Verrucous carcinoma with foci of invasive squamous cell carcinoma
Report of a case and discussion of current concepts
DOI:
https://doi.org/10.5935/2525-5711.20170019Palabras clave:
Carcinoma, Verrucous, Squamous Cell., Ki-67 Antigen.Resumen
Verrucous carcinoma (VC) is an uncommon type of low-grade, well differentiated and non-invasive squamous cell carcinoma (SCC). The development of invasive SCC within a VC is rare and distinction from the classical oral SCC is a frequent dilemma for pathologists. We report a case of a 78 years old male former smoker, alcoholic, presenting a painless leukoplastic verrucomatoous lesion in mandibular alveolar ridge measuring approximately 4cm diameter, with 2 months evolution. Histological examination of the incisional biopsy revealed proliferation of well-differentiated squamous epithelium forming high exophytic hyperkeratinized papillary projections and deep blunt buds. In focal areas, invasive tumor epithelial nests with more apparent cytologic atypia were observed. Immunohistochemical analysis showed intense expression of p16 but weak positivity for ki-67. The diagnosis was VC with microinvasive SCC areas. The patient underwent surgery with a safety mar- gin and is under follow-up. “Hybrid” lesions composed of typical VC and invasive SCC accounts for about 20% of oral VC. A discussion on the criteria of differential diagnosis and biological behavior of these lesions is also provided.
Citas
Candau-Alvarez A, Dean-Ferrer A, Alamillos-Granados FJ, Heredero-Jung S, García-García B, Ruiz-Masera JJ, et al. Verrucous carcinoma of the oral mucosa: an epidemiological and follow-up study of patients treated with surgery in 5 last years. Med Oral Patol Oral Cir Bucal. 2014;19:e506-11. DOI: 10.4317/medoral.19683
Terada T. Squamous cell carcinoma arising within verrucous carcinoma of the oral cavity: a case report. Int J Clin Exp Pathol. 2012;5:363-6.
Patel KR, Chernock RD, Zhang TR, Wang X, El-Mofty SK, Lewis JS Jr. Verrucous carcinomas of the head and neck, including those with associated squamous cell carcinoma, lack transcriptionally active high-risk human papillomavirus. Hum Pathol. 2013;44:2385-92. DOI: 10.1016/j.humpath.2013.07.011
Kolokythas A, Rogers TM, Miloro M. Hybrid verrucous squamous carcinoma of the oral cavity: treatment considerations based on a critical review of the literature. J Oral Maxillofac Surg. 2010;68:2320-4. DOI: 10.1016/j.joms.2009.09.019
Akrish S, Ben-Izhak O, Sabo E, Rachmiel A. Oral squamous cell carcinoma associated with proliferative verrucous leukoplakia compared with conventional squamous cell carcinoma--a clinical, histologic and immunohistochemical study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:318-25. DOI: 10.1016/j.oooo.2014.10.023
Kallarakkal TG, Ramanathan A, Zain RB. Verrucous papillary lesions: dilemmas in diagnosis and terminology. Int J Dent. 2013;2013:298249. DOI: 10.1155/2013/298249
Shimizu A, Tamura A, Ishikawa O. Invasive squamous cell carcinoma arising from verrucous carcinoma. Recognition of verrucous carcinoma of skin as an in situ carcinoma. Eur J Dermatol. 2006;16:439-42.
Patel KR, Chernock RD, Sinha P, Müller S, El-Mofty SK, Lewis JS Jr. Verrucous carcinoma with dysplasia or minimal invasion: a variant of verrucous carcinoma with extremely favorable prognosis. Head Neck Pathol. 2015;9:65-73. DOI: 10.1007/s12105-014-0551-7
Mohtasham N, Babakoohi S, Shiva A, Shadman A, Kamyab-Hesari K, Shakeri MT, et al. Immunohistochemical study of p53, Ki-67, MMP-2 and MMP-9 expression at invasive front of squamous cell and verrucous carcinoma in oral cavity. Pathol Res Pract. 2013;15;209:110-4. DOI: 10.1016/j.prp.2012.11.002
Myoung H, Kim MJ, Lee J, Ok YJ, Paeng JY, Yun PY. Correlation of proliferative markers (Ki67 and PCNA) with survival and lymph node metastasis in oral squamous cell carcinoma: a clinical andhistopathological analysis of 113 patients. Int J Oral Maxillofac Surg. 2006;35:1005-10. DOI: 10.1016/j.ijom.2006.07.016
