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Kristofelc N, Zidar N, Strojan P. Oral verrucous carcinoma: a diagnostic and therapeutic challenge. Radiol Oncol 2023; 57:1-11. [PMID: 36942907 PMCID: PMC10039467 DOI: 10.2478/raon-2023-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Verrucous carcinoma is a low-grade variant of squamous cell carcinoma with specific morphologic, cytokinetic and clinical features. Despite low mitotic activity and slow growth, it can infiltrate adjacent tissues in advanced stages but does not metastasize. The most frequently affected site is the oral cavity. The following article provides latest updates in the etiology, clinical presentation, diagnostics and treatment options in oral verrucous carcinoma and discusses the existing dilemmas linked to this unique malignancy. CONCLUSIONS Oral verrucous carcinoma must be differentiated from conventional squamous cell carcinoma due to its less aggressive behaviour with a more favourable prognosis. Close communication between clinician and pathologist is mandatory for making a correct diagnosis. Primary surgery with negative surgical margins seems to be the most successful treatment. However, management recommendations are not uniform since they are mostly based on case reports and small retrospective case series. Prospective and pooled multi-institutional studies are therefore needed.
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Affiliation(s)
- Nejc Kristofelc
- Department of Otorhinolaryngology, General Hospital Dr. Franc Derganc Nova Gorica, Šempeter pri Gorici, Ljubljana Slovenia
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Naik AN, Silverman DA, Rygalski CJ, Zhao S, Brock G, Lin C, Puram SV, Rocco JW, Baliga S, VanKoevering KK, Old MO, Seim NB, Kang SY. Postoperative Radiation Therapy in Oral Cavity Verrucous Carcinoma. Laryngoscope 2022; 132:1953-1961. [PMID: 34989407 DOI: 10.1002/lary.30009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS We investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) and its effect on overall survival (OS) for patients with oral cavity verrucous carcinoma (VC). STUDY DESIGN Retrospective cohort study. METHODS A retrospective cohort study of the National Cancer Database (NCDB) from 2006 to 2015 was performed. Multivariable logistic regression was used to identify independent predictive factors associated with the use of PORT. Cox Regression survival and propensity score analyses were used to evaluate the effect of PORT on mortality. RESULTS A total of 356 adult patients with primary oral cavity VC who underwent definitive surgical resection were identified. A total of 10.7% of patients underwent definitive surgical resection followed by PORT. Variables associated with PORT included distance to the hospital per 10 miles (adjusted odds ratio [aOR], 0.81 [95% confidence interval (CI), 0.70-0.95]) and stage III-IV disease (aOR, 12.13 and 23.92, respectively). Multivariable Cox regression survival analysis indicated no evidence of survival benefit in patients undergoing PORT compared to surgery alone (adjusted hazard ratio 1.50 [0.74-3.05], P = .23). Propensity score analysis also showed no OS benefit with the use of PORT (P = .41). CONCLUSIONS Variables associated with the use of PORT on multivariable analysis included closer distance to hospital and stage III-IV disease. No clear survival benefit with PORT was identified on either multivariable survival analysis or propensity score analysis. These results suggest that surgery alone with negative margins may be the optimal treatment for patients with oral cavity VC. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Akash N Naik
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Dustin A Silverman
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Health System, Sacramento, California, U.S.A
| | | | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Chen Lin
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Sujith Baliga
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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Mohan S, Pai SI, Bhattacharyya N. Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity. Laryngoscope 2017; 127:1334-1338. [PMID: 28150306 DOI: 10.1002/lary.26443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/25/2016] [Accepted: 11/08/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity. STUDY DESIGN Cross-sectional population analysis. METHODS Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT. RESULTS A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC. CONCLUSION Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence. LEVEL OF EVIDENCE 2C. Laryngoscope, 127:1334-1338, 2017.
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Affiliation(s)
- Suresh Mohan
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sara I Pai
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Neil Bhattacharyya
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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Franklyn J, Janakiraman R, Tirkey AJ, Thankachan C, Muthusami J. Oral Verrucous Carcinoma: Ten Year Experience from a Tertiary Care Hospital in India. Indian J Med Paediatr Oncol 2017; 38:452-455. [PMID: 29333011 PMCID: PMC5759063 DOI: 10.4103/ijmpo.ijmpo_153_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Verrucous carcinoma of the oral cavity (OVC) is an uncommon variant of oral squamous cell carcinoma (OSCC). The clinical presentation and surgical outcomes of OVC are unique; however, the management protocols for OVC are largely extrapolated from OSCC. Objectives The aim is to study the clinical, histopathological demographics, and outcome of OVC at a tertiary care referral hospital in South India. To study the need for lymph node dissection and the role of adjuvant therapy for close resection margins. Materials and Methods A retrospective review of all patients diagnosed to have OVC between January 2005 and April 2015 was undertaken. Data were collected from hospital records and telephonic interview when possible. Results Thirty patients were diagnosed to have OVC. The most common site of the presentation was the buccal mucosa. Twenty-three patients had wide local excision of the primary tumor and seven patients had neck dissection as well. None of the patients who underwent neck dissection had node-positive disease pathologically. The margins were considered close in nine patients, only one of these patients received adjuvant radiation therapy; despite among the patients with close resection margins, there was no recurrence or disease-related mortality. Among the thirty patients, there was only one patient who had recurred locally and there was no disease associated mortality. Conclusions OVC is a unique variant of OSCC which has a good prognosis. Routine lymphadenectomy can be avoided.
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Affiliation(s)
- Joshua Franklyn
- Department of General Surgery Unit 1 (Including Head and Neck Surgery), Paul Brand Building, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajinikanth Janakiraman
- Department of General Surgery Unit 1 (Including Head and Neck Surgery), Paul Brand Building, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit J Tirkey
- Department of General Surgery Unit 1 (Including Head and Neck Surgery), Paul Brand Building, Christian Medical College, Vellore, Tamil Nadu, India
| | - Cecil Thankachan
- Department of General Surgery Unit 1 (Including Head and Neck Surgery), Paul Brand Building, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Muthusami
- Department of General Surgery Unit 1 (Including Head and Neck Surgery), Paul Brand Building, Christian Medical College, Vellore, Tamil Nadu, India
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Diagnostic Biomarkers in Oral Verrucous Carcinoma: A Systematic Review. Pathol Oncol Res 2016; 23:19-32. [PMID: 27924463 DOI: 10.1007/s12253-016-0150-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 11/09/2016] [Indexed: 12/16/2022]
Abstract
Oral verrucous carcinoma (OVC), a low-grade variant of oral squamous cell carcinoma (OSCC), is most frequently seen in the oral cavity. No clear etiology has been found for this lesion, but human papilloma virus, chewing betel nuts, and ultraviolet radiation are suggested as probable causes. Differential diagnosis of OVC is challenging for oral pathologists. The aim of this study was to review the molecular-based approaches for differential diagnosis of OVC. An electronic search was conducted in Medline and Scopus from January 2004 to July 2015 limited to English language publications. Published papers on verrucous carcinoma (VC) were found according to the inclusion and exclusion criteria and analyzed qualitatively. Data extraction were performed according to PRISMA statement. A total of 423 articles were reviewed; out of which, 26 articles completely fulfilled the inclusion criteria. Most of the included studies investigated proliferative and apoptotic biomarkers such as p53 and Ki67. No definite conclusion was drawn for cytoskeletal biomarkers due to variability of factors and lack of significant expression. However, it seems that cytokeratin10 (CK 10) can be useful for differentiation of OVC and benign squamous lesions. Among cell surface and extracellular matrix biomarkers tissue biomarkers, matrix metalloproteinase (MMP)-2, -9, CD31 and CD68 seem to be useful for differentiation of OVC and OSCC and glucose transporter-1 (GLUT-1) can help in differentiation of OVC from oral epithelial dysplasia. Differences among OVC, OSCC and normal epithelium in expression profiles of the investigated biomarkers help in their differential diagnosis; although, clinicohistopathological similarities among verrucous hyperplasia, noninvasive OVC and invasive well-differentiated OSCC make the diagnosis difficult. Further studies are required to better differentiate these oral lesions.
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Chaisuparat R, Limpiwatana S, Kongpanitkul S, Yodsanga S, Jham BC. The Akt/mTOR pathway is activated in verrucous carcinoma of the oral cavity. J Oral Pathol Med 2016; 45:581-5. [DOI: 10.1111/jop.12422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Risa Chaisuparat
- Department of Oral Pathology, Developing Research Unit of Prevention and Therapy of Oral Cancers and Neoplasms by Herbal Medicine; Faculty of Dentistry; Chulalongkorn University; Pathumwan Bangkok Thailand
| | | | | | - Somchai Yodsanga
- Department of Oral Pathology, Developing Research Unit of Prevention and Therapy of Oral Cancers and Neoplasms by Herbal Medicine; Faculty of Dentistry; Chulalongkorn University; Pathumwan Bangkok Thailand
| | - Bruno C. Jham
- College of Dental Medicine-Illinois; Midwestern University; Downers Grove IL USA
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Komal K, Deshmukh SB, Deshmukh A. Verrucous Carcinoma with Oral Submucous Fibrosis: A Rare Case with Brief Review. J Clin Diagn Res 2015; 9:ED06-8. [PMID: 26468468 DOI: 10.7860/jcdr/2015/10042.6305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/14/2014] [Indexed: 11/24/2022]
Abstract
Oral verrucous carcinoma (VC) is a variant of well differentiated oral squamous cell carcinoma (OSCC) characterized by exophytic over growth. Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with chronic betel nut chewing habit. The development of OSCC is seen in one-third of the OSMF patients, but the development of VC is rare in such patients. There are very few cases of OSMF with VC reported in literature. Here, present a rare case of an elderly patient with VC in conjunction with OSMF.
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Affiliation(s)
- Khot Komal
- Professor, Department of Oral Pathology, YMT's Dental college and P.G institute , Kharghar, Navi Mumbai, India
| | - Siddharth B Deshmukh
- Senior Lecturer, Department of Oral Pathology, Yogita Dental College and Hospital , Khed, India
| | - Anjum Deshmukh
- Postgraduate Student, Department of Oral Pathology, YMT's Dental College and P.G institute , Kharghar, Navi Mumbai, India
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Alan H, Agacayak S, Kavak G, Ozcan A. Verrucous carcinoma and squamous cell papilloma of the oral cavity: Report of two cases and review of literature. Eur J Dent 2015; 9:453-456. [PMID: 26430380 PMCID: PMC4570003 DOI: 10.4103/1305-7456.163224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Verrucous carcinoma (VC) of oral cavity is a rare variant of well-differentiated squamous cell carcinoma and squamous papilloma is a benign proliferation of the stratified squamous epithelium, which results in a papillary or verrucous exophytic mass. There is a certain clinical similarity between squamous cell papilloma and VC. We presented a report of two cases which are VC and squamous cell papilloma that are showed the same clinical appearance but different pathological appearance, with a review of the literature.
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Affiliation(s)
- Hilal Alan
- Department of Oral and Maxillofacial Surgery, University of Inonu, Malatya, Turkiye
| | - Serkan Agacayak
- Department of Oral and Maxillofacial Surgery, University of Dıcle, Diyarbakır, Turkiye
| | - Gulten Kavak
- Department of Oral and Maxillofacial Surgery, University of Dıcle, Diyarbakır, Turkiye
| | - Ayse Ozcan
- Department of Oral and Maxillofacial Surgery, University of Inonu, Malatya, Turkiye
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Terada T. Multiple verrucous carcinomas of the oral cavity. J Maxillofac Oral Surg 2015; 14:393-6. [PMID: 25848148 DOI: 10.1007/s12663-014-0634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 05/16/2010] [Indexed: 10/25/2022] Open
Abstract
The author herein reports a case of multiple verrucous carcinomas (VCs) of the left lower gingiva. A 78-year-old man was admitted to our hospital because of gingival tumor. A biopsy revealed severe dysplasia. Surgical resection was performed. Grossly, there were three verrucous lesions (25, 20, 10 mm) in the left lower gingiva. Histologically, 2 tumors (4, 2 mm) were found in addition to the grossly visible 3 tumors. All the 5 tumors were VCs. The tumors showed verrucous and papillary proliferation of squamous epithelium with little cellular atypia. No invasive features were recognized. The dermis showed lymphocytic infiltration. The surrounding mucosa showed many broad foci of squamous cell carcinoma in situ and severe dysplasia (high grade intraepithelial neoplasm). Gradual merges between the VCs and squamous cell carcinoma in situ or severe dysplasia were frequently recognized. Immunohistochemically, the VC tumor cells and squamous lesions were negative for human papilloma virus antigens. P53 protein was expressed in all the VCs and squamous epithelial lesions: it was accentuated in the basal and suprabasal cells of VC. Ki-67 antigen was also expressed in the 5 VCs and in the squamous lesion, and Ki-67 labeling index ranged from 8 to 16 % in VC and from 37 to 62 % in the squamous lesions. These data support the multicentric nature of VC and that the severe dysplasia-carcinoma in situ sequence have been proposed in the etiology of VC.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shimizu-Ku, Shizuoka, 424-8636 Japan
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Dive AM, Bodhade AS, Mishra MS, Upadhyaya N. Histological patterns of head and neck tumors: An insight to tumor histology. J Oral Maxillofac Pathol 2014; 18:58-68. [PMID: 24959039 PMCID: PMC4065450 DOI: 10.4103/0973-029x.131912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This article emphasizes the basis for origin and importance of tumor patterns in diagnosis of oral and maxillofacial tumors. In this article, histological patterns and subpatterns of head and neck tumors are enlisted. Although, undifferentiated tumors remain a challenge to the histopathologist, by describing the histological patterns and the subpatterns of the tumors, an attempt has been made for the diagnosis of the tumors and subsequently for implementation of precise treatment plan for the same.
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Affiliation(s)
- Alka M Dive
- Department of Oral and Maxillofacial Pathology, Vidya Shikshan Prasarak Mandal's Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Ashish S Bodhade
- Department of Oral and Maxillofacial Pathology, Vidya Shikshan Prasarak Mandal's Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Minal S Mishra
- Department of Oral and Maxillofacial Pathology, Vidya Shikshan Prasarak Mandal's Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Neha Upadhyaya
- Department of Oral and Maxillofacial Pathology, Vidya Shikshan Prasarak Mandal's Dental College and Research Centre, Nagpur, Maharashtra, India
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Argyris PP, Kademani D, Pambuccian SE, Nguyen R, Tosios KI, Koutlas IG. Comparison Between p16INK4A Immunohistochemistry and Human Papillomavirus Polymerase Chain Reaction Assay in Oral Papillary Squamous Cell Carcinoma. J Oral Maxillofac Surg 2013; 71:1676-82. [DOI: 10.1016/j.joms.2013.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 01/13/2023]
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Terada T. Papillary squamous cell carcinoma of the mandibular gingiva. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2012; 5:707-709. [PMID: 22977668 PMCID: PMC3438768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/04/2012] [Indexed: 06/01/2023]
Abstract
Papillary squamous cell carcinoma (PSCC) has rarely been reported in the oral cavity. Herein reported is a case of PSCC in the mandibular gum. A 70-year-old man consulted our hospital because of a papillary tumor in the left mandibular gum. Physical examination revealed an exophytic papillary tumor of the left mandibular gum, and an excision of the tumor was performed. Grossly, the tumor was exophytic and papillary, and measured 1 x 1 x 0.8 cm. Microscopically, the tumor showed exophytic papillary proliferation with fibrovascular cores and consisted of atypical squamous epithelial cells. The tumor cells showed hyperchromasia, nuclear atypia, mitotic figures, apoptotic bodies, cancer pearls, and individual keratinization. Mild stromal invasion was seen. Immunohistochemically, the tumor cells were positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, p63, p53, and Ki-67 (labeling index=40%), but negative for human papilloma virus (HPV). HPV in situ hybridization revealed no signals. Therefore, PSCC was diagnosed. The lateral and vertical margins are negative for tumor cell. The pathological diagnosis was PSCC. The patient was healthy and free from tumor three months after the operation.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
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