Masquerading verrucous carcinoma: A pathologist's & surgeon's dilemma

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© 2021 Indian Journal of Medical Research, published by Wolters Kluwer - Medknow for Director-General, Indian Council of Medical Research
Indian J Med Res 152 (Supplement), November 2020, pp 189-190
DOI: 10.4103/ijmr.IJMR_2292_19
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An 80 yr old male† presented to the department of
Oral & Maxillofacial Surgery, AB Shetty Memorial
Institute of Dental Sciences, Mangaluru, Karnataka,
India, in March 2018, with a slow-growing (two
years), single, whitish-pink, well-dened, exophytic
growth on the left buccal mucosa approximately
Masquerading verrucous carcinoma: A pathologist’s & surgeon’s dilemma
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A
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Fig. 2. Photomicrograph of the incisional biopsy showing stratied
squamous epithelium with papillary masses, keratin plugging
(thin red arrow) and blunt and broad rete pegs with underlying
chronic inammatory cells (thick red arrow) in the connective
tissue (H and E, ×4).
Fig. 1. Clinical image showing single, exophytic cauliower-like whitish-pink-coloured, well-dened growth on the left buccal mucosa
approximately measuring 3 × 3 cm in size extending to the buccal vestibule.
Fig. 3. Photomicrograph of the excisional biopsy showing dysplastic
epithelium proliferating into the connective tissue (red arrow)
suggestive of papillary squamous cell carcinoma (H and E, ×40).
†Patient’s consent obtained to publish clinical information and images
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190 INDIAN J MED RES, NOVEMBER (SUPPL.) 2020
3 × 3 cm in size (Fig. 1). On palpation, the lesion
was tender, rm in consistency, with irregular
surface, no xity and no palpable lymph nodes. A
provisional diagnosis of verrucous carcinoma was
made which was conrmed on incisional biopsy
(Fig. 2), and the patient was taken up for wide
excision and reconstruction with local ap. However,
to our surprise, histopathology of this innocuous
lesion revealed features of papillary squamous
cell carcinoma (Fig. 3). The patient underwent
radiotherapy and was on regular follow up; however,
in March 2019, he reported with recurrence.
Verrucous carcinoma can pose a diagnostic dilemma
for both surgeon and pathologist. Histopathologic
grading and interdisciplinary discussions may help
in preventing over- or under-treatment.
Conicts of Interest: None.
S.V. Sreelatha1 & Shalini Krishnan2,*
Departments of 1Oral & Maxillofacial Pathology &
Oral Microbiology & 2Oral & Maxillofacial Surgery,
AB Shetty Memorial Institute of Dental Sciences,
Nitte (Deemed to be University),
Mangaluru 575 018, Karnataka, India
*For correspondence:
dr_shaluk@redimail.com
Received November 20, 2019
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