Oral medicine and radiology, Oral Pathology

Focal Epithelial Hyperplasia

Definition: A cutaneous condition characterized by multiple papillary or sessile areas of the oral mucosa and white to pinkish papules that occur diffusely in the oral cavity. It is caused by the human papilloma virus types 13 and 32.

Synonyms – Heck’s Disease, Multifocal papilloma


  • HPV – 13 & 32
  • Recently known to be associated with AIDS

Clinical Features:

  • Incidence: 40%
  • Age: Children
  • Sex: M=F
  • Race: Native indians of North & Central America
  • Site: Labial, Buccal & lingual  mucosa
Clinical Appearance:
  • Usually multiple lesions
  • Presents as well demarcated plaques, sessile & may be pink / white
  • Sites involved include Labial, Buccal and lingual mucosa, along with gingival and tonsillar lesions.
  • Soft, non tender, flattened or rounded papules usually Clustered
  • Occasionally lesions show a slight papillary surface change.
  • Individual lesions are small – 0.3 to 1.0 cm
  • Discrete and well demarcated but they cluster so close together that the entire area shows – Cobblestone or Fissured appearance

Focal Epithelial Hyperplasia clinical appearance

Histopathologic Features:

  • Acanthosis of the Oral Epithelium (characteristic feature)
  • Rete ridges are at the same level, sometimes widened and often confluent and Club shaped
  • Sometimes Superficial Keratinocytes show Koilocytic Change (similar to HPV infection)
  • Mostly Mitosoidcell – Nuclues resembling mitotic figure is seen
  • Virus like particles have been noted in the cytoplasm and nucleus which are suspected to be HPV.
Focal Epithelial hyperplasia -Mitosoid cells
Focal Epithelial hyperplasia -Mitosoid cells

Treatment and Prognosis:

  • Spontaneous Regression is seen in almost all of the cases after a period of months or years.
  • For Aesthetic purpose: Surgical Excision can be performed.
  • No Recurrence
  • No malignant transformation

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