title: Focal Epithelial Hyperplasia (Heck's Disease) in a 57-Year-Old Brazilian Patient: A Case Report and Literature Review.
abstract: Focal epithelial hyperplasia (FEH), or Heck's disease, is a rare disease of the oral mucosa associated with infection by some subtypes of human papilloma virus, especially subtypes 13 or 32. The disease is predominantly found in children and adolescents with indigenous heritage, but other ethnic groups can be affected worldwide. To the best of the authors' knowledge, it has not been reported in Brazil's elderly population. This article describes a case of FEH in a 57-year-old Brazilian patient presenting since childhood, with multiple lesions in the lips, buccal mucosa and tongue. The solitary tongue lesion underwent excisional biopsy and the histopathological analysis showed parakeratosis, acanthosis, rete pegs with a club-shaped appearance, koilocytosis and the presence of mitosoid cells. These microscopic findings in conjunction with clinical presentation were sufficient to establish the accurate diagnosis of FEH. Polymerase chain reaction (PCR) was performed, but no one human papillomavirus (HPV) subtype could be identified. Clinicians must be aware of this rare oral disease, which can even affect elderly patients, as we described here. Treatment may be indicated in selected cases due to esthetic and/or functional problems.
authors.affiliation: School of Medicine, Federal University of Tocantins, Palmas-TO, Brazil.
authors.forename: Luciano Alberto
authors.initials: LA
authors.lastname: de Castro
authors.affiliation: School of Medicine, Federal University of Tocantins, Palmas-TO, Brazil.
authors.forename: Joao Gabriel Leite
authors.initials: JG
authors.lastname: de Castro
authors.affiliation: School of Medicine, Federal University of Tocantins, Palmas-TO, Brazil.
authors.forename: Alexandre Duarte Lopes
authors.initials: AD
authors.lastname: da Cruz
authors.affiliation: School of Medicine, Federal University of Tocantins, Palmas-TO, Brazil.
authors.forename: Bruno Henrique de Sousa
authors.initials: BH
authors.lastname: Barbosa
authors.affiliation: Department of Biological and Biomedical Sciences, Pontifical Catholic University of Goias, Goiania-GO, Brazil.
authors.forename: Jose Vieira
authors.initials: JV
authors.lastname: de Spindula-Filho
authors.affiliation: Department of Pathology and Laboratory Medicine, School of Medicine, Federal University of Goias, Goiania-GO, Brazil.
authors.forename: Mauricio Barcelos
authors.initials: MB
authors.lastname: Costa
keywords: Biopsy; Elderly patients; Focal epithelial hyperplasia; Heck’s disease; Human papillomavirus