Origin of undifferentiated neoplasm from verrucous epidermal carcinoma of oral cavity following irradiation
TL;DR: It is proposed that the anaplastic lesion of an x‐irradiated verrucous carcinoma of the oral cavity arose as a new carcinoma from the cells of the latter, rather than through a transformative dedifferentiation.
Abstract: Apparent anaplastic transformation of an x‐irradiated verrucous carcinoma of the oral cavity is described in detail, including ultrastructural observations. The anaplastic lesion had definite epidermoid differentiation in the form of tonofibrils and tonofilaments, demonstrable only with electron microscopy. It and the well‐differentiated one coexisted discretely and metastasized independently. It is proposed that the former arose as a new carcinoma from the cells of the latter, rather than through a transformative dedifferentiation.
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TL;DR: Its apparent clinical benignity may lead to lengthy periods of misdiagnosis, during which it is likely not to spread to distant lymph nodes, but rather to destroy a nose, mandible, or penis as it slowly but relentlessly extends into underlying tissue.
Abstract: The concept of verrucous carcinoma as a clinicopathologic variant of squamous cell carcinoma is worthy of recognition. It is known by a confusing array of names, such as Ackerman's tumor, Buschke-Loewenstein tumor, florid oral papillomatosis, epithelioma cuniculatum, carcinoma cuniculatum, and cutis papillomatosis carcinoides of Gottron. Its apparent clinical benignity may lead to lengthy periods of misdiagnosis, during which it is likely not to spread to distant lymph nodes, but rather to destroy a nose, mandible, or penis as it slowly but relentlessly extends into underlying tissue. Morphologically warty or verrucous, its relatively bland histologic features are often more suggestive of a verruca vulgaris or pseudoepitheliomatous hyperplasia than of squamous cell carcinoma to those unfamiliar with the diagnosis. Alternatively, when it extends into underlying tissues, it may be mistaken histologically for a benign adnexal tumor or even an epidermoid cyst. Therapy may also be challenging because recurrences are common and concerns about potential anaplastic transformation after radiotherapy are often expressed.
264 citations
TL;DR: The literature regarding verrucous carcinoma of the oral cavity is reviewed, as this unusual variant of squamous cell carcinoma continues to present a diagnostic and therapeutic challenge to the clinician.
Abstract: In 1941, Friedell and Rosenthal reported a case of a well-differentiated squamous cell carcinoma of the oral cavity that they described as a \"papillary verrucoid carcinoma.\"' In 1949, Ackerman reported a series of 31 similar cases and coined the term \"verrucous carcinoma.\" He described the typical gross and microscopic appearance of this tumor, as well as its typical clinical behavior.-^ Since that time, many authors have reported similar series of patients, and their descriptions, for the most part, have remained true to Ackerman's original description. These lesions have also been shown to occur at other locations, with a predilection for the mucous membranes. These sites include the larynx, perianal region, cervix, and penis.-' We review the literature regarding verrucous carcinoma of the oral cavity, as this unusual variant of squamous cell carcinoma continues to present a diagnostic and therapeutic challenge to the clinician.
233 citations
TL;DR: A series of 77 cases of verrucous carcinoma of the larynx is presented, which appears to be exophytic, broadly implanted and fungating in aspect, with papillary fronds and a locally invasive character.
Abstract: A series of 77 cases of verrucous carcinoma of the larynx is presented. The tumor is relatively rare and the present series has been selected from 2,398 primary and recurrent malignant neoplasms of the larynx and hypopharynx evaluated at the Department of Otolaryngology of Padua University during the period from January 1966 to December 1978. The median age of patients was 58 years. The tumor appears to be exophytic, broadly implanted and fungating in aspect, with papillary fronds and a locally invasive character. It is composed of highly differentiated epithelial squamous cells covered by a thick keratinized layer arranged in deeply invaginated folds. Cellular response in tumor stroma is marked, and the neoplasm has a low-grade malignancy. Close cooperation between the pathologist and the clinician is needed in order to establish the nature of the lesion, which looks clinically malignant but may appear histologically benign. Benign reponses such as hyperkeratosis, acanthosis, or the presence of a benign papillomatous area necessitate further investigation with another biopsy examination from deeper layers. The elective treatment is surgery, as irradiation may cause anaplastic transformation with metastatic spread. Neck dissection is not indicated as this laryngeal tumor has so far never metastasized to cervical lymph nodes or to other organs.
153 citations
TL;DR: Forty‐six examples of carcinoma cuniculatum, a rare variant of squamous cell carcinoma of the skin, were studied by means of light and electron microscopy and immunoperoxidase techniques and revealed features of well‐differentiated squamouscell carcinoma.
Abstract: Forty-six examples of carcinoma cuniculatum, a rare variant of squamous cell carcinoma of the skin, were studied by means of light and electron microscopy and immunoperoxidase techniques. The tumors usually presented as ulcerated, fungating, and polypoid masses with openings of sinus tracts onto the skin surface that exuded foul-smelling greasy material when pressure was applied. On microscopic examination the tumors were seen to be composed mainly of mature squamous keratinocytes with foci of cellular atypia. Electron microscopic studies revealed features of well-differentiated squamous cell carcinoma. The tumor may affect any cutaneous area of the body, and there is a predilection for the feet, particularly the soles. The cause must still be determined, but trauma, chronic irritation, and/or viral infection may play a role. The neoplasm is a low-grade carcinoma capable of local invasion, extension into bone, and rare metastasis to the regional lymph node. Although immunoperoxidase studies revealed no inclusions, infection by human papilloma virus (HPV) remains a possibility.
150 citations
TL;DR: In this series, three of four primary lesions treated by radiation therapy recurred, while only 5 out of 11 cases of those treated surgically recurred; Surgical resection remains the treament of choice.
Abstract: Verrucous carcinoma is a unique variant of squamous cell cercinoma. Fifteen cases are presented. 11 were in the oral cavity, 3 in the larynx, and 1 in the uterine cervix. Anaplastic transformation of this lesion after radiation therapy, in about 30% of cases, is well documented in the literature but was not seen in our series. The reason for this change, which is usually within a matter of months, is not certain. In two entirely sectioned cases, no areas of synchronous poorly differentiated carcinoma were found. In our series, three of four primary lesions treated by radiation therapy recurred, while only 5 out of 11 cases of those treated surgically recurred. Surgical resection remains the treament of choice. Perineural invasion of verrucous carinoma appears to be rare. One such case is fully documented here. The patient is free of tumor after 6 years. Perineural invasion may represent invasion along the least resistant tissue planes by this biologically not so aggressive tumor. Further microscopic examination of verrucous carcinoma in all sites is necessary to attempt to correlate perineural invasion with prognosis.
130 citations
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TL;DR: Although a large number of cases of squamous carcinoma of the oral cavity have been irradiated, the poor response of verrucous carcinoma to this particular method of treatment has ...
Abstract: Verrucous carcinoma of the oral cavity has been established as a distinctive clinical and pathologic entity (1, 2, 11, 15). Typically, the lesion appears as a slow-growing warty mass on the gingival or buccal mucosa of an elderly patient. Histologically, it is characterized by a well differentiated pattern of squamous epithelium in abundant papillomatous hyperkeratotic folds. The tumor slowly invades deeper structures, including bone, but rarely metastasizes (1, 2, 7, 15). A predilection for the mucosa of the oral cavity of tobacco chewers has been noted (1,2, 11), but the lesion also occurs in the larynx and on the squamous mucosa of the vulva, vagina, and glans penis (15). Reports on satisfactory results of treatment of verrucous carcinoma with surgery and diathermy have appeared in the literature (11, 15, 21). Although a large number of cases of squamous carcinoma of the oral cavity have been irradiated (4, 8, 15, 19), the poor response of verrucous carcinoma to this particular method of treatment has ...
162 citations
TL;DR: The study of the cIinica1 and pathologic features, treatment, and prognosis of such oral cavity Iesions encountered at the Mayo CIinic is concerned.
Abstract: From the Sections of Otolaryngology and Rbinology, Surgical Pathology and Plastic Surger,y, Mayo Clinic. microscopic examinations of a11 avaiIabIe tissues in these tumors were studied. V ERRucous squamous carcinoma is a morphologic type of epidermoid carcinoma with distinctive cIinica1 and pathoIogic features [I]. In 1941, FriedelI and Rosenthal [2] reported on eight patients with verrucous lesions on the bucca1 mucosa and Iower gingiva, in which tobacco chewing was thought to be an important causative factor. Ackerman [?I first described the typica microscopic findings for this Iesion of the ora cavity in 1948, aIso reIating its unique clinical course in a study of thirty-one patients. In addition, some diff<y may he encountered in the proper pathoIogic diagnosis of this tumor unless one is aware of its typicalIy we11 differentiated composition and distinctive pattern of growth. Due to the sIow growing, yet invasive, character of this variety of ora carcinoma, a much Ionger foIIow-up period wouId appear essentia1 for a better understanding of its cIinica1 course and to determine, if possibIe, the most effective treatment. Therefore, this report concerns the study of the cIinica1 and pathologic features, treatment, and prognosis of such oral cavity Iesions encountered at the Mayo CIinic. CLINICAL DATA
134 citations
TL;DR: It would appear unnecessary to perform neck dissection in patients with verrucous‐type oral tumors who have a history of chewing tobacco and poor oral hygiene, and radiation therapy should be used in advanced verrucal‐type lesions in which surgery is difficult or not feasible.
Abstract: Verrucous-type oral tumors have been reviewed. This variety of epidermoid carcinoma of the oral cavity presents as a warty growth in patients who have a history of chewing tobacco and poor oral hygiene. They are slow-growing, locally invasive, and do not metastasize to lymph nodes in our experience. In five of these patients, the microscopic pattern was that of a well-differentiated squamous cell carcinoma. The others presented the classical histologic pattern of verrucous carcinoma. No difference was found in the behavior of these two groups. Three cases developed anaplastic transformation after irradiation and surgery. A change in the clinical behavior of the tumor was observed in these patients and all three died. There is some possibility that ionizing radiations could be the trigger mechanism in this transformation. The authors feel that surgery is the treatment of choice in early or easily resectable lesions. It would appear unnecessary to perform neck dissection in these patients. Radiation therapy should be used in advanced verrucal-type lesions in which surgical resection is difficult or not feasible. These patients require frequent and careful observation. The authors believe that this entity deserves further investigation.
129 citations
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