DT U.S. Edition, October 2010, Vol. 5, No. 21

and basaloid carcinoma; it is also possible to categorize types of OSCC based on clinical descriptors such as ulcerative, flat, polypoid and verru- coid.2 OSCC variants can have differ- ent growth patterns, ranging from small mucosal thickenings to large masses, and can appear endophytic or exophytic. These tumors are erythematous to white to tan, frequently feeling firm on palpation. Conventional OSCC is composed of variable degrees of squamous differentiation, with well- differentiated cells closely recapitu- lating normal squamous epithelium but demonstrating some degree of basement membrane violation by nests of tumor cells, to poorly differ- entiated cells with more anaplastic- like appearances. As a result of its complex exo- phytic papillary architecture, the papillary variant of SCC can be a challenge to accurately diagnose and histologic assessment of under- lying invasion can be very difficult.3 Risk factors and pathogenesis for papillary SCC are unclear although human papilloma virus subtypes are thought to play a role in some cases.3 The purpose of this paper is to (a) present a rare case of papil- lary OSCC affecting the hard palate, and (b) describe the clinical and histologic features of this tumor in supporting the dentist’s role in early detection. Case report A 63-year-old female presented to the dental clinic at the Herman Ostrow School of Dentistry, Univer- sity of Southern California with the chief complaint of a growth appear- ing on the roof of her mouth approx- imately two months prior to her pre- sentation to our clinic. The patient’s past medical history included type II diabetes mellitus controlled with diet and exercise, and denial of any alcohol or tobacco use. The remainder of her medical and social history was non-contribu- tory; she was not taking any medica- tions and a review of systems was unremarkable. Intraoral examina- tion revealed a 3.5 cm exophytic mass in the anterior midline region of the hard palate (Fig. 1). The lesion appeared vascularized with ill-defined borders and no evidence of ulceration or erosion. The patient had mild sensitivity upon palpation of the lesion. No cer- vical or submandibular lymphade- nopathy was observed during the extraoral examination of the head and neck. Panoramic radiography revealed no abnormalities of the palatal area. The patient was informed that a biopsy must be taken to obtain a definitive diagnosis; informed con- sent was obtained for incisional biopsy with local anesthesia. During the administration of local anes- thesia, the cortical bone under the tumor felt intact with the end of the needle. A representative wedge of tissue was removed and placed in 10 percent formalin for microscopic evaluation. The biopsy site was cauterized to obtain postoperative hemostasis due to the high degree of vascularity. The biopsy site was closed with four 3.0 chromic gut interrupted sutures. Hemostasis was achieved, postop- erative instructions were given and the patient’s postoperative condition was good. The gross examination of the specimen consisted of a soft, tan papillary and friable mass. The his- Clinical DENTAL TRIBUNE | OctOber 20106A AD f DT page 5A Fig. 1: Clinical image of the palate of a 63-year-old female showing an erythematous exophytic mass with a cauliflower-like or papillary surface architecture. (Photos/Provided by Paul Lee)