Verrucous Carcinoma


What is Verrucous carcinoma?

Verrucous carcinoma is a distinct type low-grade squamous cell carcinoma, which provides cauliflower-like external lesions. Typical irritation and inflammation occur at the site of development of the Verrucous carcinoma. The characteristic features of the Verrucous carcinoma include the rate of progression slow, locally aggressive with lowest metastasize and clinically exophytic. The sites where the Verrucous carcinoma develops include oral cavity, throat, exterior part of the foot and sometimes other cutaneous tissue also affected with this type of lesions.

Verrucous Carcinoma


In 1948, Ackerman was first described after studying the lesion affected on the oral cavity and he described the tumor as a low-grade carcinoma with a pathologic variant of squamous tissue. After this, 1954, the condition clinically termed as Verrucous carcinoma provided by Aird et al., as they found the histological characteristic of the tumor contains cryptlike spaces1,2.

Etiology

Some causative factors including tobacco smoking, chewing tobacco, excessive alcohol consumption, which play important role in development of the Verrucous carcinoma. Oral ulcerative condition with the association of the chronic candidiasis can also a causative factor for the development of the Verrucous carcinoma. In addition, poor dental hygiene and ill-fitting dentures can also cause oral lesion and that can turn to Verrucous carcinoma1,3.

Symptoms & Signs

The usual location of the Verrucous carcinoma is oral cavity and may involve multiple organs including throat, nasal cavity buccal mucosa, and larynx. Therefore, at the commencing of the condition may lead to organ-specific symptoms including a sore throat, hoarseness, and dysphagia. The lesion of the Verrucous carcinoma can develop at the floor surface of the mouth, mandibular retromolar area, molar area, buccal mucosa, lip mucosa and the hard palate.


At the site of the development of the Verrucous carcinoma, typically leads to swelling and irritation. Hyperkeratotic lesions are a specific clinical presentation of the Verrucous carcinoma. The lesions are extended, looks similar to white and wart-like structure.

Local lymph node at the site of the development of the Verrucous carcinoma become enlarged and tendered and influence inflammatory and metastatic tumor development1,3.


Histopathology/ Diagnosis

A sample of the tissue section showed hyperplastic natured stratified squamous para-keratinized epithelium with a low leveled cellular growth. The abnormal proliferation of the epithelium attached with the connective tissue. The lesions with parakeratin plugging have several distinguishable cracked space. Some of the epithelial cells show signs of increased basal cell layer, some cells also have hyperchromatism, mitotic activity, and pleomorphism. The associated connective tissue penetrated with many darkly bruising inflammatory cells. All these characteristic features of histopathology indicate Verrucous carcinoma4.

Treatment

The following therapeutic manifestations are applicable for Verrucous carcinoma:


  • Surgical intervention for complete removal of the tumor
  • Radiation therapy to destroy the remaining malignant tissues
  • Maintaining proper diet habit
  • Adequate rest
  • Complete restriction of tobacco smoking and chewing

Among the above-mentioned therapeutic approaches, surgical intervention is the primary therapeutic mode to treat verrucous carcinoma. Only surgical intervention may not be effective in the case of larger area extension of the carcinogenic lesion. For example, tumorigenic growth extends from buccal mucosa to the retromolar area; where surgical removal of the tumorigenic cells is difficult; then combination therapy is more effective.

If the site of the tumor development does not accept the surgical intervention, rather the conduction of the surgery is not possible can require the application of the cytostatic drugs. The dose of the cytostatic drugs depends upon the size of the tumor and the growth rate of the tumor.

The adverse effect of the cytostatic drugs, radiation along with surgical intervention can provide xerostomia, which can be managed by saliva substitution1,2,3.

Prognosis

Prognosis of the verrucous carcinoma is better in the case of early diagnosis and proper intervention of the treatment. In the case of oral development of the verrucous carcinoma, dental checkup can identify the unusual growth in the buccal mucosa and that may consider as an indicator. The reason of good prognosis in comparison with other malignant tumor is due to its slow growth.

It is very important that maintaining oral hygiene and regular follow-up is important for obtaining good prognosis. Medical evidence showed that the recurrence of the verrucous carcinoma within two years has not been reported. Saliva substitutes usually recommended for treatment related symptomatic relief3,4.

References

  1. What Is Verrucous Carcinoma? Oral Care Center. http://www.colgate.com/en/us/oc/oral-health/conditions/cancer/article/what-is-verrucous-carcinoma-0815
  2. Jennifer Shuley Ruth. Verrucous Carcinoma. June 2015. http://emedicine.medscape.com/article/1101695-overview#a6
  3. Alper Alkan, Emel Bulut, Omer Gunhan, Bora Ozden. Oral Verrucous Carcinoma: A Study of 12 Cases. Eur J Dent. 2010 Apr; 4(2): 202–207. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853822/
  4. ML Asha, Kanchan Vini, Ingita Chatterjee, Preeti Patil. Verrucous Carcinoma of Buccal Mucosa: A Case Report. International Journal of Advanced Health Sciences. August 2014.  http://www.ijahs.net/uploads/2/6/7/7/26772457/ijahs_vol_1_issue_4_4.pdf

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