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Verrucous carcinoma (VC), a rare variant of squamous cell carcinoma is an established entity with distinctive morphology and specific clinical behavior. To date, only a small series of head and neck verrucous carcinomas have been reported in the literature.
The present study evaluated 133 cases of verrucous carcinoma for the age, sex, site of invol...
Contexts in source publication
Context 1
... site distribution of verrucous carcinoma is shown in Table 1. Extension of lesion to adjacent site was noted in most cases. ...
Context 2
... retrospect, the most widely involved area is identified as the site for documentation. The correlation of site with sex predilection revealed that in almost all sites, there was a male predominance and lesions on tongue and maxillary sinus were seen exclusively in males (Table 1). Fig. 1 Graph demonstrating the sex distribution for incidence of verrucous carcinoma Majority of the lesions were asymptomatic and clinically presented as an ulcero-proliferative (78), nonulcerated exophytic lesion [13], patch [7], and nodules [14]. ...
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Background:
The objective of this study was to report the types and relative frequency of oral malignancies and precancer in the Jazan region of Saudi Arabia during the period 2009-2014.
Materials and methods:
Pathology reports were retrieved from the archives of Histopathology Department, King Fahd hospital in Jazan. Demographic data on tobacco...
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Citations
... 2 VC affects more males than females, and older individuals (average 50-70 years old) are mostly affected compared to the younger age group; 75% of VC patients are above 60 years old. 3 The cause of VC is essentially unknown. However, tobacco, alcohol, and betel nut consumption are the most associated risk factors. ...
... 5 VC is a well-recognized low-grade malignant tumor with three distinct variants, namely cutaneous, oral, and anogenital subtypes. 3 VC is known to be a slow-growing tumor that presents predominantly as an exophytic growth with pebbly, micronodular surfaces. Clinically, VC presents as a tan-white outgrowth with a broad base attachment, producing a cauliflower-like warty lesion that is locally aggressive but well circumscribed. ...
Verrucous carcinoma is a well-recognized low-grade variant of squamous cell carcinoma. Cutaneous, oral, and anogenital forms exist. Exposure to persistent chronic irritation, inflammation, and repeated injury, as well as carcinogenic agents such as human papillomavirus infection, smoking, and alcohol use, are established risk factors. These neoplasms occur mostly in the oral cavity. The usual extraoral sites include the larynx, esophagus, genitals, and perineum. It is an extremely uncommon site of occurrence for the extraoral chin region. This unusual location makes the index case unique. Other uncommon sites reported include finger and foot. Case studies of verrucous carcinoma with huge tumor sizes are rare. Although it can be destructive locally, verrucous carcinoma typically does not spread to distant sites. Wide surgical excision with free margins is the most common treatment approach with a favorable prognosis. These tumors are likely to recur if they are incompletely excised, and recurred lesions tend to be more aggressive clinically as compared to their original counterparts. Herein, the authors describe a case of a huge oral verrucous carcinoma localized on the chin of a 43-year-old female patient. The clinical course, diagnostics, and proposed treatment have been discussed with the existing available literature.
... 3 First described by Ackerman in 1948, OVC is a rare lowgrade variant of OSCC which exhibits hyperplastic epithelium with parakeratotic plugging, bulbous rete ridges with an intact basement membrane, and minimal dysplasia. 4, 5 Shear and Pindborg first described OVH as epithelial hyperplasia and verrucous surface, no invasion of the hyperplastic epithelium into the lamina propria compared with adjacent normal mucosal epithelium; however, with varying degrees of epithelial dysplasia. 6,7 A properly oriented hematoxylin-eosin stained section is the gold standard for their distinction; however, it is often worsened by very small biopsies, poorly orientated specimens, and most notably, biopsies failing to demonstrate the lesion margin. ...
Introduction Oral verrucous hyperplasia (OVH) and verrucous carcinoma (OVC) are precursors of oral squamous cell carcinoma exhibiting overlapping histopathological picture which warrants distinction. EZH2 is an epigenetic marker possessing multifaceted function in cellular proliferation, migration, and malignant transformation, whereas BCL2 is an integral part of the antiapoptotic mechanism regulating cellular homeostasis.
Aim The aim was to distinguish OVH and OVC by analysis of immunohistochemical expression of EZH2 and BCL2.
Material and Methods The study sample consisted of 79 formalin-fixed paraffin-embedded tissue sections of normal oral mucosa (10), OVH (10), oral OVC (27), and oral squamous cell carcinoma (32). Immunohistochemical analysis of EZH2 and BCL2 was done and labeling indices were calculated. Additionally, six histopathological parameters were assessed in OVH and OVC. Statistical analysis was done using Kruskal–Wallis test, Tukey honest significant difference test, and Spearman's correlation. Receiver operating characteristic curve was plotted and sensitivity, specificity, and cutoff score of each marker were calculated.
Result and Discussion Labeling indices of EZH2 and BCL2 depicted a gradual incline from normal mucosa to oral squamous cell carcinoma. Significant difference of EZH2 and nonsignificant difference in BCL2 expression between OVH and OVC were noted. Out of the six histopathological parameters, keratin plugging, juxtaepithelial lymphocytic response, and frank endophytic growth yielded a significant difference. EZH2 serves as a superior marker than BCL2 to differentiate OVH and OVC. Juxtaepithelial lymphocytic response can also serve as a histopathological parameter in distinguishing OVH and OVC.
... OVC is a rare tumor affecting the oral cavity; it is more frequent in patients between 40 and 60 years old with a male preponderance (2). Clinically, it appears as a painless, white-grey, warty, exophytic mass that resembles cauliflower ( Figure 1) (5). ...
Background: Verrucous carcinoma (VC) is a low-grade squamous cell carcinoma. It presents different morphologic, cytokinetic, and clinical characteristics. In advanced stages, it can infiltrate neighboring tissues despite slow growth and low mitotic activity, but it does not metastasis. The oral cavity is one of the mostly affected sites. Objective: This article reviews oral verrucous carcinoma (OVC) and offers information on its etiology, clinical appearance, diagnosis, and available treatments. Methods: Symptoms, pathogenesis, epidemiology, oral manifestations and management are reviewed. Discussion: OVC appears as a painless, white-grey, warty, exophytic mass that resembles cauliflower. It presents a strong predisposition for local invasion and a low predisposition for diffusion in neighboring structures
and metastasizing. Histologically, OVC exhibits a well-differentiated squamous proliferation with a papillary or verrucous epithelial surface and clear hyperkeratosis, invading the subjacent stroma with well-defined, pushing margins. Minor atypical cells are usually seen. Conclusion: OVC is an uncommon tumor. To establish an accurate diagnosis, a comprehensive evaluation is necessary, particularly one that focuses on histology.
... Verrucous carcinoma (VC) is an uncommon subtype of low-grade, well-differentiated squamous cell carcinoma (SCC) that develops mostly in the skin, genitalia, esophagus, and oral cavity. Oral verrucous carcinoma (OVC) accounts for 2-12% of all oral cavity carcinomas and mostly affects the buccal mucosa, followed by the hard palate, the floor of the mouth, and the gingiva [1][2][3][4]. ...
... OVC is a rare tumor affecting the oral cavity; it is more frequent in patients between 40 and 60 years old with a male preponderance [2,9,10]. The etiology of OVC is unknown; however, tobacco smoking, alcohol drinking, and chewing betel nuts are established major risk factors [11,12]. ...
This paper presents the case of a 75-year-old female with an extensive lesion located in the hard palate. Intraoral examination revealed an exophytic white lesion that extended from the entire left maxillary alveolar ridge to the palate beyond the midline. A thorough clinical, radiological, and histopathological examination confirmed the diagnosis of oral verrucous carcinoma
... Soft tissue=3 Rekha and Angadi 2010/retrospective [21] 133 ...
... Bone involvement is an important deciding factor for change in treatment modality. [13][14][15][16][17]20,21] There is a significant relation between size (T) and treatment performed [P < 0.001, Table 3]. Rekha and Angadi [21] reported 33/133 bony lesions and mandibular resection was added to a treatment plan. ...
... [13][14][15][16][17]20,21] There is a significant relation between size (T) and treatment performed [P < 0.001, Table 3]. Rekha and Angadi [21] reported 33/133 bony lesions and mandibular resection was added to a treatment plan. ...
Background
The objective of this study is to provide a structured protocol for the treatment of verrucous carcinoma (VC) based on size, bone invasion, recurrence and whether neck dissection is necessary or not. In addition, the study evaluates the probability of a wrong histopathological diagnosis.
Data Sources
A search was conducted in the Cochrane Library, PubMed and Google from January 1962 to October 2022 by using MeSH terms and keywords. Studies reporting treatment modalities for VC and different histopathological diagnoses after excision of the lesion were selected except case reports and review articles.
Study Eligibility Criteria
Thirteen articles were selected. Six hundred and thirty cases of VC were treated by surgery, surgery + neck dissection, radiotherapy, chemotherapy and combination therapy. Statistical analysis revealed surgical treatment as a preferred option. Despite being enlarged, the lymph node was negative for metastasis. So, in OVC cases neck dissection adds only unnecessary morbidity to patients.
Participants and Interventions
Radiotherapy or chemotherapy can be used to downstage the disease. 23.3% of cases reported wrong histopathology diagnosis.
Study Appraisal and Synthesis Methods
Patients treated for squamous cell carcinoma (SCC) will only experience unnecessary morbidity unless the correct diagnosis is made between VC and hybrid VC. Irrespective of size VC does not metastasise until there are no foci of SCC.
Conclusions
Surgical excision of T1- and T2-sized lesions can be performed under local anaesthetic as a biopsy procedure. T3 or T4 lesion can be resected with a safe margin. If it comes as hybrid VC or VC with close margin (0.5 cm, <0.5 cm), neck dissection and further margin should be excised as a second procedure respectively.
... In clinically ambiguous cases, histologic assessment is of paramount importance in guiding treatment, yet there is significant histomorphologic overlap between benign, premalignant, and malignant squamoproliferative lesions [1,7]. Cytologic atypia, while helpful, may be minimal or absent; indeed, bland cytomorphology is a hallmark of VC despite its invasive nature [1,[8][9][10]. In those cases, without frank cytologic atypia, the pathologist must be aware of the architectural atypia that are characteristic of these lesions to arrive at the correct diagnosis. ...
... In those cases, without frank cytologic atypia, the pathologist must be aware of the architectural atypia that are characteristic of these lesions to arrive at the correct diagnosis. Superficial sampling not only risks missing a deeper invasive component of the lesion, but some architectural features suggestive of a non-reactive process are only visible at the base of a lesion, such as tear shaped rete ridges and/ or drop off microinvasive carcinoma [10][11][12][13]. This loophole should be acknowledged in the pathology report and the need for re-biopsy, especially the edge of the proliferation, should be suggested. ...
Background
Squamous verrucous proliferative lesions of oral cavity can pose a diagnostic challenge for the general pathologist, especially on small biopsies. The superficial nature of incisional biopsies and inconsistent histologic terminologies used for these lesions contribute to often-discrepant clinical diagnosis, resulting in delayed treatment. This study aims to explore the proliferative squamous lesions of oral cavity, correlate biopsy & resection diagnoses, and evaluate possible reasons for discrepant diagnosis (if any).
Design
A retrospective review of oral verrucous squamous lesions was undertaken. Pathology database was searched for oral cavity biopsies from January2018 through August2022 with the keywords: atypical, verrucous, squamous, and proliferative. Cases with follow-up were included in this study. A blinded review of the biopsy slides was performed and documented by a single head and neck pathologist. Demographic data, biopsy and final diagnosis were recorded.
Results
Twenty-three cases met criteria for inclusion. The mean patient age was 61.1 years with a male: female ratio of 1.09. Most frequent site was lateral border of tongue (36%) followed by buccal mucosa and retromolar trigone. The most common biopsy diagnosis was “Atypical squamoproliferative lesion, excision recommended” (n = 16/23, 69%) with 13/16 showing conventional squamous cell carcinoma (SCC) on follow-up resection. 2/16 atypical cases underwent repeat biopsy for confirmation of diagnosis. Overall, conventional SCC was the most prevalent final diagnosis (73%, n = 17), followed by verrucous carcinoma (17%, n = 4). On slide review, six initial biopsies were reclassified as SCC, while one final diagnosis was reclassified as a hybrid carcinoma (on resection specimen). Diagnostic concordance (biopsy and resection) was observed in three cases, all three were recurrences. The primary reasons for discrepant diagnosis on initial biopsies were found to be 1. Obscuring inflammation, 2. Superficial biopsies, and 3. Under recognition of morphologic features (e.g., tear shaped rete, loss of polarity, dyskeratotic cells, paradoxical maturation) that help differentiate dysplasia from reactive atypia.
Conclusion
This study highlights the rampant interobserver variability in diagnosis of oral cavity squamous lesions and emphasizes importance of identifying morphologic clues that can aid in correct diagnosis, thereby helping in adequate clinical management.
... 6 Verrucous carcinoma most often arises on mucous membranes of the head and neck region with the oral cavity most commonly involved, particularly buccal mucosa, gum and tongue. 3 Oral verrucous carcinoma accounts for 0.57-16.08% of oral squamous cell carcinoma (SCC) [7][8][9] and is predominantly seen in males with the reported mean age at diagnosis between 49 and 69.5 years. [9][10][11] In a study by Koch et al., glottic larynx was the most frequently affected nonoral site. ...
... 3 Oral verrucous carcinoma accounts for 0.57-16.08% of oral squamous cell carcinoma (SCC) [7][8][9] and is predominantly seen in males with the reported mean age at diagnosis between 49 and 69.5 years. [9][10][11] In a study by Koch et al., glottic larynx was the most frequently affected nonoral site. 3 Other reported locations in the head and neck region affected by verrucous carcinoma are nasal cavity, paranasal sinuses, nasopharynx, oesophagus and temporal bone. ...
... Other irritants to the oral mucosa such as betel nut chewing, poor oral hygiene, a poorly fitting dental prosthesis and earlier mucosal injuries or scars have also been described as risk factors in the development of oral verrucous carcinoma. 9,[17][18][19] There is growing evidence that oral microbiota and its imbalances may play a role in the etiology of oral cancers through activation of smoking and alcohol related carcinogens locally and chronic inflammation systemically. 20 Human papillomaviruses (HPVs) have been considered as a possible etiologic factor in verrucous carcinoma, with the reported prevalence of HPV in verrucous carcinoma ranging from 0% to 100%. ...
Background
Verrucous carcinoma is a low-grade variant of squamous cell carcinoma with specific morphologic, cytokinetic and clinical features. Despite low mitotic activity and slow growth, it can infiltrate adjacent tissues in advanced stages but does not metastasize. The most frequently affected site is the oral cavity. The following article provides latest updates in the etiology, clinical presentation, diagnostics and treatment options in oral verrucous carcinoma and discusses the existing dilemmas linked to this unique malignancy.
Conclusions
Oral verrucous carcinoma must be differentiated from conventional squamous cell carcinoma due to its less aggressive behaviour with a more favourable prognosis. Close communication between clinician and pathologist is mandatory for making a correct diagnosis. Primary surgery with negative surgical margins seems to be the most successful treatment. However, management recommendations are not uniform since they are mostly based on case reports and small retrospective case series. Prospective and pooled multi-institutional studies are therefore needed.
... According to a recent study, the prevalence of VC affecting oral cavity and oropharynx is 2%-12%. [8] The male-to-female ratio of VC incidence is approximately similar. "The most affected areas are mandibular retromolar and molar area (41.6%) followed by the buccal mucosa (16.6%), the hard palate (16.6%), the floor of the mouth (16.6%), and the lip mucosa (8.3%)." ...
Verrucous carcinoma (VC) (Ackerman’s tumor/Snuff dipper’s cancer) is a variant of oral squamous cell carcinoma (SCC) with minimum
aggressive potential. The most common sites of involvement in the head‑and‑neck regions are oral cavity and larynx. VC of the oral cavity is
a different clinicopathologic tumor distinguished from the usual SCC because of its local invasiveness, nonmetastasizing behavior, and special
clinical appearance, but long‑standing cases have shown transformation into SCC. An accurate pathological diagnosis is difficult because of an
inadequate tumor sample for the study, and more importantly, a close collaboration is needed between a clinician and a pathologist to achieve the
correct diagnosis. In this article, we discuss a case of 42‑year‑old male with VC of the left buccal mucosa which was proliferating extraorally
... In this study, after the time presentation, some additional delay was expected, both due to the patient and institutional difficulties and limitations, before starting treatment. Most of the oral squamous cell carcinoma in this study are histologically diagnosed as well-differentiated WD and moderately differentiated tumors (MD), the same result was described by other authors [42,46,49,55,58,60,61], as into [47] have shown that 47.6% of their cases were histologically classified as Poorly differentiated tumors (PD) tumors, while well differentiated tumors represented 32.6% of their sample. Several oral squamous cell carcinoma variants have been reported in the literature, and the establishment of the specific appropriate histological diagnosis is essential, as some histological subtypes and distinct clinicopathological entities are managed with different treatment protocols and present variable prognosis [60,61]. ...
... Most of the oral squamous cell carcinoma in this study are histologically diagnosed as well-differentiated WD and moderately differentiated tumors (MD), the same result was described by other authors [42,46,49,55,58,60,61], as into [47] have shown that 47.6% of their cases were histologically classified as Poorly differentiated tumors (PD) tumors, while well differentiated tumors represented 32.6% of their sample. Several oral squamous cell carcinoma variants have been reported in the literature, and the establishment of the specific appropriate histological diagnosis is essential, as some histological subtypes and distinct clinicopathological entities are managed with different treatment protocols and present variable prognosis [60,61]. In study [62] have recently reported a series of 133 verrucous carcinomas, representing 16% of all SCC diagnosed in their files from India. ...
... The age and gender profile of oral squamous cell carcinoma, as well as site predilection, shows a heterogeneous pattern of distribution in different countries, different regions within the same country, and different ethnic groups within the same region, which can be linked to both genetic factors and cultural habits/behavior. Studies that focus on specific regions are beneficial because they highlight the demographic and clinical profile of oral squamous cell carcinoma in certain geographic areas, allowing for a better understanding of these tumors and the development of appropriate prevention, diagnosis, and treatment strategies [60][61][62][63]. The course of oral SCC is unpredictable, but the TNM stage (T-tumour size, N-nodal metastasis, M-distant metastasis) of the primary tumor correlates well with the survival rate [63]. ...
Background and Aim: Oral cancer is a major public health issue worldwide; it remains a highly lethal and disfiguring disease, it is primarily a disease of epithelial origin, it has various clinicopathological pictures. is to demonstrate various clinical and pathological presentations of oral squamous cell carcinoma in Iraqi population. Materials and Methods: A total of 80 cases of histologically diagnosed squamous cell carcinoma collected from the main centers of Sulaymaniyah teaching hospital/Hiwa cancer center Hospital/Sulaymaniyah/Iraq were analyzed according to age, sex, site, clinical, and pathological presentation of oral squamous cell carcinoma at the time of presentation, and histological grading. Results: Patients in their sixth decade of life were the most commonly affected with a male-to-female ratio of 1.4:1. The tongue was the most frequently affected site, followed by the floor of the mouth. The most common clinical presentation is ulceration and swelling. More than 40% of the cases were well-differentiated squamous cell carcinoma. Conclusion: Oral cancer is increasingly seen as a major health problem, in line with the general trend in the region, the need for inter-professional health care delivery approaches for reducing oral cancer mortality and improving patients’ quality of life.
... Neville et al. 7 points that the treatment of choice is surgical excision, and if cervical lymphadenomegaly is clinically evident, selective neck dissection can be performed, although most cases may experience reactive lymphadenopathy instead of metastasis. Approximately 90% of patients are disease-free after surgery. ...
Introduction: Verrucous carcinoma is a non-metastatic variant of squamous cell carcinoma. It was first reported by Ackerman in 1948. It is a verrucous exophytic tumor and, although it is a rare lesion, it mainly affects the oral cavity, with slow growth and can be locally invasive. Objective: To report a case and present an observational and retrospective analysis of medical records containing biopsy data from patients diagnosed with oral verrucous carcinoma (OVC) in an oral diagnostic referral service for a period of 24 years. Material and methods: The following data were collected: age, sex, ethnicity, anatomical location and management. Result: Eight cases of OVC were found, all in Caucasian patients (n = 8, 100%), aged between 57 and 102 years. 62% of the injuries affected women. The most affected region was the jugal mucosa (n = 4, 50%). In addition, Smoking patients were not found. In all cases, incisional biopsy was performed and referral to the head and neck surgeon. Conclusion: Caucasian women in the sixth and seventh decades of life were the most affected by OVC. The absence of smoking patients corroborates the literature, which reports that cigarettes appear to be unrelated to this injury. The dentist's role is to recognize the disease early, diagnose it and refer it for medical treatment.
