Verruciform xanthoma in the hard palate: a case report and literature review
Identifieur interne : 002301 ( Pmc/Corpus ); précédent : 002300; suivant : 002302Verruciform xanthoma in the hard palate: a case report and literature review
Auteurs : Alexandre Sim Es Garcia ; Otávio Pagin ; Paulo Sérgio Da Silva Santos ; Denise Tostes OliveiraSource :
- Journal of the Korean Association of Oral and Maxillofacial Surgeons [ 2234-7550 ] ; 2016.
Abstract
Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.
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DOI: 10.5125/jkaoms.2016.42.6.383
PubMed: 28053911
PubMed Central: 5206246
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Verruciform xanthoma in the hard palate: a case report and literature review</title><author><name sortKey="Garcia, Alexandre Sim Es" sort="Garcia, Alexandre Sim Es" uniqKey="Garcia A" first="Alexandre Sim Es" last="Garcia">Alexandre Sim Es Garcia</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Pagin, Otavio" sort="Pagin, Otavio" uniqKey="Pagin O" first="Otávio" last="Pagin">Otávio Pagin</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Da Silva Santos, Paulo Sergio" sort="Da Silva Santos, Paulo Sergio" uniqKey="Da Silva Santos P" first="Paulo Sérgio" last="Da Silva Santos">Paulo Sérgio Da Silva Santos</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Oliveira, Denise Tostes" sort="Oliveira, Denise Tostes" uniqKey="Oliveira D" first="Denise Tostes" last="Oliveira">Denise Tostes Oliveira</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28053911</idno><idno type="pmc">5206246</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206246</idno><idno type="RBID">PMC:5206246</idno><idno type="doi">10.5125/jkaoms.2016.42.6.383</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002301</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002301</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Verruciform xanthoma in the hard palate: a case report and literature review</title><author><name sortKey="Garcia, Alexandre Sim Es" sort="Garcia, Alexandre Sim Es" uniqKey="Garcia A" first="Alexandre Sim Es" last="Garcia">Alexandre Sim Es Garcia</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Pagin, Otavio" sort="Pagin, Otavio" uniqKey="Pagin O" first="Otávio" last="Pagin">Otávio Pagin</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Da Silva Santos, Paulo Sergio" sort="Da Silva Santos, Paulo Sergio" uniqKey="Da Silva Santos P" first="Paulo Sérgio" last="Da Silva Santos">Paulo Sérgio Da Silva Santos</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Oliveira, Denise Tostes" sort="Oliveira, Denise Tostes" uniqKey="Oliveira D" first="Denise Tostes" last="Oliveira">Denise Tostes Oliveira</name><affiliation><nlm:aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the Korean Association of Oral and Maxillofacial Surgeons</title><idno type="ISSN">2234-7550</idno><idno type="eISSN">2234-5930</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Shafer, Wg" uniqKey="Shafer W">WG Shafer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hegde, U" uniqKey="Hegde U">U Hegde</name></author><author><name sortKey="Doddawad, Vg" uniqKey="Doddawad V">VG Doddawad</name></author><author><name sortKey="Sreeshyla, H" uniqKey="Sreeshyla H">H Sreeshyla</name></author><author><name sortKey="Patil, R" uniqKey="Patil R">R Patil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zegarelli, Dj" uniqKey="Zegarelli D">DJ Zegarelli</name></author><author><name sortKey="Zegarelli Schmidt, Ec" uniqKey="Zegarelli Schmidt E">EC Zegarelli-Schmidt</name></author><author><name sortKey="Zegarelli, Ev" uniqKey="Zegarelli E">EV 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Korean Assoc Oral Maxillofac Surg</journal-id><journal-id journal-id-type="iso-abbrev">J Korean Assoc Oral Maxillofac Surg</journal-id><journal-id journal-id-type="publisher-id">JKAOMS</journal-id><journal-title-group><journal-title>Journal of the Korean Association of Oral and Maxillofacial Surgeons</journal-title></journal-title-group><issn pub-type="ppub">2234-7550</issn><issn pub-type="epub">2234-5930</issn><publisher><publisher-name>The Korean Association of Oral and Maxillofacial Surgeons</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28053911</article-id><article-id pub-id-type="pmc">5206246</article-id><article-id pub-id-type="doi">10.5125/jkaoms.2016.42.6.383</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Verruciform xanthoma in the hard palate: a case report and literature review</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-5630-1983</contrib-id><name><surname>Garcia</surname><given-names>Alexandre Simões</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-3189-898X</contrib-id><name><surname>Pagin</surname><given-names>Otávio</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-0674-3759</contrib-id><name><surname>da Silva Santos</surname><given-names>Paulo Sérgio</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-6163-5526</contrib-id><name><surname>Oliveira</surname><given-names>Denise Tostes</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib></contrib-group><aff id="A1">Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.</aff><author-notes><corresp>Corresponding author: Alexandre Simões Garcia. Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo 17012-901, Brazil. TEL: +55-21-14-32358251, FAX: +55-21-14-32234679, <email>alexsg@fob.usp.br</email></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>27</day><month>12</month><year>2016</year></pub-date><volume>42</volume><issue>6</issue><fpage>383</fpage><lpage>387</lpage><history><date date-type="received"><day>26</day><month>1</month><year>2016</year></date><date date-type="rev-recd"><day>02</day><month>4</month><year>2016</year></date><date date-type="accepted"><day>05</day><month>4</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016 The Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.</p></abstract><kwd-group><kwd>Xanthomatosis</kwd><kwd>Hard palate</kwd><kwd>Immunohistochemistry</kwd></kwd-group></article-meta></front><body><sec><title>I. Introduction</title><p>Oral verruciform xanthoma (OVX) is an uncommon lesion described by Shafer in 1971<xref rid="B1" ref-type="bibr">1</xref>, that appears on oral mucosa as a reactive lesion. The etiopathogenesis of this lesion remains unclear, with reaction response to trauma the most accepted explanation<xref rid="B2" ref-type="bibr">2</xref>. Contrary to skin xanthomas that are associated with metabolic disturbances of lipids, OVXs are not related to any generalized disease<xref rid="B3" ref-type="bibr">3</xref>.</p><p>This lesion may occur anywhere in the oral mucosa, but the hard palate is the second most commonly affected site, representing approximately 15% of all cases in a large survey<xref rid="B4" ref-type="bibr">4</xref>.</p><p>The treatment for OVX is surgical resection, and recurrence is extremely rare<xref rid="B4" ref-type="bibr">4</xref>. Interestingly, the three recurrence case reports in the English literature occurred in the hard palate<xref rid="B5" ref-type="bibr">5</xref><xref rid="B6" ref-type="bibr">6</xref><xref rid="B7" ref-type="bibr">7</xref>.</p><p>The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this benign lesion in the differential diagnosis of verrucous lesions in this location.</p></sec><sec><title>II. Case Report</title><p>A 43-year-old man presented with a painless lesion in the hard palate, discovered during routine examination two months before. Clinically, a lesion with a verrucous surface and erythematous spots was observed next to the first upper right molar, measuring approximately 5 mm in diameter.(<xref ref-type="fig" rid="F1">Fig. 1</xref>) The patient was a current smoker. The presumptive diagnosis was squamous cell carcinoma or traumatic ulcer. Excisional biopsy was performed, and the surgical specimen was sent to the Bauru School of Dentistry Oral Pathology Biopsy Service of the University of São Paulo (Bauru, Brazil). Histopathological examination revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining.(<xref ref-type="fig" rid="F2">Fig. 2. A, 2. B</xref>) Immunohistochemical analysis revealed that foam cells were positive for anti-CD68 antibody (<xref ref-type="fig" rid="F2">Fig. 2. C</xref>), and anti-KI-67 antibody was restricted to the basal layer of the oral epithelium and negative for foam cells.(<xref ref-type="fig" rid="F2">Fig. 2. D</xref>) Based on clinical and microscopic features, the final diagnosis of OVX was established. After seven months of follow-up, the patient showed no signs of recurrence.(<xref ref-type="fig" rid="F3">Fig. 3</xref>)</p></sec><sec><title>III. Discussion</title><p>OVX is an uncommon lesion that was first described by Shafer in 1971<xref rid="B1" ref-type="bibr">1</xref>. It typically presents as a single lesion, the color of normal oral mucosa with verrucous surface, affecting mostly individuals over 40 years<xref rid="B4" ref-type="bibr">4</xref><xref rid="B8" ref-type="bibr">8</xref>. It can be confused clinically with verruca vulgaris, traumatic ulcers, and squamous cell carcinoma.</p><p>Histologically, it is characterized by hyperkeratosis, elongated rete pegs, and aggregates of foam cells in the submucosal stroma without epidermal atypia. Foam cells of verruciform xanthoma are of monocyte-macrophage lineage, based on intense cytoplasmic positivity for anti-CD68 and cathepsin B<xref rid="B9" ref-type="bibr">9</xref><xref rid="B10" ref-type="bibr">10</xref>.</p><p>The hard palate is the second most common area affected by OVX<xref rid="B4" ref-type="bibr">4</xref>. The relationship of this lesion with local trauma can explain why the gums and hard palate are impacted. The trauma induced by cigarettes in this location may also be involved in this lesion. Interestingly, the only three reports of recurrent OVX are in the hard palate<xref rid="B5" ref-type="bibr">5</xref><xref rid="B6" ref-type="bibr">6</xref><xref rid="B7" ref-type="bibr">7</xref>. This finding reinforces that areas experiencing excessive trauma are more affected by OVX.</p><p>OVX usually presents as a small solitary, sessile, or pedunculated lesion with a rough, slightly elevated surface and tends to be asymptomatic. The prevalence of OVX is unknown, although a relative frequency rate of 0.025% to 0.05% has been reported in the literature<xref rid="B2" ref-type="bibr">2</xref><xref rid="B11" ref-type="bibr">11</xref>. Such lesions occur most often on the gingiva, followed by hard palate, tongue, buccal mucosa, floor of the mouth, and soft palate<xref rid="B4" ref-type="bibr">4</xref>.</p><p>Philipsen et al.<xref rid="B4" ref-type="bibr">4</xref> showed in a large survey that OVX are common in men below the age of 50 years. In the present case, the patient was a 43-year-old male smoker who presented with a 0.5 cm lesion in the hard palate of two months duration.</p><p>We found 12 studies in the literature reporting verruciform xanthoma in the hard palate<xref rid="B6" ref-type="bibr">6</xref><xref rid="B8" ref-type="bibr">8</xref><xref rid="B12" ref-type="bibr">12</xref><xref rid="B13" ref-type="bibr">13</xref><xref rid="B14" ref-type="bibr">14</xref><xref rid="B15" ref-type="bibr">15</xref><xref rid="B16" ref-type="bibr">16</xref><xref rid="B17" ref-type="bibr">17</xref><xref rid="B18" ref-type="bibr">18</xref><xref rid="B19" ref-type="bibr">19</xref><xref rid="B20" ref-type="bibr">20</xref><xref rid="B21" ref-type="bibr">21</xref>. Articles without clinical information, immunohistochemical studies, multiple lesions, or involving the soft palate were excluded. The results are shown in <xref ref-type="table" rid="T1">Table 1</xref>.</p><p>Men were twice as likely to be affected than women (2:1). Lesions were normally small (average size of lesions 0.85 cm); however, three OVX lesions were 2 cm or more. The lesion surface was mostly verrucous. Older patients in the 40 to 90 year age range (mean age, 54 years) were significantly more frequently affected than younger patients. Almost 63% of the patients were smokers (5 of the 8 cases).</p><p>This case reinforces that OVX in the hard palate presents as small, painless lesions and affects men below 50 years. The influence of smoking habits is discussed below.</p><p>The diagnostic hallmark of OVX is the presence of lipidladen macrophages in the connective tissue between the epithelial ridges<xref rid="B2" ref-type="bibr">2</xref><xref rid="B4" ref-type="bibr">4</xref><xref rid="B16" ref-type="bibr">16</xref>. An extensive immunohistochemical study showed that foam cells are of monocyte-macrophage lineage based on intense cytoplasmic positivity for anti-CD68 and cathepsin B<xref rid="B9" ref-type="bibr">9</xref>. Rawal et al.<xref rid="B10" ref-type="bibr">10</xref> demonstrated that macrophages present in OVX are primarily reparative and resident, supporting the chronic reactive nature of OVX. In this case, a large number of xanthoma cells with clear cytoplasm and pyknotic nucleus were found. These cells were positive for CD6, confirming them as macrophages. The anti-KI-67 antibody was restricted to the basal layer of the epithelium, showing that the lesion was not malignant.</p><p>The pathogenesis of OVX remains unknown. Most patients with OVX do not have hyperlipidemia<xref rid="B22" ref-type="bibr">22</xref>. The mechanism of the accumulation of lipid-containing foam cells in the submucosa or dermis is also not clear<xref rid="B2" ref-type="bibr">2</xref>.</p><p>An ultrastructural and immunohistochemical study showed that, after the development of OVX, oxidized low-density lipoprotein (ox-LDL) induces foam cell necrosis, and resident macrophages clean the debris and cyclically perpetuate VX<xref rid="B23" ref-type="bibr">23</xref>. Ultrastructural and in situ hybridization have not shown an association between HPV and OVX, excluding a viral etiology for this lesion<xref rid="B24" ref-type="bibr">24</xref>.</p><p>Metabolic abnormalities of lipids and lymphedema are associated with nonmucosal cutaneous verruciform xanthoma<xref rid="B3" ref-type="bibr">3</xref><xref rid="B25" ref-type="bibr">25</xref>. The obstruction of lymphatic vessels results in accumulation of lipids in the connective tissue, and these lipids are scavenged by macrophages, producing xanthomas in patients with lymphedema<xref rid="B25" ref-type="bibr">25</xref>.</p><p>Patients with CHILD syndrome show inactivity of an enzyme related with cholesterol synthesis and interestingly have been reported to have concomitant verruciform xanthoma<xref rid="B26" ref-type="bibr">26</xref>.</p><p>The association of systemic diseases with cutaneous verruciform xanthoma but not OVX indicates that local trauma and inflammation are the most likely causes of OVX, since the epithelial cell degeneration caused by this condition releases lipid material that is scavenged by local macrophages. Studies have shown that the macrophages present in OVX are resident, mature, chronic inflammatory macrophages, confirming that is a chronic, slow-growing inflammatory lesion<xref rid="B10" ref-type="bibr">10</xref>.</p><p>These findings are consistent with the influence of smoking habits in the pathogenesis of OVX. Local trauma caused by cigarettes, especially in the hard palate, may be associated with OVX development. However, further studies need to be performed to confirm this association.</p><p>We did not find specific OVX surveys by location in the literature. The hard palate is the second most affected area, and local trauma caused by smoking can be a cause of this lesion. 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elongated rete pegs and numerous foam cells with clear cytoplasm and pyknotic nucleus in the connective tissue (H&E staining, ×200; A), foam cells showing negative for periodic acid-Schiff (PAS staining, ×400; B), foam cells positive for anti-CD68 antibody (anti-CD68 staining, ×400; C), basal layer of the oral epithelium positive to KI-67 and negative for foam cells (anti-KI-67 staining, ×200; D).</title></caption><graphic xlink:href="jkaoms-42-383-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><title>Seven months of follow-up, no recurrences.</title></caption><graphic xlink:href="jkaoms-42-383-g003"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Clinical features of verruciform xanthoma in the hard palate</title></caption><alternatives><graphic xlink:href="jkaoms-42-383-i001"></graphic><table frame="hsides" rules="rows"><col width="30.93%" span="1"></col><col width="12.45%" span="1"></col><col width="6.42%" span="1"></col><col width="7.39%" span="1"></col><col width="14.79%" span="1"></col><col width="7.98%" span="1"></col><col width="12.26%" span="1"></col><col width="7.78%" span="1"></col><thead><tr><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Author</th><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Local</th><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Sex</th><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Age (yr)</th><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Surface</th><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Size (cm)</th><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Evolution (mo)</th><th valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(230,231,232)">Smoking</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Hume et al.<xref rid="B12" ref-type="bibr">12</xref>, 1980</td><td valign="top" align="center" rowspan="1" colspan="1">Palatal gingiva</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">60</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.4</td><td valign="top" align="center" rowspan="1" colspan="1">3</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="left" rowspan="3" colspan="1">Neville and Weathers<xref rid="B13" ref-type="bibr">13</xref>, 1980</td><td valign="top" align="center" rowspan="1" colspan="1">Palatal gingiva</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">59</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">1.0</td><td valign="top" align="center" rowspan="1" colspan="1">6</td><td valign="top" align="center" rowspan="1" colspan="1">No</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate lingual</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">45</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">0.4</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">56</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="left" rowspan="16" colspan="1">Nowparast et al.<xref rid="B6" ref-type="bibr">6</xref>, 1981</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">24</td><td valign="top" align="center" rowspan="1" colspan="1">Papillary</td><td valign="top" align="center" rowspan="1" colspan="1">0.7</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">31</td><td valign="top" align="center" rowspan="1" colspan="1">Papillary</td><td valign="top" align="center" rowspan="1" colspan="1">1.5</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">66</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">62</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.3</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">50</td><td valign="top" align="center" rowspan="1" colspan="1">Papillary</td><td valign="top" align="center" rowspan="1" colspan="1">1.2</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palatal junction</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">73</td><td valign="top" align="center" rowspan="1" colspan="1">Flat</td><td valign="top" align="center" rowspan="1" colspan="1">0.7</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">81</td><td valign="top" align="center" rowspan="1" colspan="1">Flat</td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">67</td><td valign="top" align="center" rowspan="1" colspan="1">Flat</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">89</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.3</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">75</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.3</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">52</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">1.0</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">77</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.4</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">78</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.4</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">71</td><td valign="top" align="center" rowspan="1" colspan="1">Flat</td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">39</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">1.3</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">67</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kakarantza-Angelopoulou et al.<xref rid="B8" ref-type="bibr">8</xref>, 1991</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">42</td><td valign="top" align="center" rowspan="1" colspan="1">Rough</td><td valign="top" align="center" rowspan="1" colspan="1">0.7</td><td valign="top" align="center" rowspan="1" colspan="1">“Slowly”</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Rhinow et al.<xref rid="B14" ref-type="bibr">14</xref>, 2003</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">46</td><td valign="top" align="center" rowspan="1" colspan="1">Granular</td><td valign="top" align="center" rowspan="1" colspan="1">2.0</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hu et al.<xref rid="B15" ref-type="bibr">15</xref>, 2005</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">48</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.3</td><td valign="top" align="center" rowspan="1" colspan="1">48</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="2" colspan="1">Yu et al.<xref rid="B16" ref-type="bibr">16</xref>, 2007</td><td valign="top" align="center" rowspan="1" colspan="1">Palatal gingiva</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">31</td><td valign="top" align="center" rowspan="1" colspan="1">Papillary</td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">No</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palatal gingiva</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">39</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.7</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Cheng et al.<xref rid="B17" ref-type="bibr">17</xref>, 2010</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">22</td><td valign="top" align="center" rowspan="1" colspan="1">Rough</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">Unknown</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Shahrabi Farahani et al.<xref rid="B18" ref-type="bibr">18</xref>, 2011</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">45</td><td valign="top" align="center" rowspan="1" colspan="1">Granular</td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="left" rowspan="2" colspan="1">Ryu et al.<xref rid="B19" ref-type="bibr">19</xref>, 2013</td><td valign="top" align="center" rowspan="1" colspan="1">Palatal gingiva</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">37</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous/papillary</td><td valign="top" align="center" rowspan="1" colspan="1">1.5</td><td valign="top" align="center" rowspan="1" colspan="1">12</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Palatal gingiva</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">35</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous/papillary</td><td valign="top" align="center" rowspan="1" colspan="1">2.5</td><td valign="top" align="center" rowspan="1" colspan="1">1</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Aggarwal et al.<xref rid="B20" ref-type="bibr">20</xref>, 2014</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">46</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">2.0</td><td valign="top" align="center" rowspan="1" colspan="1">36</td><td valign="top" align="center" rowspan="1" colspan="1">-</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Bhattacharyya and Islam<xref rid="B21" ref-type="bibr">21</xref>, 2014</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">F</td><td valign="top" align="center" rowspan="1" colspan="1">44</td><td valign="top" align="center" rowspan="1" colspan="1">-</td><td valign="top" align="center" rowspan="1" colspan="1">1.0</td><td valign="top" align="center" rowspan="1" colspan="1">2</td><td valign="top" align="center" rowspan="1" colspan="1">No</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Present case</td><td valign="top" align="center" rowspan="1" colspan="1">Palate</td><td valign="top" align="center" rowspan="1" colspan="1">M</td><td valign="top" align="center" rowspan="1" colspan="1">43</td><td valign="top" align="center" rowspan="1" colspan="1">Verrucous</td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" align="center" rowspan="1" colspan="1">2</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td></tr></tbody></table></alternatives><table-wrap-foot><fn><p>(M: male, F: female, -: not informed)</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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