Verrucous carcinoma

Introduction:

Verrucous carcinoma was first described by Ackermann. Most verrucous tumors arise in the glottic region involving one or both vocal cords.

Macroscopic appearance:

The size of this lesion is highly variable. But it is often extensive on presentation. Usually it appears as a broadly implanted papillomatous fungating mass, usually interpreted by the clinician as malignant tumor.

Microscopic features:

The lesion is characterized by the presence of well differentiated keratinizing islands and cords of tumor cells which do not display classic features of malignancy. The tumor is covered with a thick layer of keratinized cells and shows classic papillary infoldings with clefts between the folds. The clefts reach the deepest later and are often filled with keratin debris. The deeper margin is rounded and well delineated with advancing margins. Underlying stroma is compressed and contains a heavy lymphocytic and plasma cell infiltrates. A foreign body type reaction may be seen at the margins. Biopsy of the lesion taken superficially shows none of the features of malignancy. Usually it shows benign looking epithelium with much keratosis and papillomatosis.

These tumors extends locally and destroys adjacent structures.

Treatment:

Treatment of choice is surgical removal. This tumor if completely removed has a very low recurrence rate.

Irradiation is not advisable as it could lead to anaplastic transformation of the tumor.

The specimen of verrucous carcinoma should be carefully examined for microscopic foci of invasive carcinoma.