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.     

Invasive verrucous carcinoma: a temporal bone histopathology report

Only nine cases of primary verrucous carcinoma of the temporal bone have been reported in the English literature. We describe histopathologic findings in a 78-year-old man dying of intracranial complications of primary verrucous carcinoma of the external auditory canal. Following autopsy the temporal bone was prepared for light microscopic examination. The temporal bone was serially sectioned horizontally after fixation, decalcification, and embedding, and each 10th section was stained with hematoxylin and eosin and examined by light microscopy. The carcinoma originated from the external auditory canal, infiltrating the mastoid cavity, the middle ear, tissue adjacent to the internal carotid artery, and the posterior cranial fossa, where it invaded the right cerebellum and produced an abscess. The labyrinth and internal auditory canal were not infiltrated. Metastasis to lymph nodes or distant sites was not identified. In the present case, the verrucous carcinoma originating from the external auditory canal extended into the posterior cranial fossa, while it did not invade the membranous labyrinth.     

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.     

Metastatic vaginal carcinoma to the temporal bone

Metastatic carcinoma of the temporal bone is being reported with increasing frequency. A literature review reveals 16 new cases reported in the past 2 years. In this article we present the first case of vaginal squamous cell carcinoma metastatic to the temporal bone reported in the literature. The pathophysiology, clinical presentation, and diagnostic difficulties of metastatic carcinoma to the temporal bone are discussed.     

Undifferentiated small-cell neoplasm of the petrous apex. A case report.

We present a rare case of undifferentiated small-cell neoplasm involving the temporal bone petrous apex. The symptoms, physical examination, importance of roentgenographic findings, and pathologic findings are reviewed. While not absolutely conclusive, the collective evidence in this case supports a diagnosis of small-cell carcinoma of the lung with metastasis to the petrous apex. A discussion of temporal bone malignancies, their frequencies, and characteristics is included. To our knowledge, a review of the literature over the past 25 years reveals no other published cases of an undifferentiated small-cell carcinoma in the temporal bone.     

Verrucous carcinoma in the external auditory canal

The apparent rarity of verrucous carcinomas of the ear is reflected by the fact that only three well-documented cases have previously appeared in the literature. However, in other instances the diagnosis of verrucous carcinoma may have been missed because of the unfamiliarity of many clinicians and pathologists with the morphologic characteristics of these lesions. We describe the first case of a verrucous carcinoma confined to the external auditory canal in which a positive diagnosis was only made histologically after local recurrence of what was initially diagnosed as a senile keratosis. The difficulties inherent in diagnosing this lesion and the necessity of close cooperation between the surgeon and pathologist if a diagnostic error is to be avoided are emphasized. Careful follow-up of all warty lesions of the external auditory canal and middle ear cleft is recommended.     

Secondary malignant tumors of the temporal bone. A histopathologic study and review of the world literature

Metastatic involvement of the temporal bone by malignant tumors is considered to be rare. The actual incidence of metastatic temporal bone tumors, however, is probably much higher than suggested by reports in the literature. The reason for this is that histologic studies are rarely performed on temporal bones in routine postmortem examinations of patients with possible metastatic disease. Also, in patients with multiple metastatic lesions, otologic complaints and signs may often be overshadowed by other more disabling symptoms. Twelve temporal bones were histopathologically examined from 6 patients who had metastatic temporal bone disease from various primaries and the results obtained in our present series of 6 cases were: 3 cases of hematogenous dissemination from a distant primary (a hepatic cell carcinoma, a bronchogenic squamous cell carcinoma, and an adenocarcinoma of unknown primary); 2 cases of direct invasion from adjacent head and neck tumors (squamous cell carcinomas of the eyelid and hypopharynx); and one case of diffuse metastatic leptomeningeal carcinomatosis (a transitional cell carcinoma of the renal pelvis). Among these, to our knowledge either hepatic cell carcinoma or renal pelvis carcinoma metastatic to the temporal bone has not been reported previously in the world literature. We reviewed the previously published reports of metastatic temporal bone tumors and found that there were 212 reported cases cited in the literature and that the most common sites of origin in order of frequency were breast, lung, pharynx, kidney, and prostate. Our temporal bone study and literature survey reveal that there are three distinct routes of tumor spread from the primaries to the temporal bone: 1) hematogenous dissemination from a distant primary, 2) direct neoplastic extension from adjacent areas, and 3) diffuse metastatic leptomeningeal carcinomatosis (DMLC). Our study also indicates that in most cases temporal bone symptoms appeared late in the course of disease, but in some cases the otologic symptoms were an initial sign of tumor, which was particularly conspicuous in the cases of DMLC. In the cases of hematogenous dissemination, the metastatic lesion tends to be overlooked or undiagnosed because occult metastases are relatively common or, when symptomatic, the otologic symptoms often resemble the features characterized by a severe form of mastoiditis. In the cases of direct neoplastic invasion, on the other hand, recognition of temporal bone involvement is usually simple since the primary disease is quite evident. Although metastatic temporal bone malignancies are rare, otologist should always be aware of existence of this disease entity in clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)     

A case of skull base mucormycosis with osteomyelitis secondary to temporal bone squamous cell carcinoma

We describe an unusual case in which a 35-year-old man presented with skull base mucormycosis with osteomyelitis secondary to squamous cell carcinoma of the temporal bone. We also review the literature on the clinical characteristics, diagnosis, and treatment of mucormycosis.     

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 nasal septum

A case of verrucous carcinoma of the nose is presented. Initially two pathologists described the lesion as benign. The tumour was excised with free margins through a lateral rhinotomy, with a successful outcome. The literature on the topic has been reviewed. Deep wide-based biopsy should always be considered if such a lesion is not to be missed on the first consultation. Surgery in resectable lesions offers the best chance of survival in verrucous carcinoma of the nose.     

Detection of human papillomavirus in temporal bone inverted papilloma by polymerase chain reaction

There is debate about the role of human papillomavirus in the induction of rare inverted papillomas involving the temporal bone and in the higher recurrence rates and association with squamous cell carcinoma of temporal bone inverted papillomas compared with sinonasal inverted papillomas. An exhaustive review of the literature revealed that eight cases of temporal bone inverted papilloma have been analysed for human papillomavirus. None of the cases studied with in situ hybridization proved positive. Only one case was found to be positive using the more sensitive polymerase chain reaction assay. We present the first two cases of Schneiderian-type papilloma involving the temporal bone to be analysed by type-specific polymerase chain reaction methods for human papillomavirus.     

Detection of Human Papillomavirus in Temporal Bone Inverted Papilloma by Polymerase Chain Reaction

There is debate about the role of human papillomavirus in the induction of rare inverted papillomas involving the temporal bone and in the higher recurrence rates and association with squamous cell carcinoma of temporal bone inverted papillomas compared with sinonasal inverted papillomas. An exhaustive review of the literature revealed that eight cases of temporal bone inverted papilloma have been analysed for human papillomavirus. None of the cases studied with in situ hybridization proved positive. Only one case was found to be positive using the more sensitive polymerase chain reaction assay. We present the first two cases of Schneiderian-type papilloma involving the temporal bone to be analysed by type-specific polymerase chain reaction methods for human papillomavirus.     

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.     

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.     

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.     

Temporal bone and sinonasal inverted papilloma: the same pathological entity?

BACKGROUND: Inverted papilloma involving the temporal bone is an extremely rare occurrence. Reports in the literature suggest a higher recurrence rate and association with squamous cell carcinoma in Schneiderian-type papillomas of the middle ear than in sinonasal Schneiderian-type papillomas. OBJECTIVES: To investigate the expression of apoptosis-related proteins, markers of cell proliferation activity, and sex hormone receptors in temporal bone inverted papillomas and to compare this entity with sinonasal papillomas.Design and Subjects We investigated 2 rare cases of inverted papilloma of the temporal bone and a control group of 6 cases of sinonasal inverted papilloma. The expression of p53, Mib-1, p27, and progesterone and estrogen receptors was determined. RESULTS: In the 2 cases of temporal bone inverted papilloma, p53 expression was 43.75% and 4.92%; p27 expression was higher in temporal bone inverted papilloma (82.45% and 70.53%) than in the sinonasal inverted papilloma group. One of our 2 cases of temporal bone Schneiderian-type papilloma was positive for progesterone receptor. CONCLUSIONS: The expression of progesterone receptor in 1 of our 2 cases and in the only other case reported in the literature may imply some degree of hormonal dependence of temporal bone inverted papilloma. Our analysis of the expression of apoptosis-related proteins, markers of cell proliferation activity, and sex hormone receptors does not allow us to demonstrate that temporal bone and sinonasal inverted papilloma are different pathological entities.     

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。     

Small cell neuroendocrine carcinoma in the petrous apex

With the exception of moderately differentiated neuroendocrine carcinoma of the larynx, neuroendocrine carcinomas are very rare head and neck malignancies. We report a case of a small cell neuroendocrine carcinoma in the petrous apex of the temporal bone. This unusual site for this tumour has not yet been reported in the literature. We confirmed the location and extent of the primary tumour by positron-emission tomography scan. The final histopathological diagnosis was of small cell carcinoma, and this was confirmed by immunohistochemistry. We treated this patient with surgery followed by radiotherapy and chemotherapy. After the treatment was completed there was subtotal remission of the tumour, with no distant metastases.     

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.     

The verrucous laryngeal carcinoma. A rare tumor with a difficult diagnosis

OBJECTIVES: The authors report a single case of laryngeal verrucous carcinoma and review the literature. MATERIALS AND METHOD: The delay of the diagnosis, the difficulties in its establishment and the therapeutic methods are discussed in a review of the literature. RESULTS: Histopathological diagnosis remains difficult. This may explain a great number of mistakes and the subsequent delay of in treatment. The role of radiotherapy is discussed. CONCLUSION: The diagnosis and management of the laryngeal verrucous carcinoma is difficult.