Oral Pathology Reports: Key Insights on Squamous Hyperplasia and Tumor Concerns

Consultation for Oral Pathology Report Interpretation

In April of this year, an unknown growth was discovered in the upper jaw, which was asymptomatic.
After a hospital examination, it was surgically removed, and the pathology report indicated inflammatory cell fibrosis.
Less than a month later, a similar growth appeared in approximately the same location, leading to another surgery.
This time, the pathology report showed hyperplasia of squamous epithelium with hyperkeratosis.

First pathology report:
Gross description: Specimen received, labeled as oral region, consists of one fragment of grayish-tan formalin-fixed tissue, measuring 0.2 x 0.1 x 0.1 cm in size.
The specimen is submitted totally for section.
Microscopic Examination: The section reveals chronic inflammatory cell infiltration and fibrosis.
Second pathology report:
Gross description: Specimen received, labeled as oral region, consists of one fragment of grayish-tan formalin-fixed tissue, measuring 0.1 x 0.1 x 0.1 cm in size.
The specimen is submitted totally for section.
Microscopic Examination: The section reveals hyperplasia of squamous epithelium with hyperkeratosis.
1.
Is squamous hyperplasia a concerning condition? Will the pathology report indicate the presence of malignant cells?
2.
Why did the growth recur in less than a month? Is it because it is a concerning condition, making it difficult to eradicate?
3.
What should I do next? What should I pay attention to?
4.
I found information online about squamous cell carcinoma commonly occurring in the oral cavity.

A, 30~39 year old female. Ask Date: 2023/06/07

Dr. Chen Sirong reply Oncology

A / 39 years old / Female
1.
Is squamous hyperplasia a bad thing? Will the pathology report show any bad cells?
A: It is benign, so it cannot be classified as bad cells.

2.
Why did it grow back in less than a month? Is it because it is something bad? Is it therefore impossible to eradicate?
A: It is difficult to determine how soon it will grow back: 2.1 It may not have been detected previously, 2.2 the excision may not have been complete, 2.3 if it was excised too broadly, and it was considered a benign tumor, the safety margin may have been too small, making recurrence more likely.
I want to emphasize again: it is currently benign hyperplasia.
Even if it is eradicated this time, it can still grow back.

3.
What should I do next? What should I pay attention to?
A: Everyone should pay attention to their own body.
If there is a growth, further examination or excision should be done.
For oral health, it is essential to avoid tobacco, alcohol, and betel nut.

4.
I read online that squamous cell carcinoma commonly occurs in the oral cavity?
A: Yes, but you are not experiencing that right now.
Wishing you mental and physical well-being.
Dr.
Chen Sih-Rong.

Reply Date: 2023/06/07

More Info

Understanding oral pathology reports, particularly regarding squamous hyperplasia and tumor concerns, is crucial for patients navigating their health. Based on your pathology reports, it appears that you have experienced two significant findings in your oral cavity: chronic inflammation with fibrosis and squamous hyperplasia with hyperkeratosis.

1. Is squamous hyperplasia a bad thing?
Squamous hyperplasia refers to an increase in the number of squamous cells, which are the flat cells that make up the outer layer of the skin and mucous membranes. Hyperkeratosis, on the other hand, indicates an abnormal thickening of the outer layer of the skin or mucous membranes. While these conditions are not inherently malignant, they can be precursors to more serious conditions, including squamous cell carcinoma (SCC) if left unchecked. The pathology report does not indicate the presence of malignant cells, which is a positive sign. However, it is essential to monitor these changes closely, as persistent hyperplasia can sometimes lead to dysplastic changes, which are more concerning.

2. Why did it grow back within a month?
The recurrence of the lesion within a month could be attributed to several factors. First, the initial lesion may not have been completely excised, allowing residual cells to proliferate. Second, the underlying cause of the hyperplasia, such as chronic irritation or inflammation, may still be present. This could be due to factors like tobacco use, poor oral hygiene, or other irritants. It is not necessarily indicative of a malignant process, but it does suggest that the underlying issue needs to be addressed to prevent further recurrence.

3. What should I do next?
Moving forward, it is crucial to maintain regular follow-ups with your healthcare provider, preferably an oral pathologist or an oral surgeon. They may recommend further excisional biopsies to ensure complete removal of the hyperplastic tissue. Additionally, addressing any potential irritants in your oral environment is vital. This may include improving oral hygiene, quitting smoking, or avoiding certain foods that may irritate the area. Your healthcare provider may also suggest monitoring the area with periodic examinations and possibly imaging studies if warranted.

4. Concerns about oral squamous cell carcinoma (SCC):
It is understandable to be concerned about the potential for squamous cell carcinoma, especially given the context of your findings. SCC is indeed a common malignancy in the oral cavity, often associated with risk factors such as tobacco use, alcohol consumption, and HPV infection. While squamous hyperplasia itself is not cancerous, it is essential to remain vigilant. Regular check-ups and any recommended biopsies are critical in catching any potential malignant changes early. If you notice any new symptoms, such as persistent sores, changes in the texture of the tissue, or difficulty swallowing, you should report these to your healthcare provider immediately.

In summary, while your pathology reports indicate changes that warrant attention, they do not currently suggest malignancy. However, the recurrence of the lesion and the nature of squamous hyperplasia necessitate ongoing monitoring and possibly further intervention. Engaging in open communication with your healthcare team will be vital in managing your oral health effectively.

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