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Head and Neck Pathology

, Volume 7, Issue 4, pp 320–326 | Cite as

Papillary Variant of Squamous Cell Carcinoma Arising on the Gingiva: 61 Cases Reported from Within a Larger Series of Gingival Squamous Cell Carcinoma

  • Sarah G. Fitzpatrick
  • Ashley N. Neuman
  • Donald M. Cohen
  • Indraneel BhattacharyyaEmail author
Original Paper

Abstract

Papillary squamous cell carcinoma (PSCCA) is a rarely occurring variant of squamous cell carcinoma (SCCA) with distinctive exophytic and papillary features and a more favorable prognosis than conventional SCCA. The larynx is the most commonly affected site in the head and neck. The oral cavity, oropharynx, sinonasal tract, and nasopharynx are also affected. Within the oral cavity cases have been reported on the alveolar ridge, oral mucosa, floor of the mouth, ventral tongue, and rarely other areas. We identified 61 cases of gingival PSCCA within the parameters of a larger study of 519 cases of gingival SCCA. We evaluated the clinical and histologic features of these lesions. The average age of the PSCCA patient was 74 years, with a very slight male predominance of 1.2:1. The mandible was affected nearly twice as often (64 %, n = 39) as the maxilla (35 %, n = 21, and 1 % of cases unspecified), and the most common location by far was the mandibular posterior region (52 %, n = 32). Most lesions were reportedly present over 2 months in duration (48 %, n = 29) prior to biopsy but a significant amount of clinicians were unsure of the duration of the lesion as well (36 %, n = 22). Only 10 cases (16 %) were reportedly present less than 2 months. The most common clinical presentation was that of an erythematous or mixed white and red exophytic mass (74 %, n = 45). 62 % (n = 38) of submitting clinicians considered a malignant or premalignant lesion in their differential diagnosis, but other clinical impressions included papillomas, reactive gingival lesions, and fungal infections. Histologically, 88 % (n = 52 of 59 cases graded) of the lesions were either well or moderately-well differentiated. PSCCA is a rare subtype of SCCA which has been reported infrequently involving the gingiva or alveolar ridges but should be considered by clinicians for the differential diagnosis of papillary gingival masses.

Keywords

Papillary squamous cell carcinoma Oral cavity Gingiva Alveolar ridge Head and neck 

References

  1. 1.
    Crissman JD, Kessis T, Shah KV, Fu YS, Stoler MH, Zarbo RJ, Weiss MA. Squamous papillary neoplasia of the adult upper aero digestive tract. Hum Pathol. 1988;19:1387–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Thompson LDR, Wenig BM, Heffner DK, Gnepp DR. Exophytic and papillary squamous cell carcinomas of the larynx: a clinicopathologic series of 104 cases. Otolaryngol Head Neck Surg. 1999;120:718–24.PubMedCrossRefGoogle Scholar
  3. 3.
    Russell JO, Hoschar AP, Scharpf J. Papillary squamous cell carcinoma of the head and neck: a clinicopathologic series. Am J Otolaryngol. 2011;32:557–63.PubMedCrossRefGoogle Scholar
  4. 4.
    Cobo F, Talavera P, Concha A. Relationship of human papillomavirus with papillary squamous cell carcinoma of the upper aero digestive tract: a review. Int J Surg Pathol. 2008;16(2):127–36.PubMedCrossRefGoogle Scholar
  5. 5.
    Ishiyama A, Eversole LR, Ross DA, Raz Y, Kerner MM, Yao S, Blackwell K, Feneberg R, Bell TS, Calcaterra TC. Papillary squamous neoplasms of the head and neck. Laryngosope. 1994;104(12):1446–52.Google Scholar
  6. 6.
    Takeda Y, Satoh M, Nakamura S, Yamamoto H. Papillary squamous cell carcinoma of the oral mucosa: immunohistochemical comparison with other carcinomas of oral mucosal origin. J Oral Sci. 2001;43(3):165–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Khan SM, Gossweiler MK, Zunt SL, Edwards MD, Blanchard SB. Papillary squamous cell carcinoma presenting on the gingiva. J Periodontol. 2005;76:2316–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Terada T. Papillary squamous cell carcinoma of the oral cavity with acantholytic and pseudovascular features. Int J Clin Exp Pathol. 2011;4(8):794–6.PubMedGoogle Scholar
  9. 9.
    Jo VY, Mills SE, Stoler MH, Stelow EB. Papillary squamous cell carcinoma of the head and neck: frequent association with human papillomavirus infection and invasive carcinoma. Am J Surg Pathol. 2009;33:1720–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Fitzpatrick SG, Neuman AN, Cohen DM, Bhattacharyya I. The clinical and histologic presentation of gingival squamous cell carcinoma: a study of 519 cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:509–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Cardesa A, Zidar N, Nadal A, Ereno C. Papillary Squamous Cell Carcinoma. In: Barnes L, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumors: pathology and genetics, head and neck tumors. Lyon: IACR Press; 2005. p. 126.Google Scholar
  12. 12.
    Slootweg PJ, Richardson M. Squamous cell carcinoma of the upper aerodigestive system. In: Gnepp, editor. Diagnostic surgical pathology of the head and neck. 2nd ed. Philadelphia: Saunders Elsevier; 2009. p. 45–110.CrossRefGoogle Scholar
  13. 13.
    Suarez PA, Adler-Storth K, Luna MA, El-Naggar AK, Abudul-Karim FW, Batsakis JG. Papillary squamous cell carcinomas of the upper aero digestive tract: a clinicopathologic and molecular study. Head Neck. 2000;22:360–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Bao Z, Yang X, Shi L, Feng J, Liu W, Zhou Z. Clinicopathologic features of oral squamous papilloma and papillary squamous cell carcinoma: a study of 197 patients from eastern China. Ann Diagn Pathol. 2012;16:454–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Bouquot JE, Muller S, Nikai H. Lesions of the oral cavity. In: Gnepp DR, editor. Diagnostic surgical pathology of the head and neck. 2nd ed. Philadelphia: Saunders Elsevier; 2009. p. 191–308.CrossRefGoogle Scholar
  16. 16.
    Neville BW, Damm DD, Allen CM, Bouquot JE, Chi A (revision). Epithelial pathology. In: Oral and maxillofacial pathology, 3rd edition. Saunders Elsevier, St. Louis; 2008. P. 362–452.Google Scholar
  17. 17.
    Cardesa A, Nadal A. Carcinoma of the head and neck in the HPV era. Acta Dermatoven APA. 2011;20(3):161–73.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sarah G. Fitzpatrick
    • 1
  • Ashley N. Neuman
    • 2
  • Donald M. Cohen
    • 2
  • Indraneel Bhattacharyya
    • 2
    Email author
  1. 1.Department of Oral Pathology, School of Dental MedicineCase Western Reserve UniversityClevelandUSA
  2. 2.Division of Oral Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, JHMHCUniversity of Florida College of DentistryGainesvilleUSA

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