Hybrid Verrucous Carcinoma: A Wolf in Sheep's Clothing Case Report and Integrative Review of 280 Cases

ABSTRACT: Hybrid verrucous carcinoma (HVC) is defined as a rare neoplasm in which there is histopathological evidence of verrucous carcinoma and microscopic foci of squamous cell carcinoma, synchronously in the same site, affecting behavior and prognosis. This study aimed to present a new case of HVC in the mouth, and critically and comparatively analyze the cases reported in literature, to better understand the biological behavior and contribute to diagnostic precision. A review was performed using six databases, and the gray literature. Twenty-two articles were selected, with a total of 280 cases. The most frequent clinical appearance was verrucous carcinoma which included benign lesions. This implies that the potential for aggressive behavior can be detected microscopically, in the form of a ruptured basement membrane, which visualization can be facilitated by the use of some immunohistochemical markers discussed here. This is important for the diagnosis of HVC and adequate treatment. Hybrid verrucous carcinoma is what can be thought of as "a wolf in sheep's clothing." When analyzing cases with clinical suspicion of verrucous carcinoma microscopically, great attention is recommended, since they may be HVC and can recur, metastasize, and lead to death.

RESUMEN: El carcinoma verrugoso híbrido (CVH) se define como una neoplasia poco frecuente en la que existe evidencia histopatológica de carcinoma verrugoso y focos microscópicos de carcinoma de células escamosas, sincrónicamente en el mismo sitio, que afectan el comportamiento y el pronóstico. Este estudio tuvo como objetivo presentar un nuevo caso de CVH en la cavidad oral, y analizar crítica y comparativamente los casos reportados en la literatura, para comprender mejor el comportamiento biológico y contribuir a la precisión diagnóstica. Se realizó una revisión utilizando seis bases de datos y la literatura gris. Se seleccionaron veintidós artículos, con un total de 280 casos. La aparición clínica más frecuente fue el carcinoma verrugoso que incluyó lesiones benignas. Esto implica que el potencial de comportamiento agresivo puede detectarse microscópicamente, en forma de una membrana basal rota, cuya visualización puede ser facilitada por el uso de algunos marcadores inmunohistoquímicos discutidos aquí. Esto es importante para el diagnóstico de CVH y el tratamiento adecuado. El CVH es lo que se puede considerar como "un lobo con piel de oveja". Al analizar microscópicamente casos con sospecha clínica de carcinoma verrugoso, se recomienda una atención inmediata debido a que pueden ser CVH y pueden recurrir, metastatizar y conducir a la muerte.

Tumor de Buschke-Löwenstein: presentación de un caso / Buschke-Lowenstein tumor: presentation of the case

RESUMEN Fundamento: el tumor de Buschke-Löwenstein es un condiloma acuminado gigante mayor de 10 cm más frecuente en hombres, por lo que el tratamiento de elección debe ser siempre quirúrgico. Objetivo: describir un caso de condiloma acuminado gigante. Presentación del caso: paciente masculino blanco de 54 años de edad, que acudió a consulta con formaciones papilomatosis con aspecto de coliflor de consistencia blanda y húmedas, en ambas regiones inguinales; del lado derecho de 13 cm de diámetro y de 19 cm la izquierda y en la raíz del pene y región perianal de 2 cm, asociadas a dolor de ligera intensidad en miembros inferiores y fetidez ocasional. Se le realizaron estudios preoperatorios incluidos serología y VIH no reactivos. Se operó, realizándole exéresis y cierre con colgajo cutáneo abdominal. Evolucionó estable clínicamente, aunque presentó una infección de la herida quirúrgica donde se reportó Escherichia coli, sensible a gentamicina; cumplió con el tratamiento y egresó sin complicaciones posteriores. Conclusiones: el tumor de Buschke-Löwenstein se considera en la actualidad como una forma de carcinoma verrucoso, no presenta atipias celulares, descrito como benigno, pero un tercio de los casos puede malignizar. No obstante, por las frecuentes recidivas, es considerado por algunos autores como un tumor maligno. A pesar de existir varios tratamientos, es el quirúrgico el de mejores resultados.

ABSTRACT Background: the Buschke-Löwenstein tumor is a giant acuminate condyloma larger than 10 cm, more frequent in men, so the treatment of choice must always be surgical. Objective: to describe a case of giant acuminate condylomata. Case report: 54-year-old white male patient, who came with papillomatosis formations with soft and moist consistency of cauliflower, in both inguinal regions; on the right side of 13 centimeters in diameter and 19 centimeters on the left and at the root of the penis and perianal region of 2 centimeters, associated with pain of slight intensity in the lower limbs and occasional fetidity. Preoperative studies including non-reactive serology and HIV were performed. He underwent surgery, performing excision and closure with abdominal skin flap. He evolved clinically stable, although he presented an infection of the surgical wound where Escherichia Coli, gentamicin sensitive, was reported; he complied with treatment and left without further complications. Conclusions: Buschke-Löwenstein tumor is currently considered as a form of verrucous carcinoma, it does not present cellular atypia, described as benign, but one third of the cases can be maligne. Despite frequent recurrences, some authors consider it as a malignant tumor. Despite the existence of several treatments, the surgical treatment is the one with the best results.

Tumor de Buschke-Lowenstein perianal: relato de dois casos tratados com podofilina em vaselina sólida 25% / Perianal Buschke-Lowenstein tumor: report of two cases treated with 25% podophyllin ointment

O tumor de Buschke-Lowenstein (TBL) é variante extremamente rara do condiloma acuminado que, apesar de manifestar-se clinicamente por lesões de grandes proporções, apresenta comportamento biológico e características histológicas benignas. Existem diversas abordagens terapêuticas disponíveis, muitas delas apoiando-se em abordagens cirúrgicas extensas e mutilantes. Apresentamos dois casos de pacientes com TBL tratados com podofilina tópica, cujas respostas terapêuticas foram extremamente favoráveis em ambos os casos.

Buschke-Lowenstein tumor (BLT) is an extremely rare variant of condylomata acuminata that despite being clinically presented by large lesions, presents a benign biological behavior and histological characteristics. There are a number of therapeutic approaches available, many of which rely on extensive and mutilating surgical procedures. We present two cases of patients with BLT treated with topical podophyllin whose therapeutic responses were extremely favorable in both cases.

Oral carcinoma cuniculatum, an unacquainted variant of oral squamous cell carcinoma: A systematic review

PURPOSE: Oral carcinoma cuniculatum is a rare well-differentiated variant of oral squamous cell carcinoma. The purpose was to systematically review its unique features to differentiate it from other variants as verrucous carcinoma, papillary squamous cell carcinoma and well-differentiated squamous cell carcinoma. MATERIALS AND METHODS: A systematic review was performed using MEDLINE, Dentistry and Oral Sciences Source and PubMed databases and any existing articles related to the research subject missed in the search strategy to screen ones reporting cases occurring exclusively in the oral cavity in English literature. Variables analyzed included clinical, etiologic, imaging, histopatholgical features, treatment, follow-up and survival rates. RESULTS: From 229 hits, 17 articles with 43 cases were included in the systematic review. Clinically it showed a female predilection with pain and/or ulceration of a relatively long duration and exudation being the most common symptoms. Histologically, it showed more endophytic features comprising well-differentiated squamous epithelium with absent or minimal cytological atypia and multiple keratin filled crypts or cuniculus. Inflammatory stromal reaction and discharging abscesses were reported in most of the cases. Bone destruction was predominant in most imaging features. Complete surgical resection with a safety margin was the treatment of choice in most of the cases with few recorded recurrence cases. CONCLUSION: Apprehensive knowledge of oral carcinoma cuniculatum unique features is essential to avoid its misdiagnosis and provide proper treatment especially for recurrent cases.

Verrucous carcinoma of the vulva: diagnosis and treatment

Abstract: Vulvar cancer accounts for less than 1% of malignancies in women. Verrucous carcinoma of the vulva is a rare histological variation, comprising less than 1% of vulvar cancer cases. Although it is characterized as being locally invasive, the condition is not associated with metastatic spreading. Lesions present in the form of a verrucous, ulcerated, and bleeding tumor that can reach large dimensions. This type of tumor can be mistaken for condylomata, both macroscopically and microscopically. We report the case of an 81-year-old patient with a large vulvar tumor presented for eight years, initially considered as a Buschke-Löwenstein tumor. The patient underwent radical vulvectomy with a V-Y advancement flap technique. This type of tumor should be considered by clinicians dealing with condylomatous ulcerative lesions that do not respond to the usual treatment.

Analysis of clinicopathological characteristics and survival time of penile cancer after surgery / 中华泌尿外科杂志

ObjectiveTo analyze the clinicopathological characteristics and survival time of penile cancer after surgery.MethodsThe clinicopathological data of 93 cases of penile cancers patients treated from January 2002 to December 2010 were collected retrospectively.The Kaplan-Meier method was used to draw the survival function and calculate the survival rate.Log-rank test was further used to compare survival difference.ResultsThe median age of the 93 patients was 51 years ( range,23 to 82).Squamous carcinoma was most common with 87 eases (93.5％) in our group.Sixty-one patients were successfully followed up and the median follow up duration was 28 months(range,2 to 89 months).All 3 cases of verrucous carcinoma had progression free survive after surgery after follow up of 12,19,and 67 months.In the 55 patients with penile invasive squamous carcinoma,11 patients died of metastatic disease with a median survival time of 10 months ( range,2 to 24 months).Two years cumulative survival rate was 75.7％ (95％ CI 63.0％ to 88.4％ ).Six cases of 12 patients with lymph node metastasis died of penile cancer while only 5 cases of 43 patients without lymphnode metastasis died.The survival difference was significant (log rank,P =0.000).ConclusionsSquamous carcinoma is the most common type,and patients with lymphnode metastasis have poor prognosis.Verrucous carcinoma has good prognosis.

Treatment of Verrucous Carcinoma of the Lower Lip with Topical Imiquimod (Aldara(R)) and Debulking Therapy

Verrucous carcinoma is an unusual, non-metastasizing, distinct variant of squamous cell carcinoma composed of four subtypes according to the site of occurrence: oral type, anogenital type, plantar type, and other cutaneous sites. Oral type verrucous carcinoma usually shows slow progression with a low incidence of metastases. Treatment of verrcous carcinoma is challenging; multiple medical and surgical therapies are often attempted, with limited success. We reported on 2 cases of verrucous carcinoma of the lip treated with topical imiquimod and debulking therapy.

Hybrid Squamous-Verrucous Carcinoma of Penis / 대한비뇨기과학회지

We report a rare case of hybrid squamous-verrucous carcinoma of penis that grew extensively in the glans and prepuce of a 68-year-old man. He presented himself with penile discharge and pain upon voiding. The penile glans and prepuce were eroded and replaced by a large, fungating, cauliflower-like ulcerative mass. There was no inguinal or pelvic lymph node enlargement. Partial penectomy was done and histologically, the superficial spreading type, well differentiated squamous cell carcinoma was seen with only minimal invasion of the background verrucous carcinoma with a pushing margin. There were no complications and recurrence of the tumor at 12 months after partial penectomy.

Hybrid Squamous-Verrucous Carcinoma of Penis / 대한비뇨기과학회지

We report a rare case of hybrid squamous-verrucous carcinoma of penis that grew extensively in the glans and prepuce of a 68-year-old man. He presented himself with penile discharge and pain upon voiding. The penile glans and prepuce were eroded and replaced by a large, fungating, cauliflower-like ulcerative mass. There was no inguinal or pelvic lymph node enlargement. Partial penectomy was done and histologically, the superficial spreading type, well differentiated squamous cell carcinoma was seen with only minimal invasion of the background verrucous carcinoma with a pushing margin. There were no complications and recurrence of the tumor at 12 months after partial penectomy.