A Concerning Uvula Abnormality

Correct answer: B. Squamous papilloma of the uvula

Given the patient’s history and examination findings, the growth was consistent with squamous papilloma of the uvula, especially with the visual formation of the bridge of tissue.

Discussion. Papillomata are benign growths that occur mostly on the palate and tongue but can occur on the uvula as well.¹ They are usually asymptomatic, but symptoms can be present depending on the length of the lesion.² The peak occurrence is in adulthood, and patients usually present with continuous throat irritation.² However, oral squamous cell papillomata, like squamous papilloma of the larynx, are not associated with cancer.¹ The pathology of oral squamous papillomata shows stratified squamous epithelium with a fibrovascular core.² Squamous papilloma has been associated with human papillomavirus (HPV), but recent literature theorizes that it may be an unrelated incidental finding.² The treatment options include surgical or electrocautery excision, laser ablation, cryosurgery, or intralesional injections.² Recurrence is not common; individuals with HIV may have a higher risk of recurrence, but recurrence is rare among immunocompetent individuals.^1,2

Other differential diagnoses to consider are cleft uvula, uvulitis, or isolated uvular angioedema. Cleft uvula is one of the less-severe forms of cleft palate, which usually presents with cleft palate and rarely on its own.³ It can range from barely bifurcated to complete bifurcation with cleft palate and cranial nerve IX impairment.³

Uvulitis is inflammation and swelling of the uvula most commonly secondary to Haemophilus influenzae type b or streptococcal pharyngitis.⁴ It is different from allergic edema of the uvula in that uvulitis presents with fever, pain, and erythema.⁴

Isolated uvular angioedema (ie, Quincke disease) is caused by a type 1 hypersensitivity reaction.⁵ Treatment includes corticosteroids and antihistamines as well as airway protection.⁵

Patient outcome. Our patient was referred to an otolaryngologist for further evaluation. The specialist performed a biopsy, results of which showed benign squamous papilloma and no epithelial dysplasia. This confirmed the diagnosis of squamous papilloma of the uvula. The patient had completed the HPV vaccine series as a teenager. The pedunculated mass was surgically excised in the specialist’s office. No further follow-up was needed after surgical resection and pathology report per the specialist.

References

1. Frigerio M, Martinelli-Kläy CP, Lombardi T. Clinical, histopathological and immunohistochemical study of oral squamous papillomas. Acta Odontol Scand. 2015;73(7):508-515. https://doi.org/10.3109/00016357.2014.996186

2. Ramasamy K, Kanapaty Y, Abdul Gani N. Symptomatic oral squamous papilloma of the uvula - a rare incidental finding. Malays Fam Physician. 2019;14(3):74-76. https://e-mfp.org/wp-content/uploads/2019/12/v14n3-case-report-5.pdf

3. Sales SAG, Santos ML, Machado RA, et al. Incidence of bifid uvula and its relationship to submucous cleft palate and a family history of oral cleft in the Brazilian population. Braz J Otorhinolaryngol. 2018;84(6):687-690. https://doi.org/10.1016/j.bjorl.2017.08.004

4. Wald ER. Uvulitis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 7th ed. Elsevier; 2017: 165-167.

5. Chandran A, Sakthivel P, Chirom AS. Quincke's disease. BMJ Case Rep. 2019;12(9):e231967. https://doi.org/10.1136/bcr-2019-231967