Downregulation of Notch4 – a prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma

Introduction

Oral verrucous carcinoma is a special form of well-differentiated squamous cell carcinoma which possesses specific clinical, morphologic and cytokinetic features that differ from other types of oral cancers and hence diagnosis requires immense experience in histopathology. Hence it is certainly important to distinguish such a lesion from other oral tumors as treatment strategies vary widely between them.

Temporal bone verrucous carcinoma: outcomes and treatment controversy

Verrucous carcinoma is a rare tumor that presents in the head and neck with the most common sites being the oral cavity and larynx. Fourteen cases of verrucous carcinoma of the temporal bone have been described in literature; this study aims to examine treatment outcomes and discuss the controversy surrounding postoperative radiation. The study design included a literature review along with individual case report in the setting of a tertiary care medical center. Outcome analysis of all cases of verrucous carcinoma of the temporal bone, which are documented in the English literature, and presentation of a single patient report including gross, histologic and radiologic analyses were performed. The longest recorded survival for verrucous carcinoma of the temporal bone occurs in patients treated with surgery alone. Poorer outcomes for patients treated with adjuvant (chemo)radiation may be due to more advanced stage of disease at the time of treatment. Early reports of radiation leading to tumor dedifferentiation or early recurrence are not supported by more recent studies. Whether adjuvant radiation therapy is indicated in verrucous carcinoma of the temporal bone remains controversial.     

Differential diagnosis of verrucous carcinoma in the oral cavity and larynx

Two cases of local metastasing verrucous carcinoma (oral cavity and larynx) are presented. Difficulties in the histological diagnosis are demonstrated. Histological criteria of verrucous carcinoma are discussed in comparison to leucoplakia, papilloma, pseudoepitheliomatous hyperplasia, verrucous hyperplasia, and highly differentiated squamous cell carcinoma (grade 1). The importance of correct diagnosis for further diagnostic and therapeutic procedures is pointed out.     

Squamous papilloma: case report and review of literature

Squamous papillomas are common lesions of the oral mueosa with a predilection for the mucosa of the hard and soft palate.As an oral lesion,it raises concern because of its clinical appearance,which may mimic exophytic carcinoma,verrucous carcinoma or condyloma acuminatum.Its pathogenesis is related to human papilloma virus but there is controversy regarding its viral origin.We present a case of squamous papilloma presenting as oral lesion along with a review of the literature.     

Detection and typing of human papillomavirus in verrucous carcinoma of the oral cavity using the polymerase chain reaction

OBJECTIVE: This study examined the prevalence and types of human papillomavirus (HPV) DNA in oral cavity verrucous carcinoma. DESIGN: This was of a retrospective screening study. Formalin-fixed, paraffin-embedded tissue samples were examined by the polymerase chain reaction using DNA primers specific for HPV types 6b/11, 16, and 18. SETTING: The majority of patients were seen at referral centers in Ontario, Canada. PATIENTS: This study examined 29 oral cavity verrucous carcinomas occurring in a sample of 25 patients from four institutions between 1966 and 1992. All tumors met standardized histologic diagnostic criteria of verrucous carcinoma. MAIN OUTCOME MEASURE: The prevalence of HPV 6b/11, 16, and 18 DNA was determined by the PCR technique. RESULTS: The HPV DNA was detected in 12 (48%) of 25 patients. The HPV 6b/11 DNA, HPV 16 DNA, HPV 18 DNA, and HPV 16 DNA plus HPV 18 DNA, were detected in one (4%), one (4%), nine (36%), and one (4%) cases, respectively. CONCLUSIONS: The detection of HPV 18 DNA in 40% of oral cavity verrucous carcinomas suggests an association between the presence of HPV 18 DNA and some oral cavity verrucous carcinomas. The etiologic and prognostic significance of HPV 18 for oral cavity verrucous carcinoma remains unanswered and will require further study.     

喉疣状癌的诊断与治疗(3例报告及文献复习)

目的 探讨喉疣状癌的诊断与治疗。方法对 3例喉疣状癌的临床、病理、诊断、治疗及预后进行回顾性分析。结果 3例喉疣状癌患者均为男性, 年龄 51 ~59岁, 平均年龄 56岁。喉疣状癌诊断较困难, 应反复多次活检才能确诊。其中 1例先后进行两次手术、1次放疗,终因肿瘤复发、组织间变、淋巴转移、肺感染、吞咽梗阻致全身衰竭死亡。2例行喉垂直部分切除术, 随访 5 ~6年无复发。结论　喉疣状癌容易误诊, 追踪观察肿瘤生长方式、外观形态和病理学检查可确诊。喉疣状癌以手术治疗为主, 切除力求彻底, 手术方式首选喉垂直部分切除术。放射治疗不敏感。     

Verrucous carcinoma of the nasal cavity: a case report

We report a rare case of verrucous carcinoma occurring in the nasal cavity. A 53-year-old man reporting left-sided nasal obstruction and awareness of a left intranasal lesion--a whitish polypoid lesion--was found in CT to have an expansive lesion of the left nasal cavity and maxillary sinus. The tumor was completely removed by Denker's operation. Verrucous carcinoma is a rare variant of squamous cell carcinoma most commonly seen in the oral cavity. In some cases, conventional squamous cell carcinoma components may be observed focally in verrucous carcinoma, called a hybrid tumor. In our case, the tumor showed typical features of a hybrid tumor. To the best of our knowledge, this is the first case of hybrid verrucous squamous cell carcinoma originating in the nose in the Japanese literature.     

Anaplastic transformation of verrucous carcinoma following radiotherapy

A 58-year-old man with a verrucous carcinoma of the larynx initially underwent partial laryngectomy followed by radiotherapy when the carcinoma recurred locally. Subsequently, he developed an anaplastic spindle cell carcinoma of the larynx ten months after radiotherapy, which eventuated in his death. The role of radiotherapy in the treatment of verrucous carcinoma remains controversial, and the risk of transforming the low-grade verrucous carcinoma to an anaplastic, metastasizing carcinoma is a real, although uncommon, complication.     

Verrucous carcinoma of the maxillary antrum

Verrucous carcinoma is a rare variant of squamous cell carcinoma which occurs most frequently in the oral cavity and larynx. In this article we describe a patient with verrucous carcinoma of the maxillary antrum, and present a review of the literature.     

Verrucous carcinoma of the maxillary antrum

Verrucous carcinoma is a rare type of squamous cell carcinoma which is most often seen in the oral cavity and larynx. This paper describes a case of verrucous carcinoma of the maxillary antrum, a site in which this tumour has been described on only two previous occasions in the English language literature.     

Transoral management of localized carcinoma of the oral cavity using the CO2 laser

Since 1972 we have been cautiously exploring the use of CO₂ laser in the management of carefully selected cases of localized carcinoma of the oral cavity. At the present time our experience is based on the treatment of 57 patients with cancer of the oral cavity. The CO₂ laser has been found to be an indispensable tool in the transoral management of T₁ carcinomas, multiple superficial carcinoma, extensive leukoplakia and verrucous carcinoma. The laser allows precise excision of the lesion and involved mucosa and provides an excellent specimen for histologic verification of the margins. The morbidity of laser excision is minimal, so that a tracheotomy is not needed and patients can almost always be discharged on the following day. (Follow-up data on those patients at risk for 30 months indicate excellent control rates.)     

Zur Beurteilung der Dignität des verrukösen Karzinoms

Summary The verrucous carcinoma first described from Ackerman in 1948 is a tumor characterized by its unique growth and biological behaviour. The tumor can be arranged into the group of so-called low grade carcinomas.Difficulties in the histologic estimation of the tumor appears in the demonstration of corresponding atypical cells.On two examples of verrucous carcinoma of the larynx it will be demonstrated, that characteristic and atypical cells can be shown in the smear.Cytology is regarded as diagnostic help in cases of verrucous carcinoma.     

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.     

Invasive squamous cell carcinoma within verrucous carcinoma

A case of invasive squamous cell carcinoma within a verrucous carcinoma is presented in order to illustrate the potential problem of underdiagnosis of these lesions. The epidemiology, natural history and histopathology of verrucous carcinoma, and features which distinguish it from invasive squamous cell carcinoma, are reviewed. Unless rigorous attention is paid to histologic detail, a focus of invasive squamous cell carcinoma may escape detection and radiation-induced anaplastic transformation may later be suspected.     

Bilateral renal cell carcinoma metastasis in the oral cavity

Cancer metastases to the oral cavity are reported infrequently. Renal cell carcinoma has a high metastatic potential, with approximately one third of patients presenting with metastatic disease. New lesions in the oral cavity often rely on preoperative biopsy to establish the diagnosis. However, we report an unusual case in a setting of known renal cell carcinoma disease, where initial pathology and culture data were misleading. Appropriate follow-up and a high index of suspicion will remain necessary. Surgical excision is the treatment of choice.     

Carcinoma cuniculatum mimicking leukoplakia of the mandibular gingiva

Carcinoma cuniculatum (CC) is a rare variant of low-grade squamous cell carcinoma (SCC), and occurrence in the oral cavity is quite unusual. CC has a papillomatous keratinized surface like verrucous carcinoma, but CC has a propensity for aggressive local invasion, especially into the bone. Therefore, CC can be quite difficult to remove surgically. A 68-year-old man presented with a case of CC mimicking verrucous leukoplakia in the mandibular gingiva. Repeated biopsies showed no malignancy. Local resection was performed, and histological examination revealed the presence of well-differentiated SCC. Additional hemi-mandibulectomy was performed and the final histological diagnosis was CC. Local recurrence was detected at the 14-month follow-up examination. Chemotherapy with docetaxel was not effective, and he died of aspiration pneumonia. CC of the oral cavity is a rare entity and the diagnosis is hard to establish. Misdiagnosis could result in inadequate removal and local recurrence. Complete resection with a safety margin is essential because of the tendency for local invasion.     

Proliferative verruk?se Leukoplakie

BACKGROUND: Proliferative verrucous leukoplakia (PVL) is a rare variant of oral leukoplakia (OL) with a high tendency for malignant transformation. PVL starts as a flat hyperkeratosis. During the course of the disease verrucous lesions develop. AIM OF THE STUDY, MATERIAL AND METHODS: Due to the scarcity of reports on PVL five cases of PVL are presented. Clinical and histopathological findings in five female patients with PVL were evaluated retrospectively. RESULTS: The clinical appearance of PVL was characteristic as compared to criteria described in the literature. The average period of observation in these cases was short (1.7 years). There were 3.6 different localizations observed per patient. The buccal mucosa, gingiva, and edentulous alveolar ridge were most often affected. One patient had already developed squamous cell carcinoma prior to referral. The others developed malignancies during follow-up. Recurrences and secondary malignancies could not be avoided using different therapeutic modalities. Two patients died from PVL. The characteristic spectrum of histopathological findings in PVL was observed. Homogeneous flat leukoplakias are characterized by acanthosis, hyperkeratosis, and often parakeratosis. Epithelial dysplasia is not seen. The proliferative verrucous stage of the disease is characterized by papillomatous epithelial growths with signs of slight epithelial dysplasia and subepithelial infiltration with immunocompetent cells. Stages of transformation may result in verrucous carcinoma or squamous cell carcinoma. CONCLUSIONS: PVL is associated with a very high rate of malignant transformations. These, as well as recurrences, cannot be avoided with present-day therapies. In order to define the biological profile of PVL more clearly, multicenter studies are necessary to reveal possible etiologic factors and concepts for therapy.     

Verrucous carcinoma of the temporal bone

Verrucous carcinoma is a highly differentiated variant of squamous cell carcinoma. In the literature, 11 cases of primary verrucous carcinoma of the temporal bone have been reported. We present a 48-year-old woman who had undergone radical mastoidectomy because of chronic otitis media 20 years ago; consequently, verrucous carcinoma occurred in the mastoid cavity. We discuss verrucous carcinoma of the temporal bone with the review of literature.     

Carcinoma cuniculatum. Apropos of 4 cases with orofacial involvement

Carcinoma cuniculatum, a rare variant of verrucous carcinoma, was first described in the foot. The authors report 4 cases of uncommon localizations of this tumor, involving oral cavity and face, 3 of them having a 6-year follow-up. The specific histological and clinical features of this tumor are remembered and the difficulties of its diagnosis are emphasized. This slow-growing, ulcerated proliferation, invading the surrounding tissues, is often responsible for chronic suppuration, but very rarely metastasizes to the regional lymph nodes. The surgical treatment consists in a wide excision; neck dissection is theoretically useless, and radiotherapy is strictly contraindicated because of the risk of transformation into an anaplasic carcinoma. For all these reasons, carcinoma cuniculatum must be considered as an anatomoclinic entity, and deserves to be known by the clinicians and the pathologists.     

喉疣状癌的临床分析

目的：分析喉疣状癌的临床病理特点、手术方式和疗效。方法：经病理证实的喉疣状癌患者10例,5例行垂直半喉+重建术;2例行环状软骨上喉部分切除+环舌会厌吻合术（CHEP）;2例行支撑喉镜下YAG激光声带切除术,其中1例术后放疗,另1例4个月后原位复发,行垂直半喉+重建术后控制;1例行喉裂开声带切除术。结果：所有患者均恢复正常的呼吸和吞咽功能,9例插管患者拔除气管套管后均获得正常的发音功能。术后随访：1例患者原位复发,1例因其他部位肿瘤死亡,2例因心脑血管疾病死亡。全部患者手术部位癌细胞无远处转移,5年生存率75%。结论：喉疣状癌是高分化鳞状细胞癌的一种特殊类型,本病确诊有赖于病理专家与喉科医师密切配合。手术是喉疣状癌主要的治疗方式,在切除肿瘤的基础上保留喉功能,提高患者生活质量