What is believed to be the first case of focal epithelial hyperplasia in a black is reported. The painless lesions appear on the lips, cheeks, tongue, and palate, and the condition is viewed as a benign change of unknown origin.
Focal epithelial hyperplasia (Heck’s disease): report of case John R. W allace, DDS, Lafayette, La
F o c a l epith elial h y p e rp la sia is a ra re , benign, p ain less ch an g e o f th e o ral m u c o sa seen p rim a r ily in you n g w om en (le ss th a n 18 y ears old) o f in d ig en o u s p o p u la tio n s. T h e co n d itio n is seen clin ically as sm all (0.5 to 1 cm ), ra ise d , fla t, soft, sm o o th p laq u elik e lesio n s o f th e m u c o sa o f the lip s, c h e e k s, to n g u e ,1 a n d p a la te .2 L esio n s of th e flo o r o f th e m outh h a v e not b een re p o rted . ' T ’l-------------l ! i ‘ ___ * „ _ j . __ 1 • _ _______1 _1___• 1 _ j • __ •1 _ i iic coiiuuiun is nuieu in a w onuw iue uism outio n . H e re d ity 3 and viral in fe c tio n s4 h av e been im p licated as etiologic fa c to rs. T re a tm e n t is n o t o ffe re d , alth o u g h su rg ery h as b een u s e d .5 S in ce th e original d esc rip tio n o f this co n d itio n by A rc h a rd an d c o -w o rk e rs6 in 1965, fe w er th an 150 c a se s h av e b een re p o rte d . M ic ro sc o p ic sectio n s sh o w epith elial h y p e r p la sia w ith vario u s d e g re e s o f a c a n th o sis, elong atio n an d blunting o f th e re te ridges w ith a n a s to m o sin g , p ro m in e n t n u clei, v ac u o la tio n , and brisk m ito tic activ ity . T h e su b m u co sa show s p e riv a sc u la r an d ju n c tio n a l in flam m ation. M alig n a n t ch an g es a re not seen . T h e T a b le gives a rev iew o f th e c a se s as d e sc rib e d in th e availab le lite ra tu re .1'3,5'24 a
re tro m o la r area s o u t o n to the lips. A n ex am in a tion o f th e m outh sh ow ed m ultiple soft, raised , sessile , flat p ap u les varying in size from 2 m m to 1 cm o r la rg e r (F ig 1). L ingual, p ala ta l, o r p h a ry n geal lesions w ere not n o te d . T h e p a tie n t said th at th e lesio n s had b ee n p re sen t fo r alm o st a year and w ere n o t a so u rce o f co n c ern to h er. A n a ccessib le lesion w as se lecte d a n d r e m o v ed w ith the p a tien t u n d er local a n e sth esia: th e tissu e w as su b m itted to th e p a th o lo g ist w ho verified th e clinical diagnosis. ■ M ic r o s c o p ic d e s c r ip tio n : T h e seg m en t o f oral m u co sa sh o w ed a p laquelike ele v atio n o f th e su r face epithelium cau sed by a p ro n o u n c e d h y p e r p lasia o f th e epithelium , b ro a d irre g u lar a c a n th o sis, an d clublike re te ridges. T h e ep ithelium w as baso p h ilic w ith p ro m in en t nuclei ex ten d in g in to th e m idportion. V acu o latio n w as n o te d in th e stratu m m alpighii. M ito tic ac tiv ity w as brisk in th e basal p o rtio n (F ig 2). H ealin g w as u n c o m p licate d , and th e su tu res w ere rem o v ed in five days. A t th a t tim e, th e p a tie n t’s sev en siblings an d p a re n ts w e re exam ined and found to b e free o f this condition.
R e p o rt o f case D iscu ssio n A 16-year-old N e g ro girl w as re fe rred fo r the d iag n o sis an d tre a tm e n t o f a p ainless condition o f th e m u c o sa o f th e c h e e k s, ex ten d in g from the 118 ■ JADA, Vol. 93, July 1976
T h e significance o f this benign m ucosal c o n d i tion seem s to be in its specificity fo r indigenous
le ■ Summary of cases of focal epithelial hyperplasia srted in the literature. Cases lard & co-w orkers6 29 ;op& Niswander7 11 w er& Rodgers8 1 dman & Shelton9 1 1 lips & W illiam s10 genholtz" 2 ke r& d e Guzman12 4 ieira & Fonseca13 54 :hman14 1 iks, Fischman, & 3 Guzman15 1 ada16 2 ada17 1 es18 1 usen & W illis19 8 lander & van N oord20 1 ;ins& C am pbell21 1 i and others22 1 ■nez & co-workers2 7 verin23 1
Focal epithelial hyperplasia (Heck’s disease): report of case John R. W allace, DDS, Lafayette, La
F o c a l epith elial h y p e rp la sia is a ra re , benign, p ain less ch an g e o f th e o ral m u c o sa seen p rim a r ily in you n g w om en (le ss th a n 18 y ears old) o f in d ig en o u s p o p u la tio n s. T h e co n d itio n is seen clin ically as sm all (0.5 to 1 cm ), ra ise d , fla t, soft, sm o o th p laq u elik e lesio n s o f th e m u c o sa o f the lip s, c h e e k s, to n g u e ,1 a n d p a la te .2 L esio n s of th e flo o r o f th e m outh h a v e not b een re p o rted . ' T ’l-------------l ! i ‘ ___ * „ _ j . __ 1 • _ _______1 _1___• 1 _ j • __ •1 _ i iic coiiuuiun is nuieu in a w onuw iue uism outio n . H e re d ity 3 and viral in fe c tio n s4 h av e been im p licated as etiologic fa c to rs. T re a tm e n t is n o t o ffe re d , alth o u g h su rg ery h as b een u s e d .5 S in ce th e original d esc rip tio n o f this co n d itio n by A rc h a rd an d c o -w o rk e rs6 in 1965, fe w er th an 150 c a se s h av e b een re p o rte d . M ic ro sc o p ic sectio n s sh o w epith elial h y p e r p la sia w ith vario u s d e g re e s o f a c a n th o sis, elong atio n an d blunting o f th e re te ridges w ith a n a s to m o sin g , p ro m in e n t n u clei, v ac u o la tio n , and brisk m ito tic activ ity . T h e su b m u co sa show s p e riv a sc u la r an d ju n c tio n a l in flam m ation. M alig n a n t ch an g es a re not seen . T h e T a b le gives a rev iew o f th e c a se s as d e sc rib e d in th e availab le lite ra tu re .1'3,5'24 a
re tro m o la r area s o u t o n to the lips. A n ex am in a tion o f th e m outh sh ow ed m ultiple soft, raised , sessile , flat p ap u les varying in size from 2 m m to 1 cm o r la rg e r (F ig 1). L ingual, p ala ta l, o r p h a ry n geal lesions w ere not n o te d . T h e p a tie n t said th at th e lesio n s had b ee n p re sen t fo r alm o st a year and w ere n o t a so u rce o f co n c ern to h er. A n a ccessib le lesion w as se lecte d a n d r e m o v ed w ith the p a tien t u n d er local a n e sth esia: th e tissu e w as su b m itted to th e p a th o lo g ist w ho verified th e clinical diagnosis. ■ M ic r o s c o p ic d e s c r ip tio n : T h e seg m en t o f oral m u co sa sh o w ed a p laquelike ele v atio n o f th e su r face epithelium cau sed by a p ro n o u n c e d h y p e r p lasia o f th e epithelium , b ro a d irre g u lar a c a n th o sis, an d clublike re te ridges. T h e ep ithelium w as baso p h ilic w ith p ro m in en t nuclei ex ten d in g in to th e m idportion. V acu o latio n w as n o te d in th e stratu m m alpighii. M ito tic ac tiv ity w as brisk in th e basal p o rtio n (F ig 2). H ealin g w as u n c o m p licate d , and th e su tu res w ere rem o v ed in five days. A t th a t tim e, th e p a tie n t’s sev en siblings an d p a re n ts w e re exam ined and found to b e free o f this condition.
R e p o rt o f case D iscu ssio n A 16-year-old N e g ro girl w as re fe rred fo r the d iag n o sis an d tre a tm e n t o f a p ainless condition o f th e m u c o sa o f th e c h e e k s, ex ten d in g from the 118 ■ JADA, Vol. 93, July 1976
T h e significance o f this benign m ucosal c o n d i tion seem s to be in its specificity fo r indigenous
le ■ Summary of cases of focal epithelial hyperplasia srted in the literature. Cases lard & co-w orkers6 29 ;op& Niswander7 11 w er& Rodgers8 1 dman & Shelton9 1 1 lips & W illiam s10 genholtz" 2 ke r& d e Guzman12 4 ieira & Fonseca13 54 :hman14 1 iks, Fischman, & 3 Guzman15 1 ada16 2 ada17 1 es18 1 usen & W illis19 8 lander & van N oord20 1 ;ins& C am pbell21 1 i and others22 1 ■nez & co-workers2 7 verin23 1
