Verrucous carcinoma presenting as mandibular osteomyelitis

Verrucous carcinoma of the esophagus: a case report and literature review

Background

Verrucous carcinoma is an extremely rare form of cancer in the esophagus.

Case presentation

A 56-year-old woman presented with dysphagia in 2007. Endoscopic examination revealed an irregular protruding circumferential erosion in the lower thoracic esophagus, but because pathological examination of the biopsy specimen showed no evidence of malignancy, the status of the erosion was followed up by an upper gastrointestinal endoscopic examination every 3 months. A year later, polypoid lesions and fungal infection were observed in the eroded area, but no evidence of malignancy was detected in the biopsy specimen at the time. Eighteen months later, the polypoid lesions had increased in size, and the biopsy specimen was diagnosed as highly suspicious of well-differentiated squamous cell carcinoma. Because the patient’s condition deteriorated due to worsening of the dysphagia and weight loss, we performed a thoracoscopic esophagectomy with lymph node dissection and reconstructed the alimentary tract with a gastric tube via the posterior mediastinal route. Macroscopic examination of the resected specimen showed a white protruding lesion with an irregular surface, and histopathological examination led to a diagnosis of esophageal verrucous carcinoma without lymph node metastasis. No signs of recurrence have been observed in the 8 years since surgery.

Conclusion

We have reported a long-term follow-up case of verrucous carcinoma of the esophagus that was difficult to diagnose before surgery.

Mandible extensive intra osseous destructive lesion, a diagnostic challenge

Intraosseous verrucous carcinoma of the mandible is a rare situation often confused with chronic osteomyelitis. Despite the low aggressively of the tumor, prognosis is poor because of delayed diagnosis. We report 3 cases, from three different hospitals, initially diagnosed with a chronic osteomyelitis of the mandible after wisdom extraction. Imaging, bacteriological and histological samples supported each time this interpretation. The 3 patients worsened with intraosseous extension of the lesions and outflow of whitish and purulent debris. Only extensive resection with mandibulectomy allow the pathologists to identify the tumor. Adjuvant radiotherapy or radiochemiotherapy followed the surgery. One patient is in clinical remission. In front of mandible lesion resistant to antibiotic therapy and sequestrum resection, atypical squamous cell carcinoma must be evoked. MRI and CT-scan are not able to distinguish osteomyelitis and intraosseous verrucous carcinoma. Presence of whitish lysed and debris of keratin must draw the attention. Firm evidence must be provided to the pathologist but samples should be wide and thick.

Radiotherapy and verrucous carcinoma of the oral cavity. A study of 107 cases

One hundred and seven cases of oral verrucous carcinoma treated primarily with radiotherapy at Kasturba Hospital, Manipal, India between 1977 and 1987 were analysed concerning location within the oral cavity, clinical extent, and effectiveness of radiotherapy. The most common site was the buccal mucosa followed by the buccogingival sulcus. Only 13.2% of the patients presented with T1 or T2 tumours and 32.7% had clinically negative nodes. Biopsy had to be repeated more than once in 22 patients to get confirmation of invasive carcinoma. The 5-year survival rate was 35% for stage III and 26% for stage IV. The treatment results with radiotherapy were comparable with those for ordinary squamous cell carcinoma of the oral cavity. It is felt that the treatment policy for verrucous carcinoma can be the same as for ordinary squamous cell carcinoma. In order to prevent delay in diagnosis and treatment, proper cooperation between the treating oncologist and the pathologist is essential.

Oral verrucous carcinoma. An analysis of 37 cases

37 cases of oral verrucous carcinoma, occurring over a period of six years from 1981-1986, were analysed in respect of the clinical, radiological and histological findings. A delineation of the clinical presentation of this tumour, and the relation of habits to the occurrence of the lesion, has been clarified. The connotation of the term verrucous hyperplasia and its differences from verrucous carcinoma, have been discussed. Surgery and radiotherapy both seem to give good results as methods of treatment, especially when coupled with adequate nutrition and cessation of harmful habits.

Oral verrucous carcinoma

Verrucous carcinoma is a well-defined variant of the squamous cell carcinoma. Although it is reported to be rare in the Scandinavian countries, 16 cases have been diagnosed in the Southern part of Norway from 1975 to 1982. The clinical and histological characteristics were investigated. The most common site of occurrence was the mandibular alveolar ridge. The average age was 71 years, and unlike most other series of verrucous carcinoma, there was a female predominance and use of tobacco seemed to be the exception. The patients mainly complained of ill-fitting dentures. Adequate surgical excision appears to be the treatment of choice.

Verrucous carcinoma of the oral cavity

Since verrucous carcinoma was first identified as a distinct clinicopathologic entity, a great deal of confusion has developed in interpreting the proper criteria for diagnosis. Various authors, therefore, have developed considerably different concepts of the features that make this lesion a unique variant of squamous cell carcinoma. Consequently, there is great confusion in the literature as to the appropriate therapeutic approach, the incidence of recurrence, and the frequency of anaplastic transformation of verrucous carcinoma. The literature was reviewed to identify all cases of verrucous carcinoma of the oral cavity that appear to meet the clinical and histopathologic criteria for this lesion as originally set forth by Ackerman. The problems encountered in arriving at the diagnosis of verrucous carcinoma are discussed. Cases with at least a 1-year reported follow-up were grouped according to the primary modality of therapy employed and were evaluated as to the effectiveness of the initial therapy. The frequency of anaplastic transformation following radiation therapy is also addressed.

Ackerman's tumor (verrucous carcinoma) of the larynx: a clinicopathologic study of 77 cases

A series of 77 cases of verrucous carcinoma of the larynx is presented. The tumor is relatively rare and the present series has been selected from 2,398 primary and recurrent malignant neoplasms of the larynx and hypopharynx evaluated at the Department of Otolaryngology of Padua University during the period from January 1966 to December 1978. The median age of patients was 58 years. The tumor appears to be exophytic, broadly implanted and fungating in aspect, with papillary fronds and a locally invasive character. It is composed of highly differentiated epithelial squamous cells covered by a thick keratinized layer arranged in deeply invaginated folds. Cellular response in tumor stroma is marked, and the neoplasm has a low-grade malignancy. Close cooperation between the pathologist and the clinician is needed in order to establish the nature of the lesion, which looks clinically malignant but may appear histologically benign. Benign reponses such as hyperkeratosis, acanthosis, or the presence of a benign papillomatous area necessitate further investigation with another biopsy examination from deeper layers. The elective treatment is surgery, as irradiation may cause anaplastic transformation with metastatic spread. Neck dissection is not indicated as this laryngeal tumor has so far never metastasized to cervical lymph nodes or to other organs.

Verrucous carcinoma arising in an odontogenic cyst. Report of a case

A verrucous carcinoma arising in an odontogenic cyst is described for the first time. The clinical, radiographic, and microscopic features of this tumor are presented. It is mandatory to correlate the clinical and histopathologic findings to establish a diagnosis.

Oral florid papillomatosis (verrucous carcinoma)

1. Florid Papillomatosis (FP) seems to be another form of verrucous carcinoma. 2. Besides the mouth, FP can be found in the larynx, nose, genitalia, skin, etc. 3. FP would appear to be a carcinoma with a low degree of malignancy, and is locally aggressive. They do not cause generalized metastases and rarely metastasize locally. 4. In the mouth, the lesions, either single or multiple, usually occur in adult men. The most frequent sites are the buccal mucosa and the alveolar-gingival area. They develop on a healthy mucosa, or on preexisting lesions, namely, leukoplakia, atypical lichen, abrasive cheilitis and traumatic ulcers. FP may cause fistulas and jaw destruction. 5. Histologically, three stages can be recognized: type I, with acanthosis and papillomatosis, etc., type II, with the aspect of an in situ carcinoma, and type III, carcinoma-like in aspect but with some characteristics of FP. 6. Ten percent of the cases may develop an anaplastic carcinoma or may become associated with other types of carcinomas in other organs and near the area where the FP appeared. 7. Predisposing factors are the same as those for classical carcinomas (especially smoking and chewing tobacco or betel). FP may develop on preexisting lesions similar to those described for regular carcinomas. No virus has been isolated. Some authors believe FP is a precancerous condition; we think it is a cancer with a low degree of malignancy. 8. Treatment should be initiated with cytostatic drugs, especially methotrexate, followed by electrocoagulation, radium implantation and surgery. If the lesions are small in size, methotrexate is not required. If the lesions are large or there is bone destruction, surgery is the treatment of choice after methotrexate and sometimes high-voltage therapy with 60Co. 9. A cure rate of 75% can be obtained in properly treated cases.

Diagnostic problems of epithelial tumors of penis

Malignant epithelial tumors of the penis often present aspects which make difficult an accurate clinical and pathologic diagnosis. Frequently, repeated biopsies yield a benign diagnosis while the tumor continues to progress and sections through it indicate malignant components. It is suggested that epithelial tumors of the penis may consist, in many instances from their start, of a mixture of benign and malignant elements in ratios varying from one extreme to the other. This may explain why biopsies are frequently misleading, yielding a benign result while, in fact, the tumor is malignant.