Case Report of Focal Epithelial Hyperplasia (Heck's Disease) with Polymerase Chain Reaction Detection of Human Papillomavirus 13

Brehm, Mary Abigail; Gordon, Katherine; Firan, Miahil; Rády, Peter L.; Agim, Nnenna G.

doi:10.1111/pde.12862

Cited by 12 publications

(10 citation statements)

References 5 publications

(6 reference statements)

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“…Heck's disease or FEH is a rare, benign proliferation of mucosal surfaces caused primarily by the HPV subtypes 13 and 32 [5]. It typically presents as multifocal, verrucous papules of the labial, lingual, and buccal mucosa which often lacks a relevant family history [6]. Nodules from FEH are pink and non-inflammatory with no notable symptoms other than their bulk which could theoretically hinder the motion of the various oral structures.…”

Section: Discussionmentioning

confidence: 99%

“…However, FEH is unlikely in adults over 18 years of age and is strongly associated in patients of Native American or Latino descent, suggesting a genetic predisposition [5,7]. Some literature reports have linked the expression of the HLA-DR4 leukocyte antigen as a culprit, noting the possible inability of the HLA-DR4 histocompatibility complex molecules to properly bind to certain HPV-13 or 32 viral proteins [6]. Regardless of this connection, the nodules of FEH are most often self-limited with an average lifespan of 18 months.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of this connection, the nodules of FEH are most often self-limited with an average lifespan of 18 months. Our patient's ethnicity, age, and the years-long presence of her nodules make a diagnosis of FEH implausible [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Microscopy revealed a pebbly papulonodular lesion displaying surface stratified squamous epithelium accompanied by hyperparakeratosis, papillomatosis, acanthosis with elongated broad and slender rete processes, and mild suprapapillary epithelial atrophy (Figs. 4,5,6). Physiologic pigmentation (melanin pigment) was seen in the cytoplasm of the basal keratinocytes.…”

Section: Diagnosismentioning

confidence: 99%

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Multiple Oral Mucosal Hamartomas in a 34-Year Old Female

Elo

Sun

Laudenbach

et al. 2017

Head and Neck Pathol

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reported first noticing these lesions approximately 10 years prior. She also denied any history of oral surgery, facial trauma, and alcohol, tobacco, or recreational drug use. The patient's past medical history was significant for left and right mastectomy for bilateral ductal carcinoma and partial thyroidectomy for microcarcinoma. She received blood transfusions at multiple points during her surgical journey but her current medical regimen included only levothyroxine. Clinical FindingsIntraoral examination (Fig. 1) revealed generalized multiple white-pink round/oval papules on the patient's lips. She was noted to have a distinct 6 mm × 5 mm × 3 mm papillary lesion on the facial gingiva between teeth #25 and 26 with smaller lesions extending slightly inferiorly to the distal of teeth #27 and 28. Similar small patches of lesions were noted on her contralateral mandibular quadrant. Also noted was a 7 mm × 3 mm white lesion on her right buccal mucosa just superior to the occlusal plane on the distobuccal cusp of tooth #31. In addition, pink papillary growths were found on the palatal gingiva of teeth #1, 2, 3, 6, 7, 9, 10, and 11 (Fig. 2) along with a similar but white papillary lesion on the attached buccal gingiva of tooth #15 measuring 5 mm × 5 mm × 5 mm. Another 3 mm × 7 mm papillary cluster was noted on the lingual mandibular gingiva near teeth #21 and 22. White gingival tissue was noted on the crest of her #14 edentulous ridge site (Fig. 3). None of these lesions were removable with gauze. The tongue was otherwise normal, as was the floor of her mouth. Radiographic imaging of the maxillomandibular region was otherwise unremarkable.Abstract A case of Cowden syndrome (CS) is described in a 34-year-old African American female who reported a history of breast and thyroid malignancies. Clinical examination demonstrated multiple soft, white-pink papules across multiple mucosal surfaces of the oral cavity. Microscopy of the lesions revealed hyperkeratotic surface squamous epithelium with papillomatosis and acanthosis along with elongated rete processes. A genomic polymerase chain reaction direct sequencing using the patient's blood was positive for mutations of the PTEN gene typical of CS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Multiple Oral Mucosal Hamartomas in a 34-Year Old Female

Elo

Sun

Laudenbach

et al. 2017

Head and Neck Pathol

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“…The condition clinically presents as multiple 0.2–3 cm [ 2 ], whiteish to mucosal-colored, soft papular or nodular, elevated lesions in the oral cavity [ 3 , 4 , 5 , 6 ] ( Figure 1 a), which disappear when the mucosa is stretched [ 7 ]. While many cases have been reported to be asymptomatic [ 2 , 5 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ], some lesions grow to a size or at a location where treatment is recommended [ 5 , 8 , 9 , 15 , 16 , 17 ]. A recent systematic review assessed the age of published cases from 1966–2020, and found a wide range of 3–92 years, with a higher reported rate in younger individuals (mean 23.1 years) and a male-to-female ratio of 3:4 [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Focal Epithelial Hyperplasia

Bendtsen

Jakobsen

Carlander

et al. 2021

Viruses

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Focal epithelial hyperplasia (FEH) or Heck’s disease is a rare, benign, oral condition that is associated with infection by human papillomavirus type 13, 32 or both. The whiteish to mucosal-colored, soft, papular or nodular elevated lesions in the oral cavity are normally asymptomatic but can grow to a size or at a location where treatment is needed. The diagnosis is often based on clinical presentation and histopathology, and the HPV genotype can be determined using PCR utilizing specific primers or DNA sequencing. While FEH was reported to often affect several members of the same family and exist primarily among indigenous populations around the world, the number of reported cases within the European region is increasing. This contemporary review summarizes the main findings in relation to HPV genotypes, impact of superinfection exclusion and vaccination, transmission, diagnosis, geographical and ethnical distribution, comorbidities and treatment of FEH with an emphasis on including the most recent case reports within the field. Furthermore, we describe for the first time a FEH lesion infected with the low-risk HPV90.

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