Identification and diagnosis of HPV-driven oral intraepithelial neoplasia by healthcare professionals: a case series

Introduction

Human papillomavirus (HPV) is a well-known virus that can induce oncogenesis in multiple anatomic locations. In the head and neck, oropharyngeal carcinoma has become prevalent in recent decades. Notably, HPV-driven dysplasia can be seen in the oral cavity, an easily visualized site during physical exam. Understanding of common sites in the oral cavity and the patient populations affected by HPV-associated oral intraepithelial neoplasia can lead to early detection and diagnosis by dental practitioners and pathologists. The aim of this study is to describe cases of HPV-driven intraepithelial neoplasia in the context of patient population and presentation and to raise awareness of this lesser-known entity.

Methods

Four cases diagnosed as oral intraepithelial neoplasia were identified between May 2020 and June 2022. Patient demographic, initial presentation, histology, immunohistochemical, and in situ hybridization results were evaluated for each case.

Results

All cases presented in the ventral tongue and/or floor of mouth in adult males. One case was in an immunocompromised nonsmoker and the remaining three cases were in smokers. Immunohistochemistry for p16 was positive in all cases and high-risk HPV subtypes were identified in three cases by in situ hybridization. Histology showed full thickness, hyperplastic squamous dysplasia with hyperchromatic and pleomorphic nuclei, increased mitoses and apoptotic bodies, and variable keratosis with dyskeratosis in all cases.

Conclusion

Identification and diagnosis of this subset of oral epithelial dysplasia is facilitated by knowledge of how this entity presents itself, with immunocompromised adult males being the patient population at highest risk. Notably, the majority of cases illustrated here had an atypical presentation with a smoking history, which is not a commonly associated risk factor for HPV-driven lesions. Promotion of HPV vaccination by dental practitioners and early detection of these precursor lesions by healthcare professionals can lead to a decrease in oral cavity invasive squamous cell carcinoma.