Carcinoma cuniculatum

Oral carcinoma cuniculatum, an unacquainted variant of oral squamous cell carcinoma: A systematic review

Purpose

Oral carcinoma cuniculatum is a rare well-differentiated variant of oral squamous cell carcinoma. The purpose was to systematically review its unique features to differentiate it from other variants as verrucous carcinoma, papillary squamous cell carcinoma and well-differentiated squamous cell carcinoma.

Materials and Methods

A systematic review was performed using MEDLINE, Dentistry and Oral Sciences Source and PubMed databases and any existing articles related to the research subject missed in the search strategy to screen ones reporting cases occurring exclusively in the oral cavity in English literature. Variables analyzed included clinical, etiologic, imaging, histopatholgical features, treatment, follow-up and survival rates.

Results

From 229 hits, 17 articles with 43 cases were included in the systematic review. Clinically it showed a female predilection with pain and/or ulceration of a relatively long duration and exudation being the most common symptoms. Histologically, it showed more endophytic features comprising well-differentiated squamous epithelium with absent or minimal cytological atypia and multiple keratin filled crypts or cuniculus. Inflammatory stromal reaction and discharging abscesses were reported in most of the cases. Bone destruction was predominant in most imaging features. Complete surgical resection with a safety margin was the treatment of choice in most of the cases with few recorded recurrence cases.

Conclusion

Apprehensive knowledge of oral carcinoma cuniculatum unique features is essential to avoid its misdiagnosis and provide proper treatment especially for recurrent cases.

Carcinoma cuniculatum: an atypical presentation in the foot

Carcinoma cuniculatum is a rarely occurring, low-grade variant of squamous cell carcinoma most commonly found in the forefoot. It should be suspected in the differential diagnosis for chronic nonhealing verrucous wounds. The initial diagnosis of carcinoma cuniculatum is difficult and often delayed and can require repeated histopathologic evaluation by an experienced pathologist. In many cases, the final diagnosis will be made from the microscopic findings correlated with the clinical examination findings. Metastasis from carcinoma cuniculatum is rare, although it can invade deep into the soft tissues and can extend to the bone. Wide local excision with a 5-mm tumor-free margin has been the recommended treatment. If the tumor extends into the bone, amputation might be warranted. The present report describes the case of an atypical carcinoma cuniculatum found in the hindfoot of an adult female and represents the surgical follow-up to the histopathologic description of the same patient's lesion as previously described in a published report.

Atypical presentation of verrucous carcinoma: a case study and review of the literature

Verrucous carcinoma is a slow-growing lesion that is most often found on the weight-bearing surface of the foot and should be considered in the differential diagnosis for chronic nonhealing wounds in the diabetic neuropathic population. Accurate diagnosis may be difficult initially and often requires repeat histopathologic evaluation by an experienced pathologist. Verrucous carcinoma can invade deeper tissues; however, extension to bone is a rare occurrence. The authors present a case report of an atypical verrucous carcinoma on the dorsal aspect of the foot and a review of the literature. Studies suggest that multiple therapies exist and recurrence does occur; however, this is less likely with wide excision and more so with Mohs' surgery. With a high clinical suspicion and thorough histopathologic exam, bone involvement and amputation may be avoided.

LEVELS OF EVIDENCE

Therapeutic, Level IV.