Etis Duhita Rahayuningtyas, 1 Irna Sufiawati 2
Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
Oral Medicine Department, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
Objective: Within the spectrum of HIV-associated oral lesions there has been an increasing frequency in the number of oral lesions associated with the human papillomavirus-(HPV-OL), concurring with the introduction of highly active antiretroviral therapy (HAART). In this case report, we describe a tissue mass on the dorsal aspect of the tongue of a female with HIV undergoing HAART.
Method: A 37-years old woman who had been prescribed zidovudine, lamivudine, nevirapine for nine years, presented with an uncomfortable sensation while eating or talking. The discomfort was associated with a lump on the dorsum of the tongue that first appeared three months ago. Extensive caries was visible in the upper right maxillary molar a near the lump. Complete haematology tests, CD4 counts and viral load were collected in preparation for biopsy. The patient agreed to undergo the biopsy and had given valid consent.
Excisional biopsy under local anaesthesia was done to excise the tumour mass. The mass was stored in formaldehyde and a histopathological examination is performed. All haematology ranges were normal, viral load immunoserology showed HIV undetectable. CD4 counts were 1,044 cell/uL and CD8 counts 980 cell/uL. A 0.7x0.6x0.3 cm chewy brownish white of mass. The microscopic view revealed mucosa lined with layered squamous epithelium that grows hyperplastically, papillomatosis. The cell's core is within normal limits. The sub-epithelium consists of fibrocolagen connective tissue associated with inflammatory cell lymphocytes, plasma cells, and histiocytes. Muscle tissues within normal limits. There were no signs of malignancy. Based on the histopathological examination, a diagnosis of squamous cells papilloma was made.
Conclusion: Squamous cells papilloma in this case is a benign lesion which had occurred in a patient taking long-term HAART. The concern in HIV patients is that it is important to distinguish between benign lesions and Oral Premalignant Disorders (OPMD). Regular follow up is required to prevent progression to a dysplastic lesion and neoplasia.