Verrucous carcinoma of the temporal bone

An individual drug-therapy and genetic testing report of temporal bone verrucous carcinoma

Objective

To investigate the pathology and pathogenesis of and treatment methods for temporal bone verrucous carcinoma.

Materials and methods

A single-patient report of verrucous carcinoma on the left external auditory canal is presented and analyzed along with all cases of temporal bone verrucous carcinoma that have been documented in the English literature.

Results

Most of the patients with verrucous carcinoma of the temporal bone have histories of surgery, trauma, or infection, and verrucous carcinomas are sensitive to antimicrotubule chemotherapeutic medicines. Adjuvant radiation therapy is not effective, but surgical treatment might be relatively more effective.

Conclusion

Temporal bone verrucous carcinoma has a poor prognosis; therefore, the preferred treatment is surgical resection facilitated with antimicrotubule chemotherapeutic treatment. Adjuvant radiation therapy is not a preferred treatment for temporal bone verrucous carcinoma.

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.

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 temporal bone and maxillary antrum: two unusual presentations of a rare tumor

BACKGROUND

Verrucous carcinoma (VC) is a low-grade variant of squamous cell carcinoma. The involvement of the temporal bone and maxillary antrum is very rare.

PATIENTS AND METHODS

The clinicopathologic features of 2 such tumors are reported, and the pertinent literature is reviewed.

RESULTS

In the 2 patients, the diagnostic procedure was complicated due to initial inconclusive histology. Both were treated with concomitant radiochemotherapy. They were free of disease for 5.8 and 11 years after diagnosis. An additional 15 cases of VC of the temporal bone and 10 cases of maxillary antrum tumors have been reported in the literature. In 10 patients, multiple biopsies were required, and in 7 patients, a definitive histological diagnosis was not obtained before surgery. The disease reappeared in 8 out of 15 patients treated solely with surgery. Only 2 of them were salvaged by reoperation. Radiochemotherapy only (without any surgery) was successfully used in 4 patients.

CONCLUSIONS

VC of the temporal bone or maxillary antrum is an extremely rare tumor. For reliable histological diagnosis, multiple biopsies of deep and ample tissue samples are mandatory. Surgery is a mainstay of therapy; however, radiochemotherapy also represents a viable treatment option with curative potential.

Verrucous carcinoma of the temporal bone: a wolf clothed in wool

Verrucous carcinomas are rare tumors that predominantly affect the head and neck region. A paradox of slow, aggressive invasion, apparent lymphadenopathy, yet seemingly bland histopathology, they can beguile unwary clinicians into multiple diagnostic biopsies and regional lymphadenectomy. We report a rare verrucous carcinoma of the temporal bone associated with extensive destruction around the skull base. Placed in the context of the few reports involving this site, extratemporal spread may be associated with a uniformly poor prognosis regardless of the treatment modality. Given new insights into the pathophysiology of this tumor, palliative radiotherapy may be a more appropriate primary treatment compared with the significant local morbidity associated with surgery.

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.