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.     

Papillary squamous cell carcinoma versus verrucous squamous cell carcinoma of the head and neck

Papillary squamous cell carcinoma and verrucous squamous cell carcinoma of the head and neck may be confused. The clinicopathological profile of the two neoplasms is presented and the differential diagnosis is discussed. A correct diagnosis is imperative in order to institute the most appropriate treatment.     

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.

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.     

Verrucous carcinoma of the oral mucosa]

Verrucous carcinoma is a distinct variant of differentiated squamous cell carcinoma with low-grade malignancy, slow growth and no metastatic potential. Although it has been reported at extraoral sites, the tumor is mostly found in the oral mucosa. Clinically warty tumours with a grey-white, deeply cleaved surface are detected. The special feature of this tumour type is that it appears macroscopically malignant but histologically benign. The diagnosis of verrucous carcinoma may be difficult, since it is often lumped with verrucous hyperplasia or epidermoid carcinoma. In our study the clinical and histological characteristics of 32 cases of verrucous carcinoma of the oral cavity were investigated. The most common site was the mandibular buccal sulcus. The average age amount to 69 years. Adequate surgical excision is considered the treatment of choice. Because of the lack of metastatic spread a systematic treatment of the regional lymph nodes ist not mandatory. The prognosis of verrucous carcinoma is fairly good.     

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.     

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.     

Clinical and histopathological considerations for the diagnosis and treatment of verrucous carcinoma of the larynx

Verrucous carcinoma of the larynx is quite distinct from well-differentiated squamous cell carcinoma has a characteristic morphology and specific clinical behavior. It accounts for approximately 1%-2% of all laryngeal carcinomas. However, difficulties are encountered clinically in separating verrucous carcinomas from keratoses, verruca vulgaris and squamous cell carcinomas with a verrucous appearance. Between 1962 and 1982, 1504 patients with squamous cell carcinomas of the larynx were diagnosed and treated by staff physicians in the Department of Otolaryngology--Head and Neck Surgery, Washington University in St. Louis. Fifteen of these patients (1%) had verrucous carcinomas. These cases were studied in order to clarify any diagnostic problems, trace the biologic behavior of the tumors and report the results of the treatment used. Of these 15 patients, we were able to follow up 8. The latter had been treated only with surgery and none of them had received radiotherapy. One death occurred, but the patient died of other causes and remained free of cancer. Reports in the literature describe a high rate of recurrence of verrucous carcinomas following radiotherapy with occasional anaplastic transformation of tumors. No patients in our series developed a metastasis in the neck, indicating that neck dissection is not justified for patients with these neoplasms even though clinically enlarged neck nodes may be present.     

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.     

Clinical and histopathological considerations for the diagnosis and treatment of verrucous carcinoma of the larynx

Summary Verrucous carcinoma of the larynx is quite distinct from well-differentiated squamous cell carcinoma and has a characteristic morphology and specific clinical behavior. It accounts for approximately l%–2% of all laryngeal carcinomas. However, difficulties are encountered clinically in separating verrucous carcinomas from keratoses, verruca vulgaris and squamous cell carcinomas with a verrucous appearance. Between 1962 and 1982, 1504 patients with squamous cell carcinomas of the larynx were diagnosed and treated by staff physicians in the Department of Otolaryngology — Head and Neck Surgery, Washington University in St. Louis. Fifteen of these patients (1%) had verrucous carcinomas. These cases were studied in order to clarify any diagnostic problems, trace the biologic behavior of the tumors and report the results of the treatment used. Of these 15 patients, we were able to follow up 8. The latter had been treated only with surgery and none of them had received radiotherapy. One death occurred, but the patient died of other causes and remained free of cancer. Reports in the literature describe a high rate of recurrence of verrucous carcinomas following radiotherapy with occasional anaplastic transformation of tumors. No patients in our series developed a metastasis in the neck, indicating that neck dissection is not justified for patients with these neoplasms even though clinically enlarged neck nodes may be present.On leave from the Department of Otorhinolaryngology, University of Kosovo, Prishtina, Yugoslavia     

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 the larynx. Possible human papillomavirus etiology

Verrucous carcinoma of the larynx is a distinct and uncommon variant of well-differentiated squamous cell carcinoma. By DNA hybridization techniques, we clearly demonstrated human papillomavirus (HPV-16-related) sequences in five patients with this neoplasm. In addition, HPV-16-related sequences were found in adjacent normal tissues. The DNAs from squamous cell carcinomas of the larynx were negative when hybridized to HPV-6, -11, or -16. Postirradiation anaplastic transformation of verrucous carcinoma has been described. We believe that radiotherapy should not be given unless the potential consequences are fully explained because of its potential to activate or alter HPV-16-related sequences.     

Papillary squamous neoplasms of the head and neck

Papillary squamous neoplasms of the upper respiratory tract are rare variants of squamous cell carcinoma and are related temporally to proliferative verrucous leukoplakia. Fifty-two cases of papillary squamous neoplasms were selected from 2366 cases of squamous cell carcinoma. This is the first study to characterize the biological behavior of papillary squamous neoplasms. Papillary squamous neoplasms exhibit two distinct, yet sometimes overlapping, histologic patterns including an exophytic papillary and an inverting verrucous morphologic appearance. A high rate of synchronous or metachronous lesions were found, especially with the inverting-type of papillary squamous neoplasm. Stage T3 and T4 lesions had a high rate of neck metastasis. Early surgical intervention and close long-term follow-up is mandatory.     

Intranasal verrucous carcinoma: relationship to inverting papilloma and human papillomavirus

OBJECTIVES: To establish the incidence, appearance, behavior, and appropriate treatment of intranasal verrucous carcinoma and determine its relationship to inverting papilloma and human papillomavirus (HPV). STUDY DESIGN: Retrospective review of all cases of intranasal verrucous carcinoma seen at the Mayo Clinic from 1960 through May 1996. METHODS: Retrospective chart review and data collection for age, sex, smoking history, location, association with inverting papilloma, treatment, recurrence, and follow-up. Polymerase chain reaction (PCR) testing for the presence of HPV DNA was performed on all specimens. RESULTS: Of the 13 patients identified, most presented with nasal obstruction (10) or a noticeable intranasal lesion (8). The maxillary sinus was the extranasal site most often involved. Five patients had verrucous cancer develop in an inverting papilloma, and one had squamous cell carcinoma with the verrucous component (a hybrid tumor). All but one patient underwent surgery as initial treatment; only one patient had preoperative radiation therapy. Surgical procedures ranged from local excision to a craniofacial resection. Follow-up ranged from 2 months to 32 years (mean, 6.5 y). Four patients had a single recurrence and two tumors recurred a second time. No metastases developed and no one died from the tumor. In seven patients (10 specimens), DNA was successfully amplified for PCR testing, and no HPV DNA was detected. CONCLUSIONS: When verrucous tumors are discovered early, they can be treated effectively with wide local excision. In some cases, a more extensive procedure may be required. A possible role for HPV in the etiology of these tumors was not found.     

Malignant laryngeal epithelial tumors and lymph node involvement: therapeutic and prognostic considerations

The relationship among various malignant epithelial tumors of the larynx, with or without their respective lymph node and visceral metastases, is discussed. The tumors considered include squamous cell carcinoma, verrucous squamous cell carcinoma, spindle cell squamous carcinoma, small cell carcinoma, atypical carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and primary malignant melanoma. Other, rarer, malignant epithelial neoplasms of the larynx are only mentioned. The choice of therapy should be determined by tumor stage, oncotype, and patient status.     

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.     

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 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.     

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     

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.