Large symptomatic oral squamous papilloma: a report of two unusual cases

Oral squamous papilloma is a common benign tumor of the oral mucosa that typically presents as a solitary, exophytic mass less than 10 mm in diameter. The abnormal outgrowth is often slow-growing and asymptomatic. However, its finger-like projections or cauliflower-like appearance, as well as emerging complications such as pain, can raise concerns. While most solitary oral squamous papillomas are usually innocuous, large, symptomatic, or multiple lesions may warrant closer surveillance because they have been linked, albeit rarely, to malignant transformation. We report two atypical cases of large, symptomatic oral squamous papilloma. In the first case, two lumps were found on the surface of the soft palate in a female patient: a large pediculated mass (15 × 10 × 8 mm) with finger-shaped projections and irritating pain, and a small asymptomatic sessile mass (3 × 2 × 2 mm) with a pink, cauliflower-like appearance. In the second case, a large papilloma (20 × 10 × 6 mm) developed on the buccal gingiva of an impacted, decayed maxillary third molar, accompanied by orofacial pain and limited mouth opening. These papillomas were surgically removed for histopathological examination. The final diagnoses of oral squamous papilloma in both cases were based on clinical presentation and histopathological examination. Notably, the oral mucosa of the first patient was positive for human papillomavirus type 58 (HPV58), which is a high-risk type of HPV and prevalent in countries of East Asia. In contrast, the oral mucosa of the second patient was negative for all 21 HPV subtypes that were tested. There were no recurrences in the two cases at the 6- and 18-month follow-up, respectively. The first unusual case shows that HPV58 infection of the oral mucosa might be associated with oral squamous papillomas, particularly large, multiple papillomas. Meanwhile, the second case in this report demonstrates that chronic gingival inflammation caused by microbial infection around an impacted third molar may contribute to the development of large, symptomatic oral squamous papillomas. These two atypical cases also underscore the importance of histopathological examination and HPV screening of the oral mucosa for diagnosis, differential diagnosis, and elucidation of the etiology and pathophysiology of oral squamous papillomas. Large, symptomatic, and multiple oral squamous papillomas require early intervention and close postoperative follow-up to monitor recurrence and potential malignant transformation.