Verrucous carcinoma of the larynx.

Verrucous carcinoma of the larynx in a middle-aged male patient is reported. The related diagnostic problems are described in detail and clinical and morphological differentiating features from other variants of squamous cell carcinoma are outlined on the basis of literary data and our own experience.     

Verrucous carcinoma of the larynx: Role of human papillomavirus,radiation, and surgery

There is confusion regarding verrucous carcinoma of the larynx, an enigmatic, well-differentiated variant of squamous cell carcinoma known for local recurrence and anaplastic transformation following irradiation. This report adds 12 new cases and reviews the literature concerning radiation results versus surgical results. Treatment of 37 patients with primary radiotherapy resulted in a 49% cure rate and a 51% failure rate; the death rate from anaplastic transformation was 11%. Primary surgery on 144 patients resulted in a 92.4% cure rate, a 7.6% initial failure rate, and a 3.5% rate of deaths attributed to neoplasm. Isolation of human papillomavirus type 16 (HPV-16) DNA sequences indicates that the lesion is genetically abnormal. Radiation-induced DNA breaks may activate these sequences. These findings support a surgical approach. Treatment recommendation for T1 lesions is carbon dioxide laser excision to minimize tissue trauma and local recurrence. For T2 to T4 lesions, the recommendation is sound oncologic extirpation. Neck dissection is not indicated.     

Verrucous carcinoma of the larynx

Verrucous carcinoma, because of its oftentimes unusual clinical appearance, may be misdiagnosed if there is not good communication between the surgeon and the pathologist. We have reviewed our series of 20 cases of verrucous carcinoma from 1964 through 1974 and have analyzed the results of our therapy. We have concluded that verrucous carcinoma is a slow-growing, locally invasive lesion that does not metastasize to the cervical lymph nodes. Radiation therapy does not seem to be an effective method of treatment; the recurrence rate is high. Conservative laryngeal surgery is the preferred method of treatment in these patients and should prevent loss of life and spare laryngeal function.     

Verrucous carcinoma of larynx

A 55 years male presented with hoarsness of voice (4 months), cough (1 month), difficulty in breathing (15 days). Patient underwent an emergency tracneostomy and further workup proved it to be a case of verrucous carcinoma of larynx. Patient was treated surgically with satisfactory result.     

Verrucous carcinoma of the larynx

Summary Verrucous carcinoma of the larynx in a middle-aged male patient is reported. The related diagnostic problems are described in detail and clinical and morphological differentiating features from other variants of squamous cell carcinoma are outlined on the basis of literary data and our own experience.     

Verrucous carcinoma of the larynx — a misnomer

Summary A serie of our observations of so-called verrucous carcinomas of the larynx show that these peculiar lesions do not develop true infiltrating growths or metastases, and do not fulfill the criteria of a true carcinoma. Our experiences indicate that these cases can be treated successfully by repeated endoscopic resections. We have found that no aggressive radical treatment — either by surgery or irradiation — is necessary in managing these lesions. Although the etiology of Ackerman's tumor of the larynx is still uncertain, we suggest that the lesions develop as the result of a virus infection and propose again the term verrucous acanthosis instead of verrucous carcinoma for this disease.Presented at the American Academy of Otolaryngology, Head and Neck Surgery, San Antonio, Texas, September 1986     

Verrucous carcinoma of the larynx. - A study of its pathologic anatomy.

In the 10 years between 1964 and 1974, 276 patients with infiltrating carcinoma of the larynx included 31 cases of varrucous carcinoma (11 per cent of the series). This tumor is characterized by the pushing invasion of well differentiated squamous epithelium growing in a vertically folded invasive pattern. The tumor appears most frequently in the two decades between 50 and 69 years of age. The ratio of male to female patients was 3.4:1. Verrucous carcinoma has a predilection for the supraglottic regions of the larynx. Cut surface of the tumor shows clefting and sharp margins. Lymph node metastasis occurred in five cases. The marked inflammatory host reaction can cause misleading cervical lymphadenopathy. Problems in diagnosis are discussed.     

9例喉疣状癌和乳头状鳞状细胞癌的临床分析

目的：探讨喉疣状癌（VC）和乳头状鳞状细胞癌（PSCC）的临床、病理特点及鉴别诊断。方法：回顾性分析我院收治的4例喉VC及5例PSCC的临床资料,观察喉Vc及PSCC的临床及病理学特点。结果：4例喉VC均可见鳞状上皮高度增生,伴有角化珠形成,基底膜不受侵犯,肿瘤基质可见中至重度炎性浸润,未见颈部淋巴结转移,无局部复发,预后良好。5例喉PSCC均可见外生性恶性增殖并有血管纤维核心的鳞状细胞,细胞病理学表现与传统的鳞状细胞癌（SCC）基本一致,未见颈部淋巴结转移,预后较传统SCC好。结论：VC和PSCC两者在外观上较相似,但肿瘤细胞的分化、异型性,间质的炎性浸润,复发,局部转移,治疗及预后等方面存在差异,临床及病理医生需密切配合检查,以便鉴别诊断两类疾病。     

Verrucous carcinoma of the larynx: problems of diagnosis and treatment

The first report of a case of verrucous carcinoma from Africa is presented. Problems of diagnosis and treatment are highlighted and the need for co-operation between the clinician and the pathologist for an accurate diagnosis is emphasized.     

Verrucous squamous cell carcinoma of the larynx: diagnostic and therapeutic considerations

The clinical findings, histopathology, management and outcome of 31 patients with verrucous squamous cell carcinoma of the larynx (VSCC) are discussed. Laryngeal VSCC is a rare, highly differentiated variant of SCC and has specific morphological features and clinical behavior. A close liaison between the laryngologist and pathologist is needed to formulate a correct diagnosis, because this tumor appears to be malignant clinically and histologically benign. A low-power magnification of multiple large specimens, including the deep margins of the lesion, is required in order to differentiate VSCC from keratosis, verruca vulgaris or SCC with verrucous appearance, and to detect underlying microscopic foci of invasive SCC within or adjacent to a verrucous carcinoma. Long-lasting hoarseness was the most common symptom as the glottic region was the most common site of VSCC. Presumed clinically positive N1 lymph nodes were observed in the necks of 7 patients, but none had metastatic disease on histopathological study. Surgery alone was the most effective form of treatment, as it allowed a good outcome of all treated patients. Surgery plus radiotherapy was associated with an early recurrence and a poor outcome in 2 of 7 patients treated. The generally benign behavior of VSCC allows for conservative surgery, with complete endoscopic resection using the carbon dioxide laser representing a more conservative surgical approach. Neck dissection is not indicated due to the non-metastatic behavior of this tumor.     

Human papillomavirus infection in the etiology of laryngeal carcinoma

PURPOSE OF REVIEW: One fifth of cancers worldwide are associated with viral infection. Indeed, the causal link between human papillomavirus and cervical carcinoma is so well established that it is thought to be the first necessary cause of human cancer ever identified. One of the primary aims of research in this area is to reduce cancer prevalence by vaccination. However, the role that human papillomavirus plays in carcinogenesis of the head and neck region may also have important implications for its prevention and treatment. RECENT FINDINGS: Although human papillomavirus was first identified in the larynx 20 years ago, the extent to which it is present in epithelium of the normal population is unclear. Laryngeal papillomas are the most common benign tumors in the larynx. They are associated with a small risk (3 to 7%) of malignant transformation, in which smoking and irradiation appear to be cofactors. The search for alternate risk factors for the development of laryngeal cancer, particularly in those who are nonsmokers and nondrinkers, has led to the hypothesis that human papillomavirus may have a pivotal role. Epidemiologic studies, although not conclusive, strongly suggest its involvement in the etiology of a subset of laryngeal carcinomas. Recent molecular evidence supports this. SUMMARY: An adequately powered, multicenter case-control study is required to elucidate the full extent of this association and to examine the relation between the virus and other risk factors.     

Verrucous carcinoma of the laryn

Verrucous carcinmoma of the larynx is an uncommon but distinct variety of well differentiated squamous carcinoma and accounts for 1–2% of all laryngeal squamous carcinomata. Awareness of the condition both by clinician and histopathologist is essential otherwise the diagnosis may not be made. From a review of the literature and personal assessment of the cases presented here it would appear that local conservative endoscopic treatment with careful follow-up may be the treatment of choice for certain verrucous carcinomata. Such treatment may be either suction diathermy or cryosurgery or laser surgery. Anaplastic transformation has been said to occur following irradiation of these tumours, though this view is not held by all clinicians, some of whom recommend radiotherapy for selected cases.     

Oat-cell carcinoma of the larynx.

The diagnoses of three cases of laryngeal oat-cell carcinoma were confirmed by electron microscopy. As in pulmonary oat-cell carcinoma, the prognosis in these cases is poor; of our three cases and the previously reported cases of this tumor type in the larynx, all but one of the patients, for whom there is adequate follow-up information, have died of widespread metastases. Aggressive radiation therapy and systemic chemotherapy appear indicated if improved survival is to be achieved.     

Verrucous carcinoma of the larynx--a misnomer

A serie of our observations of so-called "verrucous carcinomas" of the larynx show that these peculiar lesions do not develop true infiltrating growths or metastases, and do not fulfill the criteria of a true carcinoma. Our experiences indicate that these cases can be treated successfully by repeated endoscopic resections. We have found that no aggressive radical treatment - either by surgery or irradiation - is necessary in managing these lesions. Although the etiology of "Ackerman's tumor" of the larynx is still uncertain, we suggest that the lesions develop as the result of a virus infection and propose again the term "verrucous acanthosis" instead of verrucous carcinoma for this disease.     

Verrucous carcinoma of the oral cavity

The clinical course and morphologic (light and ultrastructural) characteristics of a case of verrucous carcinoma of the lower gingival mucosa are presented. Clinical course of the patient was unfavorable following surgery (supposedly incomplete) and radiotherapy (6,000 R) of the tumor. The therapeutic factors that may influence an unfavourable prognosis are commented upon, especially in regard to a slow-growing neoplasm with a generally good course.