Verruciform xanthoma of the oral mucosa. Report of four cases and a review of the literature

We present four new cases of verruciform xanthoma (VX) in the oral mucosa and review the literature. Clinical, histological, and immunohistochemical features of four new cases of VX were analysed together with cases found in a review of the literature. Expression of CD-68 was studied by immunohistochemistry. Only 162 cases were reported in the oral mucosa. Ninety were males (55.5%) and 72 were females (44.5%). Mean age was 44.9 years. The majority of cases occurred in masticatory mucosa (69.7%). Our cases exhibited papillary or verrucous proliferation of squamous epithelium associated with hyperparakeratosis and with numerous foamy cells confined to the lamina propria papillae. Foamy cells were positive to CD-68 antibody, showing a macrophagic nature. VX is a rare benign lesion, and is probably inflammatory. However, its aetiology and pathological mechanisms remain unknown.     

Verruciform xanthoma--biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan

The biological profile of oral verruciform xanthoma (VX) is presented based on a world-wide literature survey of 282 cases. From 1979 onwards, extraoral cases have also been reported. This rare, harmless lesion with a sessile or pedunculated base is a red/pink, papillary/granular/verrucous mucosal growth, occurring in females (mean age, 54.9 yrs) and males (mean age, 44.2 yrs) in a female:male ratio of 1:1.1. The most common location is by far the gingival margin and other areas of the masticatory oral mucosa. Comparison between 173 non-Japanese and 109 Japanese patients with oral VX showed few discrepancies in epidemiological data, indicating only few significant ethnic differences between the two cohorts. Histomorphologically, the epithelium covering the lesion can be divided into three groups: (A) a verrucous, (B) a papillary and (C) a flat pattern. The hallmark of all VX, irrespective of the lesion being intra- or extraoral is, however, the presence of vacuolated, foam or xanthoma cells which ultimately replace the connective tissue between the epithelial ridges. The xanthoma cells have been shown to be cells of the monocyte/macrophage lineage. The present concept of the etiology and pathogenesis of VX, including the possible viral (HPV) association is revised, based on both intra- and some extraoral cases, and it is concluded that it is still far from being clarified.     

The association of lichen planus of the penis with squamous cell carcinoma in situ and with verrucous squamous carcinoma

Two cases of squamous cell carcinoma (SCC) of the penis, one verrucous type and one in situ, arising in association with an inflammatory dermatosis most consistent with lichen planus, are described. Although SCC has previously been reported to have arisen from lichen planus of the oral mucosa, these are the first reported cases of the coexistence of these processes on the penis.     

Proliferative verrucous leukoplakia and its related lesions

Proliferative verrucous leukoplakia (PVL) is a unique type of clinical oral leukoplakia. Enigmatic in etiology, PVL behaves in a far more aggressive fashion than other forms of leukoplakia. Its aggressiveness relates not only to a high recurrence rate, but more so to a very high level of and relentless progression from a localized simple keratosis to extensive oral disease and squamous carcinomas of verrucous, or conventional squamous cell type. Diagnosis is often late in the protracted course of PVL with the disease in an advanced stage when it is especially refractory to treatment. Within the histologic spectrum that is seen in PVL, usually as a function of time, are: (1) verrucous hyperplasia (VH), a histologically defined lesion; (2) varying degrees of dysplasia; and (3) three forms of squamous cell carcinoma: verrucous, conventional and, according to some, papillary squamous cell carcinoma. Each of these are discussed both within and outside the context of PVL. VH is a forerunner of verrucous carcinoma and the transition is so consistent that the hyperplasia, once diagnosed, should be treated like verrucous carcinoma. VH is not only an oral lesion; it can occur in the upper airway (sinonasal tract and larynx) where it is not usually found within a maternal soil of PVL. Papillary squamous cell carcinoma has been a loosely defined neoplasm, more often considered a verrucal type of malignancy. It nonetheless is a distinct clinicopathologic entity, separate from verrucous carcinoma and without a predilection for the oral cavity or an association with PVL.     

Transitional cell carcinoma of the anterior urethra

We report a case of transitional cell carcinoma of the anterior male urethra. Unlike squamous cell carcinoma of the anterior urethra, which usually requires partial penectomy, transitional cell carinoma of this location can be managed with conservative local resection and preservation of the penis. Possible explanations for the origin of this lesion are discussed.     

Verrucous carcinoma in penile lichen sclerosus et atrophicus

A patient presented with a verrucous carcinoma within a lesion of penile lichen sclerosus et atrophicus. We report a case of lichen sclerosus and the specific squamous cell carcinoma variant, verrucous carcinoma, treated by Mohs surgery.     

CLINICOPATHOLOGICAL AND SURGICAL STUDY OF VERRUCOUS CARCINOMA OF PENIS

ＣＬＩＮＩＣＯＰＡＴＨＯＬＯＧＩＣＡＬＡＮＤＳＵＲＧＩＣＡＬＳＴＵＤＹＯＦＶＥＲＲＵＣＯＵＳＣＡＲＣＩＮＯＭＡＯＦＰＥＮＩＳＷａｎｇＸｕｚｈｏｕ；ＺｈａｎｇＺｉｘｕａｎ；ＧａｏＺｈｏｎｇｙｕ；ＬｉａｎｓＳｉｔａｉ；ＴｉａｎＪｉｘｉ王绪洲，张紫萱，高促...     

6例口腔粘膜疣状黄瘤的诊断及治疗

目的:探讨疣状黄瘤的临床生物学特征、病理诊断及治疗.方法:对6例口腔粘膜疣状黄瘤的临床病理资料进行回顾性分析,并进行随访.结果:6例患者5例术前误诊,术中快速病理及术后病理确诊为疣状黄瘤,局部切除即可治愈,随访无复发、恶变病例.结论:疣状黄瘤临床上易误诊,怀疑恶性肿瘤者术中需作快速病理确诊,以避免过度治疗,局部切除后预后良好.     

Verrucous carcinoma arising in ulcerative lichen planus of the soles

Verrucous carcinoma is a low-grade squamous cell carcinoma. Chronic inflammation is an important factor in its pathogenesis. This is the first case of plantar verrucous carcinoma arising in a lesion of ulcerative lichen planus. This paper also lends further support to the successful use of Mohs micrographic surgical technique as the treatment of choice for verrucous carcinoma.     

阴茎疣状癌的诊断及治疗

目的：探讨阴茎疣状癌的临床诊断及治疗方法。方法回顾性分析1例阴茎疣状癌的临床诊治过程,并结合相关文献进行复习。结果阴茎疣状癌的临床表现及其诊断治疗方法不同于普通阴茎鳞癌,常被误诊为局部感染病灶或低度鳞状细胞癌,明确诊断主要依据病理检查。结论阴茎疣状癌为临床罕见病例,易误诊,手术治疗是其有效治疗手段。     

Radiotherapy and verrucous carcinoma of the oral cavity. A study of 107 cases.

One hundred and seven cases of oral verrucous carcinoma treated primarily with radiotherapy at Kasturba Hospital, Manipal, India between 1977 and 1987 were analysed concerning location within the oral cavity, clinical extent, and effectiveness of radiotherapy. The most common site was the buccal mucosa followed by the buccogingival sulcus. Only 13.2% of the patients presented with T1 or T2 tumours and 32.7% had clinically negative nodes. Biopsy had to be repeated more than once in 22 patients to get confirmation of invasive carcinoma. The 5-year survival rate was 35% for stage III and 26% for stage IV. The treatment results with radiotherapy were comparable with those for ordinary squamous cell carcinoma of the oral cavity. It is felt that the treatment policy for verrucous carcinoma can be the same as for ordinary squamous cell carcinoma. In order to prevent delay in diagnosis and treatment, proper cooperation between the treating oncologist and the pathologist is essential.     

High-resolution DNA flow cytometry in oral verrucous carcinoma

The classification of verrucous carcinoma as an entity unto itself or as a variant of well differentiated squamous cell carcinoma is controversial. To contribute new insights into the biological behavior of this rare tumor, we applied DNA flow cytometry to three node-negative verrucous carcinomas of the oral cavity. All tumors expressed a single aneuploid cell population. One of the patients experienced three courses with local recurrence. All secondary tumors retained the initially established aneuploid clone. The development of aneuploidy is thus a cytogenetic event common to both verrucous and squamous carcinoma of the oral cavity.     

Metastasis to the penis in a patient with squamous cell carcinoma of the lung with a review of reported cases

Metastasis to the penis is very rare in lung cancer. We describe a patient with squamous cell carcinoma of the lung who developed a metastatic lesion in the penis. A 75-year-old Japanese male visited a local hospital complaining cough and bloody sputum. A chest plain radiograph and computed tomographic (CT) scans of the chest demonstrated a right hilar mass. He was diagnosed with squamous cell carcinoma of the lung at stage IIIB (T4N2M0). Then he was treated with concurrent chemoradiotherapy consisting of cisplatin, docetaxel, and thoracic irradiation, and after the chemoradiotherapy, he achieved a partial response. However, 6 months later, he visited an urologist complaining of firm mass in the penis with slight pain. A biopsy of the corpus cavernosum penis was performed, which provided a histological diagnosis of squamous cell carcinoma. The histology of the specimen was consistent with that of previous lung cancer, so he was considered to have penile metastasis from squamous cell carcinoma of the lung. Radiotherapy was given to the metastatic tumor in the penis. The penile tumor was diminished and the pain was completely relieved. In addition, we review reported cases to investigate the clinical characteristics and appropriate management of this rare involvement.     

Pathological and clinical analysis of 102 cases of lip carcinoma

102 cases (103 tumors) of lip carcinoma treated by surgery are analyzed. There were 37 (35.9%) verrucous carcinoma and 66 (64.1%) squamous cell carcinoma which included grade I 29 cases, grade II 21, grade III 14 and grade IV 2. Of the 66 squamous cell carcinomas, six lesions co-existing with verrucous carcinoma were derived from the latter. This fact demonstrated that anaplastic transformation of verrucous carcinoma could occur in patients without radiotherapy. This study suggests that the enlarged neck lymph nodes need not be dissected prophylactically for patients with squamous cell carcinoma grade I and grade II, and with verrucous carcinoma. The management of the cervical nodes still suffices if they enlarge after the primary lesion has been removed. But radical dissection of neck lymph nodes should be performed promptly for patients with squamous cell carcinoma grade III and grade IV.     

Penile metastasis from lung cancer.

A case of metastatic tumor of the penis from lung cancer is reported. The patient, who had received a right pneumonectomy 17 months previously for a squamous cell carcinoma of the lung, complained of urinary retention and painful erection of the penis. He underwent an emergency suprapubic cystostomy. Twenty days after the procedure, he died of disseminated lung carcinoma. The autopsy demonstrated massive metastasis to the penis from squamous cell carcinoma of the lung. Penile metastasis from lung cancer is a very rare condition and only 14 cases of this secondary carcinoma have been reported.     

Verrucous carcinoma of the maxillary antrum

Verrucous carcinoma is a well-differentiated variant of squumous cell carcinoma. In this article, we present a patient of verrucous carcinoma of the maxillary annum. There are only 6 reported cases of verrucous carcinoma of the maxillary antrum. Ours is the 7th case. We, here, would like to highlight that our case had a different clinical presentation from the previously reported cases.     

Oral verrucous carcinoma. Treatment with radiotherapy

Fifty-two cases of oral verrucous carcinoma treated with radiotherapy at the Regional Cancer Centre, Trivandrum, Kerala, India in 1982 were evaluated to determine the distribution within the oral cavity, clinical extent, and effectiveness of radiotherapy in controlling the disease. The most common site was the buccal mucosa. Fifty percent of the patients had clinically negative regional lymph nodes and 33% were in earlier stages (T1, T2, N0, and M0). The overall 3-year no evidence of disease (NED) survival rate was 44%. The 3-year NED survival rate with radium implant was 86%. We cannot comment on anaplastic transformation after radiotherapy because our treatment failures have not been subjected for biopsy concerning this matter. Because the results are comparable with those of well-differentiated squamous cell carcinoma, we think that the treatment policies advocated for oral squamous cell carcinoma are also applicable to oral verrucous carcinoma.     

Synchronous squamous cell carcinoma of the stomach, the lung and the skin

BACKGROUND: The incidence of multiple primary cancers is reported to be 0.3-4.3%. CASE REPORT: A 70-year-old man was admitted to the hospital because of fatigue, weight loss, epigastric pain with melena. A biopsy taken from a tumoral lesion in the gastric corpus revealed squamous cell carcinoma. A nodular lesion was also detected on the nasal columella and biopsy from this lesion also showed squamous cell carcinoma. Computed tomography performed as a part of metastatic work-up revealed a lesion in the left pulmonary lower lobe. Bronchoscopic biopsy from this lesion also demonstrated squamous cell carcinoma. RESULTS: We report a case with synchronous squamous cell carcinoma of the lung, skin and stomach and discuss the multiple synchronous occurrence of carcinoma with the same histopathology in different sites with a review of the literature.     

Plantar verrucous carcinoma (epithelioma cuniculatum): case report with review of the literature

Verrucous carcinoma is a rare highly keratinizing variant of squamous cell carcinoma that is a slow-growing, locally aggressive, and rarely metastasizing tumor. It may involve various body sites including oral, genital, and plantar areas. The tumor has a characteristic gross appearance with multiple sinuses opening on the surface and may present a difficult diagnostic problem. Multiple biopsies and close clinical correlation are frequently required before a definite diagnosis is possible. The differential diagnosis is especially difficult if only fragments or superficial portions of the lesion are submitted for histological evaluation. Reviewing surgical material from our institution from 1976 to 1983, we located four cases of verrucous carcinoma of the foot. These four cases were diagnosed on the bases of clinical, gross, and microscopic appearances. One of the cases had bilateral lesions. One of the cases is described with review of the literature.