15 August 2022

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Papillary white excrescence on the tongue - a clinical case

Author: M. Berardini

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A male patient, aged 60, underwent a visit complaining about the presence of a whitish and detected neoformation located in the right anterior abdomen of the tongue (Fig. 1). It also reports that it has noticed a slow but progressive increase in the size of the lesion in question. The medical history is negative for current or previous systemic diseases.
At the physical exam, the lesion is presented as a white excrescence of about 0.5 cm with evident long and papillary digits. The lesion appears well delimited by the surrounding tissues and the passage between the healthy lingual mucosa and the lesion is absolutely clear.
The peculiar aspect of the excrescence leads us to hypothesize with absolute certainty for a benign neoplasia with an infectious origin and opts for an excisional biopsy with excision of the whole lesion.

The patient, informed about the proposed therapy, declares his consent to the surgical removal of the lesion. Informed consent to publish the case was also obtained. After local infiltration of anesthetic (mepivacaine with adrenaline 1: 100,000), the lesion is pinched and two sutures are made (one medial and one distal to the lesion) in order to bind the terminal capillaries and avoid copious bleeding once the lesion has escaped. At this point we proceed to draw a diamond incision with blade 15 with margins on healthy tissue at least 2-3 mm from the lesion itself. The incision is then deepened a few millimeters in order to allow the detachment of the tissue to be taken (Fig. 2). The sample is immediately immersed in 4% formalin and was sent to the pathologist for histological analysis. The suture is completed with some stitches detached. Histological analysis revealed a framework that consists of vascular-connective pedicle and a thick layer of hyperkeratotic epithelium everted into multiple digits.
 
Papillomas are relatively common benign neoformations that may appear to be white if keratinized (in most cases) or rosaceous in the absence of keratinization. The cause is the human papilloma virus (HPV) DNA that can also be transmitted with saliva. Three types of lesions are recognized: squamous papilloma (preferring the tongue, the retromolar trine and the soft palate), verruca vulgaris (rare in the oral cavity) and condyloma (in single or multiple form). Surgical excision is therapeutic and recurrence is quite rare (Fig. 3).