Papillary Hyperplasia

Papillary hyperplasia is typically seen in the hard palate. In many cases it is related to dentures as part of the clinical spectrum of denture-induced stomatitis [174]. Although Candida albicans is frequently invoked as the causal agent, in a significant number of cases there is no evidence of fungal infection. The large majority of cases involve the hard palate, particularly when this is high-arched, but similar lesions are occasionally seen on the dorsum of the tongue. The lesions form painless, nodu-

Fig. 3.16. Papillary hyperplasia of the palate showing long rete processes extending into the connective tissue cores

lar or papilliferous proliferations. Florid cases have been reported in immunocompromised patients [151].

Microscopy shows nodular, papilliferous hyperpla-sia of the epithelium and underlying fibrous connective tissue (Fig. 3.16). The surface usually shows parakerato-sis or less commonly orthokeratosis. There may be evidence of candidal infestation such as spongiform pustules or obvious hyphae. The underlying hyperplastic rete ridges often extend into the cores of the papillae, resulting in a striking pseudoepitheliomatous appearance. The corium often contains a dense chronic inflammatory cell infiltrate. The condition then needs to be distinguished from oral papillary plasmacytosis [66].

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