The treatment results with radiotherapy were comparable with those for ordinary squamous cell carcinoma of the oral cavity. Oral verrucous carcinoma is a rare tumor first described by ackerman. The ages range from 50 to 80 years with a male predominance and a median age of 67 years. In this paper we discuss a case of 42 year old female with verrucous carcinoma of left buccal mucosa. Case report hybrid verrucous carcinoma of the oral cavity. Anaplastic transformation in verrucous carcinoma of the. Oral verrucous carcinoma ovc is a verrucous variant of oral squamous cell carcinoma oscc, which accounts for 212% of all oral carcinomas with a 5year survival rate of only approximately 50%. Verrucous hyperplasia of the oral cavity application of standardized criteria for diagnosis asian pac j cancer prev, 17 9, 44914501 introduction verrucopapillary lesions vpls of the oral cavity include benign, potentially malignant and frankly malignant disorders.
The oral cavity is one of the predilection sites for vc. Verrucous squamous cell carcinoma of the oral cavity fonts. The oral cavity and oropharynx help you breathe, talk, eat, chew, and swallow. Current management strategies for verrucous hyperkeratosis and verrucous carcinoma. Verrucous carcinoma is a distinctive, extremely welldifferentiated, slowgrowing variant of the squamous cell carcinoma. Past history of hyperthyroidism increased appetite, loss of weight, tremors, and menorrhagia present commonest location verrucous carcinoma is the oral cavity, and extraoral sites are genitalia and feet, but on the leg is rare. Oral verrucous carcinoma vc, as defined by ackerman, is a rare, nonmetastasizing, welldifferentiated variant of oral squamous cell carcinoma scc. Verrucous carcinoma may occur in various head and neck locations, as well as in the genitalia or sole of the foot. Apr 20, 2011 verrucous carcinoma vc is a rare type of lowgrade, well differentiated squamous cell carcinoma, and develops mainly in the skin, genitalia, esophagus, and oral cavity. All 3 patients had received external irradiation 1 by orthovoltage and 2 by supervoltage, and 2 had received radium applications.
Verrucous carcinoma ackermans tumor is a low grade variant of oral squamous cell carcinoma oscc. Verrucous carcinoma is a lowgrade variant of squamous cell carcinoma reported to occur in all anatomic sites in the head and neck region, most commonly the oral cavity. It is well known for its locally aggressiveness and for its clinically slowgrowing behaviour with minimal metastatic potential. The sites where the verrucous carcinoma develops include oral cavity, throat, exterior part of the foot and sometimes other cutaneous tissue also affected with this type of lesions. Ovc often occurs in buccal mucosa, tongue, lip, gingiva, alveolar ridge and mouth floor 39, exhibiting a predilection for. Verrucous carcinoma and squamous cell papilloma of the. Verrucous carcinoma in the oral cavity at an advanced stage can present with lymph node metastasis, for which selective neck dissection should be considered 12. Although hpv types 6, 11, 16 and 18 have been detected to varying degrees in verrucous carcinoma of the oral cavity and the larynx10,11. Papillary and verrucous lesions of the oral mucosa. Verrucous carcinoma is an uncommon but distinct variety of well differentiated squamous cell carcinoma.
Verrucous carcinoma vc first described in 1948 by lauren v. Differential diagnosis of verrucous carcinoma in the oral cavity and larynx volume 102 issue 8 m. Verrucous carcinoma verrucuous carcinoma is an uncommon kind of welldifferentiated squamous cell carcinoma. Verrucous carcinoma of the tongue a rare case study. Verrucous carcinoma is a slow growing, well demarcated, exophytic variant of squamosus cell carcinoma with a characteristic verrucous presentation.
This neoplasm typically involves the oral cavity, larynx, genitalia, skin, and esophagus. The demographics, clinical presentation, and surgical outcomes of vc are believed to be different from oscc. Verrucous carcinoma is a rare variant of squamous cell carcinoma. The commonest sites of involvement in the head and neck regions have been oral cavity 29% and larynx 2%. A retrospective analysis for clinicopathologic features wanjari g sonalika, tegginamani anand department of oral and maxillofacial pathology, hitkarini dental college and hospital, jabalpur, madhya pradesh, india. Cutaneous verrucous carcinoma is referred to as carcinoma cuniculatum or epithelioma cuniculatum and is predominantly located on the plantar surface of the foot. In the strict sense,the word does not imply a neoplastic process. Ackermann first described this neoplasm of the oral mucous membrane, which is now also know as verrucous carcinoma of ackermann or ackermanns tumor. The pathogenesis of vc of the oral cavity is thought to be associated with human papilloma virus hpv 1 3, poor oral hygiene, chewing of tobacco, and use of snuff. This carcinoma has also been reported in the nasal cavity, larynx and esophagus. Our study documents, for the first time, the coexistence of foci of lessdifferentiated squamous carcinoma within verrucous lesions of the oral cavity 20%. Verrucous carcinoma also called as ackermans tumor is a subtype of low. National survey of head and neck verrucous carcinoma. They are characterized by a unique proliferation of the stratified squamous epithelium.
They are generally considered as slow growing tumors with good prognosis. A troubling diagnosis of verrucous squamous cell carcinoma. The most common site of origin of this type of cancer normally develops in gingiva gums, alveolar mucosa and buccal mucosa of the oral cavity or buccal cavity. Verrucous carcinoma registered dental hygienist rdh. The papillary or verrucoustype lesions are quite common in the oral region, representing 3% of all the biopsied oral lesions. A variety of verrucous and papillary lesions affect the oral mucosa. However, dysplastic and malignant verrucous and papillary lesions are a much greater diagnostic challenge, not helped by confusing terminology. The diagnoses of vc in these patients were proved by pathologic report of a further deep incisional biopsy or wide excision. This variety of epidermoid carcinoma of the oral cavity presents as a warty growth in patients who have a. A challenge for the clinician and the pathologist rita a. There is a certain clinical similarity between squamous cell papilloma and vc. Verrucous carcinoma of the oral cavity, found most commonly on the buccal mucosa, is known as florid oral papillomatosis or ackerman carcinoma. Verrucous carcinoma of the oral cavity international. The problems in diagnosing vc are discussed in many reports in the literature.
The striking difference in the distribution of gender between the oral cavity and other head and neck sites has been addressed previously. Differential diagnosis of verrucous carcinoma in the oral. Various names are used in the literature to describe this entity, including ackermans tumor, buschkeloewenstein tumor, florid oral papillomatosis, epithelioma cuniculatum, and. In the current literature, 16 although the most common site for verrucous carcinoma is the buccal mucosa, the most affected areas in the present study were the mandibular retromolar and molar area 41. In 1948, ackerman first described the characteristics of verrucous carcinoma vc, a variant of epidermoid malignancy of the oral cavity, that has since been. Verrucous carcinoma in the oral cavity report of two cases. Pdf verrucous carcinoma vc, a rare variant of squamous cell carcinoma is an established entity with distinctive morphology and specific. An association between human papilloma virus and verrucous carcinoma has also been proposed. Nextgeneration sequencing analysis for detecting human papillomavirus in oral verrucous carcinoma. Verrucous carcinoma vc ackermanns tumor is a rare type of lowgrade, well differentiated squamous cell carcinoma, and develops mainly in the skin, genitalia, esophagus, and oral cavity. Although vc has a slow and continuous local growth pattern. Verrucous carcinoma is a rare type of cancer with external lesions that appear cauliflowerlike, typically developing at a site of chronic irritation or inflammation.
Verrucous carcinoma on the lower extremities mdedge. The oral cavity is the most common site for this type of tumor, as well as other areas such as the larynx, nasal cavity and throat. Case report verrucous carcinoma a diagnositic dilemma. Clinical pathology study of oral verrucous carcinoma. The 5year survival rate was 35% for stage i11 and 26% for stage iv. Exophytic verrucous hyperplasia of the oral cavity.
Origin of undifferentiated neoplasm from verrucous. In 1948, ackerman was first described after studying the lesion affected on the oral cavity and he described the tumor as a lowgrade carcinoma with a pathologic. Verrucous hyperplasia and verrucous carcinoma are indistinguishable clinically. Verrucous carcinoma of oral cavity is a highly well differentiated variant of squamous cell carcinoma with a low potential for invasion and metastasis.
Ackerman 1 is a form of squamous cell carcinoma with specific clinical, morphologic and cytokinetic features. Therefore, at the commencing of the condition may lead to organspecific symptoms including a sore throat, hoarseness, and dysphagia. It rarely occurs in the floor of the mouth and tongue. Verrucous carcinoma of the leg a rare variant of squamous. We confirm previous observations that verrucous lesions tend to recur in the form of lessdifferentiated carcinomas. One hundred four patients had verrucous carcinomas of the oral cavity. Anaplastic transformation in verrucous carcinoma of the oral. Verrucous carcinoma vc is an uncommon but distinct variety of well differentiated squamous cell carcinoma first delineated by ackerman in 1948. Verrucous carcinoma vc is a rare type of lowgrade, well differentiated squamous cell carcinoma, and develops mainly in the skin, genitalia, esophagus, and oral cavity. Verrucous carcinoma in the oral cavity report of two cases venkateswarlu m1, geetha p2, batchu pavan kumar3, namratha4, sunitha5 abstract.
Histologically, it is characterized by a well differentiated pattern of squamous epithelium in abundant papillomatous hyperkeratotic folds. Verrucous carcinoma and squamous cell papilloma of the oral. In the oral cavity, the buccal mucosa and lower gingiva is the common site imaiet al, 1995. Verrucous carcinoma vc is a rare oral tumor that is classified under carcinomas owing to characteristics that exists amid a benign verrucous lesion and. Radiotherapy in the treatment of verrucous carcinoma of the oral cavity. Pdf radiotherapy in the treatment of verrucous carcinoma of.
Verrucous carcinomas typically are slow growing, exophytic, and low grade. Hybrid verrucous squamous carcinoma of the oral cavity. Enormous effort has been dedicated to this cancer, and the past decades have witnessed significant advances in relevant diagnostic and therapeutic. Verrucous carcinoma also known as ackerman tumor is an uncommon exophytic lowgrade welldifferentiated variant of squamous cell carcinoma.
The pathogenesis of verrucous carcinoma of oral cavity is still obscure but is thought to. Good prognosis is characteristic for this tumour, since the 5year survival is 93%. Verrucous carcinoma of the oral cavity mcdonald 1982. This variety of epidermoid carcinoma of the oral cavity presents as a warty growth in patients who have a history of chewing tobacco and poor oral hygiene. Oral verrucous carcinoma ovc is an uncommon variant of oral squamous cell carcinoma oscc. Vc is occasionally developed in the oral cavity,2,3 though it may be found on. It is a rare tumour and in 75% of cases it is localised in the oral cavity, and sporadically within the tongue.
Pdf radiotherapy in the treatment of verrucous carcinoma. The incidence of vc of the oral cavity is between 2% and 16% of all oral cancers. The usual location of the verrucous carcinoma is oral cavity and may involve multiple organs including throat, nasal cavity buccal mucosa, and larynx. Verrucous carcinoma causes, symptoms, treatment, prognosis. It is a slow growing tumor, which presents predominantly as an exophytic growth with a pebbly, micronodular surface and tends to spread locally. It develops mainly in skin, genitalia, esophagus and the oral cavity. Ackermans tumour or verucous carcinoma is a unique clinicopathological variant of squamous cell carcinoma, occuring mainly in oral cavity and larynx, buccal mucosa being most commonly involved. Clinical and pathologic study of 105 cases involving oral cavity, larynx and genitalia. In the strict sense,the word does not imply atissue. It is felt that the treatment policy for verrucous carcinoma.
Oral verrucous carcinoma 810 verrucous hyperplasia was the initial pathologic diagnosis in 60% of our cases. Oral verrucous carcinoma ovc presents predominantly as an exophytic growth. Ingita chatterjee, post graduate student, department of oral medicine and radiology. Verrucous squamous cell carcinoma of the oral cavity. Those which are benign and reactive, for example squamous papilloma or verruciform xanthoma, usually present little diagnostic difficulty. Tumors and growths in the oral cavity and oropharynx. Good prognosis is characteristic for this tumour, since the 5year. Minor salivary glands throughout the oral cavity and oropharynx make saliva that keeps your mouth and throat moist and helps you digest food. Verrucous carcinoma vc of oral cavity is a rare variant of welldifferentiated squamous cell carcinoma and squamous papilloma is a benign proliferation of the stratified squamous epithelium, which results in a papillary or verrucous exophytic mass. Verrucous carcinoma is mostly found in the oral mucosa, but it has been reported at extraoral sites like the larynx i2,2j,2h, esopha gus, nasal cavity10, skirr. Verrucous carcinoma vc is a rare oral tumor that is classified under carcinomas owing to characteristics that exists amid a benign verrucous lesion and malignant squamous cell carcinoma scc. Verrucous carcinoma vc is a variant of welldifferentiated squamous cell carcinoma ackerman, 1948.
The oral cavity is the most common site of this tumor. Typically, the lesion appears as a slowgrowing warty mass on the gingival or buccal mucosa of an elderly patient. In addition, it is knowntooccurinthelarynx,pyriformsinus,esophagus,nasalcavityandparanasalsinuses,externalauditorymeatus, lacrimal duct, skin, scrotum, penis, vulva, vagina, uterine cervix, perineum, and the leg. The pathogenesis of vc of the oral cavity is still obscure, but is thought to be associated with human papilloma virus hpv 1 3, poor oral hygiene, chewing of tobacco, and use of snuff. The tumor grows locally invasive but is histologically benign and metastasizes rarely. In addition, it is known to occur in the larynx, pyriform sinus, esophagus, nasal cavity and. A tumor, by definition, is simply a swelling of thea tumor, by definition, is simply a swelling of the tissue. Verrucous carcinoma of the oral cavity has been established as a distinctive clinical and pathologic entity 1, 2, 11, 15. Ingita chatterjee, post graduate student, department of. Clinical and histopathological diagnosis of these lesions is challenging. National survey of head and neck verrucous carcinoma koch.
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