Focal Epithelial Hyperplasia (Heck`s Disease)
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Transcript Focal Epithelial Hyperplasia (Heck`s Disease)
Focal epithelial hyperplasia (FEH) is a rare disorder described by Heck primarily as a
disease of Native American children and adolescents, being extremely rare among the
white population.
The disease is characterized by multiple, soft, circumscribed, sessile, nodular elevations of
the oral mucosa.
This lesions may be single or clustered; in extreme cases, the confluent lesions may result
in a ”cobblestoned” mucosa.
Convincing evidence assigned the etiologic role to HPV infection of squamous epithelia
with subtypes 13 and 32.
There is a tendency toward multiple familial cases, suggesting genetic predisposition.
Clinical features
9-year young girl with multiple asymptomatic
lesions of oral mucosa
5-10 mm in diameter
soft rounded or nodular appearance
similar in color to the surrounding mucosa,
with no inflammatory appearance
lasting for 7 months
Clinical differential diagnosis
multiple squamous papillomas
condylomata acuminata
neurofibromatosis
acanthosis nigricans
multiple hamartoma of Cowden’s syndrome
=> shave-biopsy and histological examination of one lesion
• minimal parakeratosis
• acanthotic epithelium with prominent clubbing and fusion of epithelial ridges
• minimal connective tissue papillae without well-defined projetions of epithelium
• special ballooning type of nuclear degeneration in some
epithelial cells dispersed in all epithelium levels
• typical koilocytic change
• no epithelial dysplasia
• coarse clumped heterochromatin with
pseudomitotic appearance = ”mitosoid bodies”
Mitosoid body = the characteristic feature which enable
the diagnosis of Focal Epithelial Hyperplasia with certainity.
FEH is a benign asymptomatic condition, requiring only reassurance.
Ancillary studies for HPV detection are unnecessary in an appropriate clinical context.
A careful histopathological examination is essential in order to rule out sexually
transmitted viral diseases with medico-legal implications, especially in areas with very
low prevalence of Heck’s disease.