Acute visual loss in a head and neck cancer patient with ocular metastasis and sphenoid pyocele

We report an extremely rare case of head and neck cancer patient with right acute visual loss by ocular metastasis after excluding compressive optic neuropathy by endoscopic decompression of the sphenoid pyocele. The ocular metastasis from head and neck cancer had been reported only once in English literatures. Besides, the patient combined with sphenoid pyocele increases the difficulty in differentiating the etiologies. In this article, we describe the history of this patient and discuss the possible cause of acute visual loss and the treatment strategy. Although to differentiate the etiology of acute visual loss between metastatic malignancy and compressive optic neuropathy remain difficult, treatment strategy should focus on rescuing visual acuity. Ocular metastases should always keep in mind when acute visual loss is encountered in patients with previously treated head and neck squamous cell carcinoma.

Combined ultrasound and magnetic resonance imaging findings on cervical verrucous carcinoma with endometrial invasion: a case report

BACKGROUND

Cervical verrucous carcinoma is a rare form of cervical cancer. Very few reports present the correlation between diagnostic images and clinicopathologic findings.

CASE

A 50-year-old woman was treated with laser ablation for cervical condyloma 6 years prior to her presentation with progressive vaginal bleeding and a foul-smelling discharge at our clinics in August 2004. Biopsy of the cervical mass was compatible with pathologic features of condyloma acuminata. Ultrasonography with color Doppler revealed a 5.9x4.1-cm, hyperechogenic mass with a honeycomb appearance in the lower uterine corpus and hypervascularization of the tumor with resistance indexes ranging from 0.41 to 0.47. Magnetic resonance imaging (MRI) showed that the tumor had a homogeneous intensity on T1-weighted images and heterogeneous intensity on T2-weighted images. After administration of contrast medium, the tumor exhibited a lower signal intensity than did the surrounding cervical stroma. A human papillomavirus test was positive for types 11 and 53. Combined with the clinicopathologic findings, verrucous carcinoma of the cervix, stage Ib2, was suspected and the patient underwent radical hysterectomy and bilateral pelvic lymph node dissection. The final pathology report proved the impression of malignancy. The patient had an uneventful postoperative course, and no disease recurred during 1 year of follow-up.

CONCLUSION

The diagnosis of cervical verrucous carcinoma requires a good clinical and pathologic correlation. Nevertheless, detailed imaging studies, such as ultrasound and MRI, as in our case, may provide valuable presurgical information for treatment.

Fatal genital verrucous carcinoma

A rare, fatal case of verrucous carcinoma on the labia majora of a 65-year-old woman is presented. Histopathologically, the neoplasm was repeatedly diagnosed as a verruca over the course of many years. A diagnosis of verrucous carcinoma was rendered only after the documentation of lymph node metastasis. Although most cases of verrucous carcinoma have a favorable prognosis, this case illustrates that verrucous carcinoma can metastasize even when the neoplasm is superficially situated and the histopathologic findings are subtle.

Sinonasal verrucous carcinoma with oral invasion

Verrucous carcinoma is a rare warty variant of squamous cell carcinoma, most often seen in the oral cavity and larynx. Its occurrence in the sinonasal tract is rare. This tumor constitutes approximately 1% of all sinonasal neoplasms. The clinical presentation and the histopathological features of verrucous carcinoma are a subject of continuous discussion amongst diagnosticians and pathologists. A case with oral and nasal presentation of this tumor is reported here.

Verrucous hyperplasia: a common and problematic finding in the high-risk diabetic foot

Although verrucous hyperplasia may be common in high-risk insensitive feet, the literature contains little discussion on this topic. Treatment of verrucous hyperplasia is aimed primarily at reducing the causative forces. In cases that result from edema, external compression has proved to be adequate. If verrucous hyperplasia on the foot results from frictional forces, then shoe modifications with proper fit, accommodative liners, or fillers in the case of amputation are necessary. In recalcitrant cases, excision of the affected tissue with local soft-tissue or graft coverage has been successful. We describe a 56-year-old man with verrucous hyperplasia.

Association of verrucous carcinoma and inverted papilloma in the sinonasal tract

It is well known that inverted papilloma (IP) is sometimes associated with malignancies; however, the association of IP with verrucous carcinoma (VC) is extremely rare. We herein report a case of IP in the nasal cavity with VC in the maxillary sinus. A 73-year-old Japanese woman presented with a 3-month history of right-sided nasal obstruction and repetitive epistaxis. A biopsy of the mass was performed and the pathological result proved to be IP. Computed tomography and magnetic resonance imaging revealed a moderately enhanced soft-tissue lesion filling the right nasal cavity and a ring-enhanced expansive lesion in the maxillary sinus. Under a tentative diagnosis of IP of the nasal cavity with maxillary empyema, she underwent right medial maxillectomy via a lateral rhinotomy approach, and a histopathological diagnosis of IP in the nasal cavity with VC in the maxillary sinus was obtained. Her postoperative clinical course was uneventful. She is currently free from symptoms, and there is no evidence of recurrence 5 months after surgery. The pathology, clinical manifestation, and treatment of VC associated with IP are reviewed from literature.

Verrucous carcinoma of the temporal bone and maxillary antrum: two unusual presentations of a rare tumor

BACKGROUND

Verrucous carcinoma (VC) is a low-grade variant of squamous cell carcinoma. The involvement of the temporal bone and maxillary antrum is very rare.

PATIENTS AND METHODS

The clinicopathologic features of 2 such tumors are reported, and the pertinent literature is reviewed.

RESULTS

In the 2 patients, the diagnostic procedure was complicated due to initial inconclusive histology. Both were treated with concomitant radiochemotherapy. They were free of disease for 5.8 and 11 years after diagnosis. An additional 15 cases of VC of the temporal bone and 10 cases of maxillary antrum tumors have been reported in the literature. In 10 patients, multiple biopsies were required, and in 7 patients, a definitive histological diagnosis was not obtained before surgery. The disease reappeared in 8 out of 15 patients treated solely with surgery. Only 2 of them were salvaged by reoperation. Radiochemotherapy only (without any surgery) was successfully used in 4 patients.

CONCLUSIONS

VC of the temporal bone or maxillary antrum is an extremely rare tumor. For reliable histological diagnosis, multiple biopsies of deep and ample tissue samples are mandatory. Surgery is a mainstay of therapy; however, radiochemotherapy also represents a viable treatment option with curative potential.

Carcinome cuniculatum : un diagnostic difficile, à évoquer devant une ostéite chronique d'évolution défavorable sous traitement

INTRODUCTION

The clinical and histological features of cuniculatum carcinoma (CC) are often misleading.

CASE REPORT

We report a case of CC of the foot, which was misdiagnosed as osteomyelitis for a two year period and which relapsed 2 months after complete resection.

DISCUSSION

The CC has to be evoked in patients with chronic osteomyelitis and torpid wound. The anatomopathologist needs to be aware of the suspected diagnosis.

[Epithelioma cuniculatum plantare in the region of a skin scar due to mechanical trauma. Insurance law aspects of scar carcinomas]

We herein report a case of a highly differentiated verrucous squamous cell carcinoma of the sole of the left forefoot ("epithelioma" or "carcinoma cuniculatum plantare") that had--as a specific feature--developed within a preexisting long-standing skin scar due to an earlier occupational crush injury. Because of expansive tumor growth extending to the metatarsal bones and penetrating the tissue between the tendons, an ultrashort amputation of the hindfoot was performed according to the method of Chopart. The pathogenetic mechanisms possibly underlying the formation of scar carcinomas are discussed. For judgement of legal liability insurance questions, the criteria indicating a causal relationship between traumatic scars and cancer development are presented.

Recalcitrant verrucous lesion: verrucous hyperplasia or epithelioma cuniculatum (verrucous carcinoma)

A 37-year-old woman originally presented in May 2003 with a nonhealing, painless ulcer on the plantar surface of her right foot that had been slowly increasing in size for the previous 1.5 years. Two weeks before presentation, a biopsy of the lesion, performed at another institution, had indicated a probable verrucous carcinoma. After preoperative workup, the patient underwent resection of the lesion, with clear margins and full-thickness skin grafting. The final pathologic findings were not consistent with verrucous carcinoma. A recurrent lesion was noted during a follow-up visit, and a second biopsy revealed a hyperkeratotic papillomatous verrucous lesion, type unclassified. No viral particles were isolated in the random biopsy samples. This recurrent lesion was refractory to treatment with topical acyclovir. Subsequent treatments consisted of imiquimod and CO(2) laser ablation, which succeeded in reducing the lesion. Verrucous lesions can be frustrating, and the diagnosis of epithelioma cuniculatum can be difficult to prove. We report a case highly suggestive of but not definitively diagnosed as epithelioma cuniculatum and summarize the literature on this entity.

Verrucous Carcinoma of the Scalp Associated with Human Papillomavirus Type 33

BACKGROUND

Verrucous carcinoma (VC) is a low-grade, well-differentiated squamous cell carcinoma of the skin or mucosae, and human papillomavirus (HPV) infection has been considered to be one of the causative factors of VC at three main sites, including the oral cavity, the genitoanal region, and the foot. However, the relationship between cutaneous VC at other sites and HPV infection remains obscure.

OBJECTIVE

We describe a rare case of cutaneous VC originating in a burn scar on the scalp and our attempt to find HPV infection in the lesion.

METHODS

We investigated the presence of HPV by polymerase chain reaction-restriction fragment length polymorphisms and immunohistochemical analysis.

RESULTS

HPV type 33 was detected in the lesion, and positive stains for HPV were observed in several cell nuclei at the upper stratum malpighi.

CONCLUSION

Since HPV type 33, as well as HPV types 16 and 18, is regarded as a high-risk, mucosal type, HPV type 33 infection likely contributed to the development of the lesion. We suggest that HPV infection should be relevant to a subset of cutaneous VC.

[Verrucous carcinoma versus papillary squamous cell carcinoma of the larynx 9 cases report]

OBJECTIVE

To investigate the clinical, pathological character and differential diagnosis between verrucous carcinoma (VC) and papillary squamous cell carcinoma (PSCC) of the larynx.

METHOD

Four cases of VC and five cases of PSCC of larynx in our hospital between 1991 approximately 2003 were studied retrospectively, the clinical and pathology character of VC and PSCC were observed.

RESULT

Highly differentiated squamous cell and epithelial pearls or keratinized matter can be seen in the four cases of VC. Invasion of the basement membrane is often nonetheless, moderate to serve inflammatory reaction usually exist in the stroma adjacent to the advancing margin, no cervical lymph node metastases, no local recurrence and the prognosis is excellent. Exophytic malignant proliferation of the squamous cell with fibrovascular core can be seen in all the cases of PSCC, cell pathology is similar to the conventional SCC but no cervical metastases were observed and the prognosis is better than the conventional SCC.

CONCLUSION

The external appearance of VC and PSCC is similar, but there are discrepancy in the cellular differentiation and the atypia of the tumor cells, stroma inflammatory reaction, recurrence, regional metastases, treatment, prognosis. Accurate differential diagnosis requires close cooperation between the laryngologist and the histopathologist.

Diagnostic utility of cell cycle and apoptosis regulatory proteins in verrucous squamous carcinoma

A major problem in the diagnosis of verrucous squamous cell carcinoma is the lack of readily reproducible objective criteria for distinguishing this malignant lesion from reactive epithelial hyperplasia. Both lesions are characterized by thickened (well-differentiated) squamous epithelium without cellular atypia and subjacent stroma densely infiltrated by lymphocytes and plasma cells. This study was carried out to evaluate the use of cell cycle and apoptosis-related regulatory proteins in the diagnosis of verrucous carcinoma. The study materials consisted of representative formalin-fixed and paraffin-embedded tissue blocks from 19 cases of verrucous carcinoma, 18 classic squamous cell carcinoma, and 14 squamous epithelial hyperplasia (acanthosis). The immunohistochemical expression of the following of cell cycle and apoptosis-related regulatory proteins was evaluated using avidin-biotin complex detection technique: p16, p21, p53, Ki67, and retinoblastoma gene product (RBGP) (also known as retinoblastoma protein [pRb]). Expression of Ki67 was detected only in the single basal layer of the epithelium in all 14 cases of acanthosis. In verrucous carcinoma, Ki67 was detected in basal and suprabasal cells in the lower third of the neoplastic epithelium in 19 of 19 cases (100%). In neoplastic squamous epithelium with frankly invasive squamous cell carcinoma, Ki67 was diffusely expressed throughout the entire thickness of the epithelium as well as in the underlying invasive tumor nests. The pattern of p53 expression was similar to that of Ki67 in all the experimental groups, with a Pearson correlation coefficient of 0.98. In addition, immunohistochemical expression of p53 in the hyperplastic squamous epithelium was very weak, in contrast to the more intense immunoreactivity observed in verrucous carcinoma and classic squamous cell carcinoma. There was an overlapping in the expression of p16, p21, and RGBP in all the experimental groups, being present in more than half the thickness of the epithelium in 50% to 100% cases in each study group. We therefore conclude that the pattern of Ki67 and p53 expression in verrucous carcinoma is readily reproducible and distinctly different from that observed in epithelial hyperplasia and that seen in invasive squamous cell carcinoma. Thus Ki67, and p53 immunostains are reliable adjuncts that may be helpful in resolving diagnostic problems associated with verrucous carcinoma.

[Therapeutic solutions in post-excision defects for plantar verrucous carcinoma]

Carcinoma verrucous--anatomoclinical entity histological high rate of differentiation of the spinocellular epithelioma, clinically associated with 3 types of lesion. We present the therapeutical solution of a plantar carcinoma verrucous case, a large post-excisional defect-free flap transfer of latissimus dorsi muscle using microsurgical techniques.

Carcinoma cuniculatum of the esophagus

AIMS

Extremely well-differentiated squamous cell carcinoma with the features of so-called carcinoma cuniculatum (CC) is a rare neoplasm. We describe the clinicopathologic findings of the first 2 cases of CC of the esophagus.

METHODS AND RESULTS

Two elderly men presented with symptoms and clinical signs of esophageal malignancy. Repeated endoscopic biopsies of their esophageal tumors were inconclusive. Resection revealed CC of the esophagogastric junction in both cases. The tumors extended into the adventitia but no lymph node metastases were present. In situ hybridization for human papillomavirus HPV subtypes was negative.

CONCLUSION

Carcinoma cuniculatum is reported for the first time in the esophagus. The diagnosis of this tumor variant is difficult by means of cytological examination or by endoscopic biopsies alone. Carcinoma cuniculatum in this location shows biologic features similar to verrucous carcinoma (deep penetration, no lymph nodes metastases, and location at one end of the esophagus). No evidence of human papillomavirus could be demonstrated.

[Penile verrucous carcinoma]

Penile verrucous carcinoma is a rare tumor. Verrucous carcinoma is thought by most to represent a well-differentiated or low-grade squamous-cell carcinoma. The term Buschke-Lowenstein tumor and giant condyloma have also been used to identify this histological lesion. A review of literature points to the role of human papillomavirus infection. The authors report a case of a penile verrucous carcinoma in a circumcised man.

[Verrucous carcinoma of the esophagus. A case report]

Verrucous carcinoma (VC) of the esophagus is a rare variant of squamous cell carcinoma and only 20 cases have so far been reported in the international literature. The neoplasm is usually highly differentiated, presents a slow growth pattern with invasion of surrounding organs rather than blood-borne metastases. Recently, a causative role of human papillomavirus (HPV) has been hypothesized. The case of a patient affected with locally advanced VC of the esophagus and treated by means of local antiviral therapy is reported. A 41-year-old male patient was admitted to our institution for persistent atypical thoracic pain. The imaging techniques (thoracic and abdominal CT scans; upper GI endoscopy; hydrosoluble contrast swallow; endoscopic US) revealed a cauliflower-like protruding esophageal mass, active mucosal mycosis, multiple ulcerations of the distal esophagus, as well as 2 broncho-esophageal fistulas. The neoplasm extended beyond the esophageal wall, infiltrating surrounding cervical and mediastinal organs and the patient presented with secondary esophageal achalasia and right bilobar pneumonia. The histologic specimen was consistent with VC of the esophagus and the presence of HPV infection was detected by means of qualitative PCR assay. The patient was deemed not fit for surgery and a local antiviral treatment with hydroxy-phosphonyl-methoxypropyl-cytosine 5 mg/kg a week was started. After initial response to treatment, the patient presented with sudden progression leading to further broncho-esophageal fistula treated with endoscopic stent placement and ultimate death 6 months after referral to our center. In keeping with international data, our case confirms that esophageal VC has a highly unfavorable outcome, despite its high degree of differentiation and slow growth pattern. The long natural history, the lack of specific symptoms and the presence of coexisting esophageal diseases delay the diagnosis and account for the local advancement of this malignancy. Surgery is the option of choice for early stage lesions and advanced VC does not seem to benefit from current chemotherapeutic regimens. The causative role of HPV and the advancements of molecular pharmacology might allow for effective treatment in high-risk patients.

Verrucous carcinoma of the cervix--diagnostic and therapeutic difficulties with regards to HPV status. Case report

Verrucous carcinoma of the cervix is of special interest because of its rare occurrence and frequently existing difficulties in the differential diagnosis, which in verrucous disease eventually leads to a final, more favorable diagnosis. We present a case report of cervical verrucous carcinoma as a rare variant of squamous cell carcinoma in a 65-year-old woman who underwent total hysterectomy based on initial histological diagnosis of cervical dysplasia. Special attention is focused on clinical assessment of the lesion with the depicted restriction of exfoliated cytology as well as misdiagnoses of inappropriately taken, even colposcopically directed biopsy, not covering a full thickness of biopsied tissue. The macro- and micromorphologic similarities of cervical verrucous carcinoma with condylomata acuminata on one hand and invasive squamous cell carcinoma on the other, inclined us to search for a common factor causing human papillomavirus infection.

[Oral verrucous carcinoma]

Verrucous carcinoma is a rare, low-grade, well-differentiated form of squamous cell carcinoma seen on skin and mucosa. It is a slow-growing and locally aggressive tumor whose standard treatment is surgery. A case of strongly invasive oral verrucous carcinoma is presented with the medical history. The differential diagnosis of this neoplasm is difficult and requires clinic and pathologic data confrontation. In this paper, the importance of knowing the malignant potential of this lesion is stressed. Indeed, in 20% of verrucous carcinoma, foci of squamous cell carcinoma can be found. A review of literature and a differential diagnosis of verrucous carcinoma are presented.

Verruk�ses spinozellul�res Karzinom auf Lichen ruber hypertrophicus

We report about a 64-year-old patient who developed a verrucous squamous cell carcinoma in a long-standing hypertrophic lichen planus of the right lower leg. Neoplastic transformation of hypertrophic lichen planus has rarely been described in the literature.

Verrucous hyperplasia of the great toe: a case and a review of the literature

BACKGROUND

Verrucous hyperplasia is a hyperplastic disease that manifests as coalescent warty papules at stump amputation sites. Often overlooked, it can be confused with verrucous carcinoma. As such, it is of concern for dermatologic surgeons.

OBJECTIVE

To present a patient with verrucous hyperplasia and review its literature.

METHODS

We report a 62-year-old diabetic patient with a verrucous nodule that arose at the amputation site of her first three right toes. Despite repeated surgical removals and skin graftings, the verrucous nodule redeveloped. A biopsy revealed digitate epidermal hyperplasia with dilated tortuous capillaries in thin dermal papilla without invasive features, mitotic figures, or acanthotic downgrowth. Polymerase chain reaction did not detect human papilloma virus.

RESULTS

Verrucous hyperplasia secondary to amputation was diagnosed.

CONCLUSION

Verrucous hyperplasia occurs should not be confused with verrucous carcinoma or warts. Moreover, because it recurs after removal, surgery is not indicated; rather, compression therapy is indicated.

[The verrucous laryngeal carcinoma. A rare tumor with a difficult diagnosis]

OBJECTIVES

The authors report a single case of laryngeal verrucous carcinoma and review the literature.

MATERIALS AND METHOD

The delay of the diagnosis, the difficulties in its establishment and the therapeutic methods are discussed in a review of the literature.

RESULTS

Histopathological diagnosis remains difficult. This may explain a great number of mistakes and the subsequent delay of in treatment. The role of radiotherapy is discussed.

CONCLUSION

The diagnosis and management of the laryngeal verrucous carcinoma is difficult.

[Verrucous carcinoma of the nasal cavity: a case report]

We report a rare case of verrucous carcinoma occurring in the nasal cavity. A 53-year-old man reporting left-sided nasal obstruction and awareness of a left intranasal lesion--a whitish polypoid lesion--was found in CT to have an expansive lesion of the left nasal cavity and maxillary sinus. The tumor was completely removed by Denker's operation. Verrucous carcinoma is a rare variant of squamous cell carcinoma most commonly seen in the oral cavity. In some cases, conventional squamous cell carcinoma components may be observed focally in verrucous carcinoma, called a hybrid tumor. In our case, the tumor showed typical features of a hybrid tumor. To the best of our knowledge, this is the first case of hybrid verrucous squamous cell carcinoma originating in the nose in the Japanese literature.

[Verrucous carcinoma of the penis]

OBJECTIVE

The objective of the present retrospective research is to examine cases of verrucous carcinoma of the penis, an uncommon variant of squamous cell carcinoma, as well as to examine the localisation, evolvement and the ways of treatment.

METHODS

Patients, treated for carcinoma of the penis at the Clinic of Urology, have been examined for a 13-year interval. From 80 cases of cancer localized in the penis, in only 3 of these verrucous carcinoma has been histologically proved, accounting for 2.4 per cent of the penile cancers. A rare case of a hybrid tumor between verrucous carcinoma and invasive squamous cell carcinoma, which is compared to similar finding as described by other authors.

RESULTS

Slow and continuous evolvement of the disease has been observed, which has been followed by periods of aggressive development. The average age of the patients has been specified to be 52.7 years. The tumor has been mainly localized on the surface of the Glans penis. The results have been compared to those described in the literature.

CONCLUSION

Wide surgical excision, usually requiring partial or total penectomy, is the treatment of choice. Radiotherapy and chemotherapy have proved to be unsuccessful.

[Long-term course of laryngeal verrucous carcinoma]

Verrucous carcinoma is an odd kind from squamous or epidermoid carcinoma, amounting between 1 and 3.5% percent of the whole number of laryngeal growths. Its predominant sitting is glottic and are characterized through the pathological anatomy and its good prognosis. We report one case treated in our Department which evolved during 14 years and we point out its good prognosis and other particularities regarding its etiology, pathologic anatomy and diagnosis.

Oral cancer and precancerous lesions

In the United States, cancers of the oral cavity and oropharynx represent approximately three percent of all malignancies in men and two percent of all malignancies in women. The American Cancer Society estimates that 28,900 new cases of oral cancer will be diagnosed in 2002, and nearly 7,400 people will die from this disease. Over 90 percent of these tumors are squamous cell carcinomas, which arise from the oral mucosal lining. In spite of the ready accessibility of the oral cavity to direct examination, these malignancies still are often not detected until a late stage, and the survival rate for oral cancer has remained essentially unchanged over the past three decades. The purpose of this article is to review the clinical features of oral cancer and premalignant oral lesions, with an emphasis on early detection.

Oral cancer. The importance of early diagnosis and treatment

Oral cancer is an important health issue. The WHO predicts a continuing worldwide increase in the number of patients with oral cancer, extending this trend well into the next several decades. In the US the projected number of new cases of oral and oropharyngeal cancer will exceed 31,000 per year. Mortality due to cancers in this region exceeds the annual death rate is the US caused by either cutaneous melanoma or cervical cancer. Significant agents involved in the etiology of oral cancer in Western countries include sunlight exposure, smoking and alcohol consumption. Use of the areca or betel nut in many cultures is a major etiological factor outside of the USA. Other etiologic factors associated with oral squamous cell carcinoma, but far less significant statistically, include syphilis and sideropenic dysphagia. Recently, strong evidence for an etiological relationship between human papilloma virus and a subset of head and neck cancers has been noted. It is generally accepted that most sporadic tumors are the result of a multi-step process of accumulated genetic alterations. These alterations affect epithelial cell behavior by way of loss of chromosomal heterozygosity which in turn leads to a series of events progressing to the ultimate stage of invasive squamous cell carcinoma. The corresponding genetic alterations are reflected in clinical and microscopic pathology from hyperplasia through invasiveness. A wide range of mucosal alternations fall within the rubric of leukoplakia. Proliferative verrucous leukoplakia represents a relatively new type of leukoplakia that is separate from the more common or less innocuous form of this condition. Erythroplakia is particularly relevant considering its almost certain relationship with dysplasia or invasive carcinoma. Squamous cell carcinoma will develop from antecedent dysplastic oral mucosal lesions if an early diagnosis has not been made and treatment given. Early diagnosis within stages I and II correspond to a vastly improved 5-year survival rate when compared with more advanced stage III and IV lesions. Surgical management of this disease remains the mainstay of treatment. Other therapies include radiation and chemotherapy options that may be used adjunctively and palliatively. Following treatment, it is important to understand the significant risks of second primary cancers developing within the upper aerodigestive tract as a result of field cancerization. The most important message is that early detection of the asymptomatic early stage oral cancer translates in general terms to satisfactory clinical outcome and cure in most patients.

[Verrucous epidermoid carcinoma of the bladder unrelated to schistosomiasis]

The authors report two cases of papillomatous squamous carcinoma of the bladder unrelated to schistosomiasis. Both patients were treated by endoscopic resection. The staging assessment comprised thoraco-abdominopelvic computed tomography. A papillomatous squamous carcinoma of the bladder was detected in both cases: one was classified as pT2 G1 N0 M0 and the other as pT1 G1 N0 M0. Recurrence was rapidly observed, at the first follow-up cystoscopy. The tumour initially classified as pT1 subsequently underwent transformation to sarcomatoid carcinoma with peritoneal metastases. Papillomatous squamous carcinoma of the bladder, a rare squamous cell carcinoma, is a well differentiated tumour with an exclusively local and regional development. The prognosis is determined by the degree of tumour invasion, with a high local recurrence rate. The prognosis of invasive tumours is identical to that of conventional squamous cell carcinoma. Therapeutic management is poorly defined, but the only curative treatment appears to be radical cystectomy.

Carcinoma cuniculatum of the foot assessed by magnetic resonance scanning

We describe a case of carcinoma cuniculatum of the foot assessed by magnetic resonance scanning. The potential use of this imaging technique in the management of this condition is discussed.

Verrucous carcinoma of the renal pelvis

We report a case of a verrucous carcinoma of the renal pelvis after a long history of a renal pelvis stone. Only 1 case of verrucous carcinoma of the renal pelvis has been previously reported, and ours is the first case not associated with a horseshoe kidney.

National survey of head and neck verrucous carcinoma: patterns of presentation, care, and outcome

BACKGROUND

Verrucous carcinoma is distinguished by controversy regarding appropriate diagnosis and treatment. This study provides a contemporary survey of demographics, patterns of care, and outcome for this disease in the United States.

METHODS

The National Cancer Data Base had 2350 cases of verrucous carcinoma of the head and neck diagnosed between 1985 and 1996. Statistical procedures included chi-square analyses, Student t tests, and relative survival.

RESULTS

Tumors originated most frequently in the oral cavity (55.9%) and larynx (35.2%). Although most patients were male (60.0%), oral cavity tumors were more common among older females. The most prevalent treatment was surgery alone (69.7%), followed by surgery combined with irradiation (11.0%) and irradiation alone (10.3%). For oral cavity tumors, surgery alone was more common among early (85.8%) than advanced cases (56.9%); a larger proportion of advanced disease received radiation alone or surgery and irradiation combined. Most laryngeal tumors were treated with surgery (60.3% for early and 55.6% for advanced disease), but a higher proportion received radiation alone or surgery combined with radiation compared with oral cavity cases. Five-year relative survival was 77.9%. For localized disease, survival after surgery was 88.9% compared with 57.6% after irradiation.

CONCLUSIONS

Demographic differences implicate different mechanisms of carcinogenesis for verrucous carcinoma arising in the oral cavity and the larynx. Although selection bias may account for the differences observed, patients receiving initial treatment with surgery had better survival than those treated with irradiation, especially for cases originating in the oral cavity.

[Verrucous carcinoma of the kidney: report of 2 cases]

The verrucous carcinoma is an unusual shape of well differentiated squamous cell carcinoma, first described at the ORL region; the kidney location is rare; the risk factors are represented essentially by lithiasis and/or urinary infection; the clinical symptom is not specific. Diagnosis is facilitated by radiological investigations and particularly excretory urogram/ultrasound; certainly diagnosis is pathological. The nephro-ureterectomy with collar resection of the bladder is the choice treatment. We report two observations and we clarify clinicopathological aspects of this type of carcinoma and we discuss the prognosis.

Cutaneous verrucous carcinoma

Verrucous carcinoma is a rare, low-grade, well-differentiated squamous cell carcinoma most commonly seen on mucosa. It has been infrequently reported to occur on the skin, where it is a slow-growing and locally aggressive tumour. It is not uncommon for cutaneous verrucous carcinomas to be mistaken for the more frequent verruca vulgaris and treated accordingly. Three cases of cutaneous verrucous carcinoma are presented with the medical history and follow-up data. Surgery is the treatment of choice; these lesions may sustain a potentially anaplastic transformation after radiation therapy.

Verrucous carcinoma arising in hidradenitis suppurativa

There are many reported cases of squamous carcinoma complicating hidradenitis suppurativa, but only one previous mention of verrucous carcinoma in this setting. We describe a case of verrucous carcinoma arising in hidradenitis suppurativa of the anal margin in a non-immunosuppressed man. This is the second report of verrucous carcinoma arising in a lesion of hidradenitis suppurativa. Although hidradenitis suppurativa can involve multiple intertriginous sites, malignant degeneration occurs mostly in the anogenital region. This suggests a role for a regional factor which, when combined with chronic inflammation, predisposes to malignant degeneration. A likely candidate for this factor is human papillomavirus; our case showed histologic evidence for this, but the specimen did not show viral DNA by polymerase chain reaction in situ hybridization. The ability of anogenital hidradenitis suppurativa to form squamous and verrucous cancers reinforces the argument for early and complete resection.

[Ackerman's tumors of the larynx: results of CO2 laser surgery]

BACKGROUND

Ackerman's tumor, named after the author of the first description in 1948, is a low grade malignant tumor. The aim of this paper is to clarify the role of the carbon dioxide laser therapy in the management of this neoplastic disorder of the larynx.

PATIENTS

Twenty-four men and one woman suffering from glottic tumors fulfilled the diagnostic criteria laid down by Ackerman from 1986 to 1998. All patients were treated with transoral laser surgery with a follow-up ranged from 14 to 142 months.

RESULTS

Seventeen patients were diagnosed at T1, seven at T2, and one at T3. In T1 lesions, a laser cordectomy or an extended laser cordectomy was performed. In T2 and T3 tumors, partial laryngectomy with a CO2 laser was performed. No patient died tumor-related. In this series, initial failure rate of laser resection was 8%: one patient was salvaged with endolaryngeal laser surgery, another patient (initially T3 tumor) with total laryngectomy. No patient required radiation therapy. No cases of anaplastic transformation were recognized.

CONCLUSIONS

Based on this material, recommended treatment for T1 and T2 Ackerman-Tumors is oncologic CO2 laser resection in combination with a meticulous follow up for every recognition of local recurrences.

[Presternal verrucous carcinoma]

Verrucous carcinomas represent rare, highly differentiated variants of squamous cell carcinoma. They preferentially develop on the oropharyngeal mucosa (Ackerman tumor), the urogenital mucosa (Buschke-Loewenstein tumors), and the soles of the feet (epitheliomata cuniculata). Various synonyma have been coined for these tumors. We report the uncommon occurrence of a large verrucous carcinoma on apparently uninvolved chest skin of a 79-year old patient. The tumor was excised radically. Complete extirpation was confirmed histologically and there was no sign of recurrence during a 3 month observation period. The clinical appearance, histomorphological features, epidemiological aspects, differential diagnosis, therapy, and nomenclature of verrucous carcinomas are discussed.