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103:Unusual Diagnosis of Multifocal Epithelial Hyperplasia in a Caucasian Septuagenarian[AAOM2020}
EP35994
Poster Title: 103:Unusual Diagnosis of Multifocal Epithelial Hyperplasia in a Caucasian Septuagenarian[AAOM2020}
Submitted on 29 Mar 2021
Author(s): Alhendi, Fatmah D.D.S.1, Musto, Charles J., D.M.D.2, Bilodeau, Elizabeth A., D.M.D., M.D., M.S.Ed.3, Stoopler, Eric T. D.M.D.,1
Affiliations: Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, 2 Private Practice, Forty Fort, Pennsylvania, 3 Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania.
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
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Poster Information
Abstract: Background

Multifocal epithelial hyperplasia [(MEH), also known as Heck disease], is a proliferative condition characterized by multifocal nodules of the oral squamous mucosa. Etiopathogenesis is associated with human papillomavirus [HPV], with subtypes 13 and 32 most frequently implicated. Clinically, it presents in papulonodular or papillomatous forms. This condition is most frequently observed in children and adolescents of specific ethnic groups, such as Eskimo, and those of North, Central and South American Indian descent.

Case Report

A 77-year-old Caucasian female complained of multiple asymptomatic oral lesions of 3 months’ duration intermittently traumatized with function. Medical history was significant for atrial fibrillation, asthma, bronchiectasis, cystic fibrosis, hypercholesterolemia, hypertension, hypothyroidism and pancreatic insufficiency. Past surgical history included hemorrhoidectomy, hysterectomy, lung resection and total hip replacement. Patient reported twenty-nine prescription medications and multiple drug allergies. Past family and social histories were unremarkable. Review of systems was positive for anosmia, dyspnea, hypogeusia and xerophthalmia. The patient appeared as a well-nourished, well-developed female in no apparent distress. Extraoral examination was negative for lymphadenopathy, salivary gland enlargement or thyromegaly. Intraoral examination revealed multiple 0.5 cm, non-tender, smooth-surfaced nodules on the buccal and labial mucosae of normal mucosal color. Clinical diagnosis was consistent with MEH, papulonodular form. Excisional biopsy of two nodules on the maxillary and mandibular labial mucosa, respectively, were consistent with fibroepithelial hyperplasia. Pan-HPV immunohistochemical stain was positive (HPV subtyping not available). Cumulative findings were consistent with MEH, papulonodular form. Current management consists of excising nodules of esthetic concern and / or functional impediment.

Conclusions

MEH may present as a diagnostic and therapeutic challenge, particularly with an atypical demographic presentation as the patient described herein. MEH may be observed in immunocompromised adults, including those with age-related immunosenescence. Oral health care providers should be familiar with MEH in order to provide optimal patient care.
Summary: Multifocal epithelial hyperplasia [(MEH), also known as Heck disease], is a proliferative condition characterized by multifocal nodules of the oral squamous mucosa.

Ask the author questions about this poster:falhendi@upenn.edu, fatmaj_13@hotmail.com
References: 1. Said AK, Leao JC, Fedele S, Porter SR. Focal Epithelial Hyperplasia – An Update. J Oral Pathol Med. 2013; 42:
435 - 442.
2. de Castro LA, de Castro JG, da Cruz AD, et al. Focal Epithelial Hyperplasia (Heck's Disease) in a 57-Year-Old
Brazilian Patient: A Case Report and Literature Review. J
Clin Med Res. 2016; 8: 346-350.
3.Agnew C, Alexander S, Prabhu N. Multifocal Epithelial Hyperplasia. J Dent Child (Chic). 2017; 84: 47-49.
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