Heck Disease — MFDS Part 1 MCQ

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HardOral PathologyHeck DiseaseMFDS Part 1

A 13-year-old presents with multiple asymptomatic, soft, mucosa-coloured, sessile papules affecting the labial and buccal mucosa. Biopsy shows acanthosis, broad anastomosing rete ridges, koilocytosis and mitosoid bodies, without epithelial dysplasia. Which viral association is most characteristic of this condition?

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Correct answer: B — Human papillomavirus type 13 or 32

The findings indicate focal epithelial hyperplasia (Heck disease), a benign oral mucosal disorder strongly associated with the low-risk human papillomavirus genotypes HPV-13 and HPV-32. Typical features include multiple soft, painless papules in younger patients, with koilocytosis, broad or anastomosing rete ridges and characteristic mitosoid bodies histologically. HPV-16 and HPV-18 are high-risk oncogenic genotypes associated principally with anogenital and oropharyngeal malignancy rather than Heck disease. HSV-1 causes primary herpetic gingivostomatitis and recurrent herpes; EBV is associated with oral hairy leukoplakia and several lymphoid malignancies; VZV causes varicella and herpes zoster.

Reference: Bendtsen SK et al. Focal Epithelial Hyperplasia. Viruses. 2021;13(8):1529. https://pubmed.ncbi.nlm.nih.gov/34452393/