  3. Khanal S et al (2016) Human papillomavirus detection in histologic samples of multifocal epithelial hyperplasia
    : a novel demographic presentation.
    Oral Surg Oral Med Oral Pathol 120:733-743.
  4. Kose O et al (2001) Focal epithelial hyperplasia treated with interferon alpha-2a. J Dermatologist Treat 12: 111-113
  5. Knoth W et al (1978) Hyperplasia multilocularis mucosae oris HECK (Sog. Focal epithelial hyperplasia). Z Hautkr 53: 675-679
  6. Nartey NO et al (2002) Focal epithelial hyperplasia: report of six cases from Ghana, West Africa. J Clin Pediatr Dent 27: 63-66
  7. Sabeena S et al (2016) Papilloma of lip associated with human papilloma viruses-32 infection in a child. Indian J Med Microbiol 34:97-99
  8. Syrjanen S (2003) Human papillomavirus infections and oral tumors. Med Microbiol Immunol (Berl) 192: 123-128
  9. Witkop CJ Jr, Niswander JD (1965) Focal epithelial hyperplasia in Central and South American Indians and Latinos. Oral Surg Oral Med Oral Catholic 20: 213-217

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020