Focal Epithelial Hyperplasia

Abstract

Focal epithelial hyperplasia (FEH) or Heck's disease is a rare, benign, oral condition that is associated with infection by human papillomavirus type 13, 32 or both. The whiteish to mucosal-colored, soft, papular or nodular elevated lesions in the oral cavity are normally asymptomatic but can grow to a size or at a location where treatment is needed. The diagnosis is often based on clinical presentation and histopathology, and the HPV genotype can be determined using PCR utilizing specific primers or DNA sequencing. While FEH was reported to often affect several members of the same family and exist primarily among indigenous populations around the world, the number of reported cases within the European region is increasing. This contemporary review summarizes the main findings in relation to HPV genotypes, impact of superinfection exclusion and vaccination, transmission, diagnosis, geographical and ethnical distribution, comorbidities and treatment of FEH with an emphasis on including the most recent case reports within the field. Furthermore, we describe for the first time a FEH lesion infected with the low-risk HPV90.

Keywords: FEH; HPV13; HPV32; Heck’s disease; MEH; focal epithelial hyperplasia; human papillomavirus 13; human papillomavirus 32; multifocal epithelial hyperplasia.

Figure 1

Clinical manifestations of focal epithelial hyperplasia (FEH). (a) Clinical photo of two minor FEH lesions located on the lateral side of the tongue. (b) Example of a histopathological examination of an FEH lesion (H&E stain) from a 56-year-old Danish female. The lesion was located on the inside of the lower lip and the diagnosis was based on the clinical and histopathological examination. The biopsy revealed a small, flat squamous papilloma with conspicuous koilocytosis that was characterized by several layers of cells with hyperchromatic nuclei with irregular contours and a perinuclear halo. HPV90 was detected with PCR using the VisionArray HPV Chip 1.0. There were no signs of dysplasia or malignancy. (c) Example of a mitosoid body (indicated by an arrow) from the FEH lesion described in (b).