Forum for Clinical and Surgical Oral Pathology

Case BBOPF 07-6

Dr. Beatriz Aldape (Faculty of Odontology, National Autonomous University of Mexico, MEXICO) invites your comments and suggestions for management of the ensuing case. Please send your comments in the window located below the images. This case will be posted from September 7 to September 14, 2007. A summary of the responses will be posted in BBOP.

Clinical History

A 38 year-old female reported having had oral sex with the subsequent development of lingual lesions that were clinically diagnosed by a dermatologist as "condylomas." No biopsy was obtained. The dermatologist decided to use cryotherapy to treat these lesions. The patient underwent 8 cryotherapy sessions and was expected to receive 5 more. However, the patient declined to continue with this treatment due to severe pain.

The clinical picture shows the status of the lingual lesions when she came to see us. We performed a biopsy of the largest papillary lesion. Representative images are included below.

1. Do you think that these lesions are consistent with HPV warts?
2. The microscopic images show dysplastic changes. In your experience, is it common to see this type of cellular abnormalities in tissues adjacent to sites previously treated with cryotherapy?
3. Do you think that the epithelial dysplasia is virally induced?
4. I would greatly appreciate your therapeutic suggestions to manage this patient.

Thank you for your help!

Images

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Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).