Hyperparakeratosis — MFDS Part 1 MCQ

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ModerateOral PathologyHyperparakeratosisMFDS Part 1

An oral biopsy from a persistent white plaque shows a thickened surface keratin layer composed of flattened squames that retain small pyknotic nuclei. Epithelial maturation and polarity are otherwise preserved, with no cytological atypia. Which histopathological term best describes the surface change?

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Correct answer: D — Hyperparakeratosis

The finding is hyperparakeratosis: an abnormally thickened parakeratin layer in which superficial flattened squames retain pyknotic nuclei. In hyperorthokeratosis, the thickened surface keratin consists of anucleate squames, making option B the principal differential. Non-keratinised epithelium lacks a true surface keratin layer. Epithelial atrophy refers to reduced epithelial thickness rather than surface keratin accumulation. Dysplasia requires architectural or cytological abnormalities, such as disordered maturation, loss of polarity, pleomorphism or abnormal mitoses; it cannot be diagnosed from hyperparakeratosis alone. The preserved maturation and absence of atypia in the stem therefore specifically exclude dysplasia.

Reference: Farci F, Mahabal GD. Hyperkeratosis. StatPearls, updated 2023; section distinguishing orthokeratotic and parakeratotic hyperkeratosis. https://pubmed.ncbi.nlm.nih.gov/32965877/