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A digital manual for the early diagnosis of oral neoplasia

Verrucous carcinoma  Search in Medline for Verrucous carcinoma



Verrucous carcinoma is a variant of squamous cell carcinoma characterized by a predominantly exophytic overgrowth of well-differentiated keratinizing epithelium having minimal atypia and with locally destructive pushing margins at its interface with underlying connective tissue  Pindborg JJ, Reichart PA, Smith CJ, van der Waal I, (1997). World Health Organisation International Histological Classification of Tumours.Histological Typing of Cancer and Precancer of the Oral Mucosa. 2 ed. Berlin: Springer.. These tumours are characterized by slow-growing warty lesions with low metastatic potential  Pindborg JJ, Reichart PA, Smith CJ, van der Waal I, (1997). World Health Organisation International Histological Classification of Tumours.Histological Typing of Cancer and Precancer of the Oral Mucosa. 2 ed. Berlin: Springer.Pereira MC, Oliveira DT, Landman G, Kowalski LP (2007). Histologic subtypes of oral squamous cell carcinoma: prognostic relevance. J Can Dent Assoc 73: 339-344.. Involvement of the regional node is uncommon.

Histopathology:

Verrucous carcinoma has thick, heavily keratinised papillae and blunt, broad stromal invaginations of well-differentiated squamous cells with minimal cytologic atypia and rare mitosis. The tumour extends into the underlying stroma with broad pushing rather than infiltrating border. A dense lymphoplasmocytic response is common. One fifth of verrucous carcinoma contains a co-existing squamous cell carcinoma with a greater tendency to recur locally.

Treatment:

These lesions are treated with surgery, and the 5-year survival rate is 80–90%. The role of radiotherapy is controversial because of low responsiveness to it and the potential for anaplasic transformation. However, several authors have found similar radio-responsiveness compared to well-differentiated squamous cell carcinoma without any anaplastic transformation Nair MK, Sankaranarayanan R, Padmanabhan TK, Madhu CS (1988). Oral verrucous carcinoma. Treatment with radiotherapy. Cancer 61: 458-461.Jyothirmayi R, Sankaranarayanan R, Varghese C, Jacob R, Nair MK (1997). Radiotherapy in the treatment of verrucous carcinoma of the oral cavity. Oral Oncol 33: 124-128.Burns HP, van Nostrand AW, Palmer JA (1980). Verrucous carcinoma of the oral cavity: management by radiotherapy and surgery. Can J Surg 23: 19-21, 25.. Today, it is recommended that these tumours be treated like any other squamous cell carcinoma of the oral cavity.

Image

Caption

Figure 1: Verrucous carcinoma right commissure. Note the exophytic growth with finger-like projections (arrows), extending to the right cheek in a patient with oral submucous fibrosis.
Figure 2: Verrucous carcinoma of the lip. Note the extensive warty growth with fingerlike projections involving almost all of the lower lip.
Figure 3: Verrucous carcinoma lower lip. Note a 3x3 cm verrucous growth in the lower lip in this 65–year-old woman who has been chewing betel quid for the past 45 yrs.
Figure 4: An extensive verrucous carcinoma involving the entire tongue causing difficulty in closing the mouth.
Figure 5: Verrucous carcinoma of the right buccal mucosa. Note the extensive verrucous growth extending from the commissure to the posterior aspect of right buccal mucosa.
Figure 6: Verrucous carcinoma on the right buccal mucosa.
Figure 7: Verrucous carcinoma of the left buccal mucosa extending to the adjacent part of the lower lip.
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