Carcinoma verrucoso, una variante inusual de tumor laríngeo / Verrucous carcinoma, an unusual variant of laryngeal tumor

Introducción: El carcinoma verrucoso es una variante poco común de carcinoma escamoso bien diferenciado, que carece de rasgos citológicos de malignidad, tiene un crecimiento lento, es infiltrativo, pero no metastatiza. Objetivo: Identificar los aspectos clínico-histopatológicos y terapéuticos de una variante inusual de tumor laríngeo. Presentación del caso: Se reporta un nuevo caso de carcinoma verrucoso, paciente masculino de 78 años que se presentó en la consulta de Otorrinolaringología del Hospital Docente general "Enrique Cabrera" con disfonía. Se realizó laringoscopia indirecta y se detectó lesión exofítica sugestiva de neoplasia. Se tomaron tres biopsias, solo la última, fue de utilidad para diagnosticar un carcinoma verrucoso. Se trató con radiaciones y cirugía. El paciente presenta un intervalo libre de enfermedad después de ocho años de seguimiento. Conclusiones: Para el diagnóstico del carcinoma verrucoso es necesario biopsias profundas y la acuciosidad del patólogo para llegar al diagnóstico. Se hace énfasis en la importancia del trabajo en el contexto del grupo multidisciplinario(AU)

Introduction: Verrucous carcinoma is an uncommon variant of a well differentiated squamous carcinoma that lacks cytological features of malignancy and is often slow-growing, infiltrative, but not metastatic. Objective: To identify the clinical, histopathologic and therapeutic aspects of an unusual variant of laryngeal tumor. Case presentation: A 78-year-old male patient who attended the otorhinolaryngology consultation at "Enrique Cabrera" General Teaching Hospital with dysphonia is reported as a new case of Verrucous carcinoma. Indirect laryngoscopy was performed and an exophytic lesion suggestive of neoplasia was detected. Three biopsies were taken, but only the last one was useful to diagnose a Verrucous carcinoma. It was treated with radiation and surgery. The patient has a disease-free survival after eight years of follow-up. Conclusions: Deep biopsies performed by a skillful pathologist are necessary to reach the diagnosis of Verrucous carcinoma. Emphasis is placed on the importance of working in the context of a multidisciplinary team(AU)

Presentación inusual de epitelioma curriculatum en escolar de 12 años / Unusual presentation of curriculatum epitelioma in a 12 years old schoolchild

Introducción: El carcinoma verrugoso es una variante inusual bien diferenciada del carcinoma epidermoide que tiende a aparecer en adultos de mediana edad o mayores. Se considera una neoplasia maligna de grado bajo con cuatro subtipos principales. Objetivo: Referir la infrecuente presentación del carcinoma verrugoso en un adolescente. Presentación de caso: Escolar masculino de 12 años de edad, de raza mestiza, que acude a Consulta Especializada de Dermatología en el Hospital Clínico Quirúrgico Docente Celia Sánchez Manduley con lesión vegetante localizada en planta de pie derecho; se realizan complementarios, biopsia excisional más injerto y se concluye el caso como epitelioma curriculatum. Conclusiones: A nivel clínico, los carcinomas verrugosos se presentan en forma de tumores exofíticos con una superficie papilomatosa o verrugosa. Se asocian con frecuencia a la infección por el virus del papiloma humano, y puede ser difícil distinguir entre un carcinoma verrugoso y una verruga. Es importante el reconocimiento temprano para guiar un diagnóstico preciso y tratamiento oportuno(AU)

Introduction: Verrucous carcinoma is a well differentiated unusual variant of squamous cell carcinoma that tends to occur in middle-aged or older adults. It is considered a low-grade malignant tumour with four main subtypes. Objective: To explain the uncommon presentation of the verrucous carcinoma in a teenager and the importance of early recognition to guide an accurate diagnosis and a timely treatment. Case presentation: 12 years old, school age male, mixed race who attends to specialized consultation of Dermatology in Celia Sánchez Manduley Surgical Clinical Hospital presenting a vegetating lesion located in the right foot´s sole; there were made complementary blood tests, an excisional biopsy plus graft and the case was finally diagnoses as curriculatum epithelioma. Conclusions: At the clinical level, the verrucous carcinomas are presented in the form of exophytic tumors with a papillomatous or verrucous surface. They are often associated with the human papilloma virus infection, and it may be difficult to distinguish between a verrucous carcinoma and a wart(AU)

Downregulation of Notch4 - a prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma / Regulação descendente de Notch4 - um marcador prognóstico na distinção entre carcinoma verrucoso oral e carcinoma de células escamosas oral

Abstract Introduction: Oral verrucous carcinoma is a special form of well-differentiated squamous cell carcinoma which possesses specific clinical, morphologic and cytokinetic features that differ from other types of oral cancers and hence diagnosis requires immense experience in histopathology. Hence it is certainly important to distinguish such a lesion from other oral tumors as treatment strategies vary widely between them. Objective: In search of a critical diagnostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma, Notch4 receptor, one of the key regulatory molecules of the Notch signaling family has been aberrantly activated in the progression of several types of tumors. However its function in oral verrucous carcinoma remains unexplored. Thus the present study aims in determining the differential expression pattern of Notch4 in oral verrucous carcinoma and oral squamous cell carcinoma. Methods: Ten patients reported positive for oral cancer (5 patients with oral verrucous carcinoma and 5 patients with oral squamous cell carcinoma). Five normal tissue samples were also obtained and evaluated for clinicopathological parameters and immunohistochemistry, western blotting and real time polymerase chain reaction for Notch4 expression. Results: Our results reveal that the expression of Notch4 was considerably high in oral squamous cell carcinoma lesions compared to normal tissue, whereas in oral verrucous carcinoma, irrespective of the clinicopathological features, complete regulação descendente of Notch4 was observed. Conclusions: These preliminary findings strongly support the fact that Notch4 is downregulated in oral verrucous carcinoma and could be considered as a suitable prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma. This distinguishing marker can help in improving therapeutic options in patients diagnosed with oral verrucous carcinoma.

Resumo Introdução: O carcinoma verrucoso de cavidade oral é uma forma especial de carcinoma de células escamosas bem diferenciada que tem características clínicas, morfológicas e citocinéticas específicas que diferem de outros tipos de cânceres orais. Por essa razão, o diagnóstico requer grande experiência em histopatologia. Portanto, é certamente importante distingui-lo de outros tumores orais, pois as respectivas estratégias de tratamento variam muito. Objetivo: Em busca de um marcador de diagnóstico crítico na distinção entre o carcinoma verrucoso e o carcinoma de células escamosas de cavidade oral, o receptor Notch4, uma das principais moléculas reguladoras da família de sinalizadores Notch, foi ativado de maneira anormal na progressão de vários tipos de tumores. No entanto, sua função no carcinoma verrucoso permanece inexplorada. Assim, o presente estudo tem como objetivo determinar o padrão de expressão diferencial de Notch4 no carcinoma verrucoso e de células escamosas de cavidade oral. Método: Dez pacientes tiveram resultado positivo para câncer oral (cinco pacientes com carcinoma verrucoso e cinco pacientes com carcinoma de células escamosas) e cinco amostras normais foram também obtidas. Além da avaliação dos parâmetros clínico-patológicos, foram feitos análise imuno-histoquímica, Western Blot e reação de polimerase em cadeia em tempo real para a expressão de Notch4. Resultados: Nossos resultados revelam que a expressão de Notch4 foi consideravelmente alta em carcinomas de células escamosas em comparação com os tecidos normais, enquanto que no carcinoma verrucoso, independentemente das características clínico-patológicas, observou-se regulação descendente completa de Notch4. Conclusão: Esses achados preliminares apoiam fortemente o fato de que Notch4 estava regulado para baixo no carcinoma verrucoso oral e poderia ser considerado um marcador prognóstico adequado para distinguir entre carcinoma verrucoso e carcinoma de células escamosas de cavidade oral. Esse marcador distintivo pode ajudar a melhorar as opções terapêuticas em pacientes com diagnóstico de carcinoma verrucoso oral.

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.

Buschke-Loewenstein tumor: a case series from Brazil / Tumor de Buschke-Loewenstein: uma série de casos brasileira

Buschke-Loewenstein Tumor or giant condyloma acuminatum is a disease caused by a DNA virus, the self-inoculable human papilloma virus (HPV), being sexually transmitted. Histologically BLT is a benign tumor, but with malignant clinical behavior and a high propensity for local recurrence and malignant degeneration. The clinical picture consists of the presence of a cauliflower-like bulky condylomatous perianal mass with multiple fistulous tracts, which can cause great destruction of the anal canal, with invasion of adjacent tissues. Bleeding, foul odor, local pain and weight loss are also described. The diagnosis is established by biopsy, that should exclude the presence of malignant transformation, which occurs in 30-50% of cases. Associated with a biopsy, the hybridization test may be performed to diagnose HPV infection, especially subtypes 6 and 11, that are commonly related. The treatment of choice is radical surgical excision; however, those patients presenting with extensive fistulous lesions may require a temporary colostomy. Some authors advocate an abdominoperineal resection in cases of infiltration of the sphincter or rectum. This study was designed to evaluate the experience of the service of Coloproctology at a referral hospital in Northeastern Brazil with this rare entity, contributing to world literature in addressing this disease. (AU)

Tumor de Buschke-Loewenstein ou condiloma acuminado gigante é uma doença causada por um vírus de DNA, o papilomavírus humano (HPV), auto-inoculável, sendo transmi-tido sexualmente. Histologicamente, são tumores benignos, porém, de comportamento clínico maligno, apresentando alta propensão à recorrência local e a degeneração maligna. O quadro clínico consiste na presença de uma volumosa massa condilomatosa perianal, com aspecto de couve-flor, com numerosos trajetos fistulosos, podendo provocar grande destruição do canal anal e invasão dos tecidos adjacentes. Sangramento, odor fétido, dor local e perda ponderal são também descritos. O diagnóstico é feito por biópsia, que deve afastar a presença de transformação maligna, que ocorre em 30-50% dos casos. Associado à biópsia, pode ser realizado um teste de hibridização para diagnosticar a infecção por HPV, principalmente os subtipos 6 e 11 que são comumente relacionados. O tratamento de escolha é a excisão cirúrgica radical, entretanto, os pacientes que apresentam lesão extensa com fístula, podem requerer colostomia temporária. Alguns autores advogam a amputação abdominoperineal do reto nos casos de infiltração dos esfíncteres ou do reto. O estudo foi designado para se avaliar a experiência do serviço de coloproctologia de um hospital de referência no Nordeste brasileiro com esta rara entidade, contribuindo com a literatura mundial na abordagem desta enfermidade. (AU)

Verrucous carcinoma in association with oral submucous fibrosis.

Oral verrucous carcinoma is a form of well differentiated squamous cell carcinoma characterized by exophytic over growth. It is slow growing and locally invasive tumor occurring in 6 th and 7 th decade of life. Smoking and chewing tobacco is found to be the most common etiological factor of verrucous carcinoma although oral leukoplakia may act as a predisposing factor. This is a rare case of oral varrucous Carcinoma seen in association with oral submucous fibrosis in a younger patient with long standing history of chewing tobacco.

Experiencia de 15 años en el manejo del cáncer de pene / Fifteen years experience in the management of penis cancer

Conocer características clínicas, factores pronósticos, tratamiento quirúrgico y sobrevida en pacientes con cáncer de pene en el Instituto de Oncología Dr. Miguel Pérez Carreño. Estudio descriptivo, transversal, en 50 de 65 pacientes con cáncer de pene en nuestro hospital entre 1995-2009. Obtuvimos 11 pacientes evaluados entre 1995-1998, 12 entre 1999-2002, 15 de 2003 a 2006 y 12 de 2007 a 2009. 32 por ciento fueron < de 50 años, 26 por ciento entre 51-60, 12 por ciento entre 61-70 y 9 por ciento > de 71 años. 80 por ciento fue carcinoma epidermoide, 2 por ciento epidermoide con patrón sarcomatoso y 18 por ciento verrugosos. El 66 por ciento grado histológico GI, 32 por ciento GII y 2 por ciento GIII. La falectomía parcial se practicó en 44 por ciento, esta más linfadenectomía bilateral en 18 por ciento, emasculación en 16 por ciento. El estadio patológico fue de 36 por ciento para I y III 20 por ciento para estadio IV y 8 por ciento estadio II. La realización de vaciamientos inguinales en su mayoría fue en estadios avanzados con un 29,6 por ciento en pT3 G1. La sobrevida global en estadio I fue 88,8 por ciento al primer año y 50 por ciento a 5 años, estadios IV en un año 70 por ciento y cero en 5 años. El pronóstico depende del estadio patológico, afectación ganglionar, grado histológico, los pacientes pT3 y pT4 independientemente del grado histológico tienen peor pronóstico así se describe en la literatura, la linfadenectomía es fundamental en el manejo de estos casos.

To determine clinical characteristics, prognostic factors, surgical treatment and survival in patients with penile cancer at the Institute of Oncology Dr. Miguel Perez Carreño. Descriptive, transversal, in 50 of 65 patients with penile cancer. 11 patients evaluated in the years 1995 to 1998. 12 from 1999 to 2002, 15 patients from 2003 to 2006, and 12 from 2007 to 2009. 32 percent were < 50 years, 26 percent between 51-60, 12 percent between 61-70 and 9 percent > 71 years. 80 percent were squamous cell carcinoma, 2 percent with a sarcomata’s squamous and 18 percent warty. 66 percent was in GI histological grade, 32 percent and 2 percent GII GIII. The partial penectomy were performed in 44 percent, bilateral lymphadenectomy in 18 percent, 16 percent emasculation. The pathological stage was 36 percent for I and III 20 percent for stage IV and 8 percent stage II. The performance of inguinal dissection was mostly in advanced stages with 29.6 percent in pT3 G1. Overall survival of stage I patients was 88.8 percent in the first year and 50 percent at 5 years, while stage IV in 70 percent and zero in five years. Penile cancer prognosis depends on the pathological stage, lymph node involvement and histological grade, pT3 and pT4 patients regardless of histological grade are the ones who have a worse prognosis as described in the literature, therefore, is central lymphadenectomy handling these cases.

Carcinoma verrucoso oral: reporte de un caso clínico y revisión de 20 casos del Instituto de Referencia en Patología Oral (IREPO), Chile / Oral verrucous carcinoma: a case report and review of 20 cases of the Oral Pathology Referral Institute (IREPO), Chile

El carcinoma verrucoso (CV) es una variante rara del carcinoma de células escamosas con características morfológicas y comportamiento específico. El presente estudio relata el caso de una paciente de género femenino, de 68 años de edad, que presenta un carcinoma verrucoso en lengua, indoloro y con 8 meses de evolución. Además, se realizó una breve revisión de casos clínicos del Instituto de Referencia en Patología Oral (IREPO) de la Facultad de Odontología de la Universidad de Chile, diagnosticados entre enero de 1984 y octubre de 2010, encontrándose 20 casos, con un promedio de edad de 70 años, localizados con mayor frecuencia en encía inferior y lengua.

Verrucous carcinoma (VC), a rare variant of squamous cell carcinoma is an established entity with distinctive morphology and specific clinical behavior. The present study describe a case report of a 68-year-old women who presented a tongue verrucous carcinoma, asymptomatic, that had about 8 months of evolution. A brief review of VC cases diagnosed in Oral Pathology Referral Institute (IREPO), Faculty of Odontology, University of Chile, between 1984 and 2010. It was found 20 cases of verrucous carcinoma with a median age of70-years-old, the most common places were lower gingiva and tongue.

Radioterapia y el carcinoma verrucoso de laringe: [revisión] / Radiotherapy and verrucous carcinoma of the larynx: [revision]

El carcinoma más común en las vías aéreo-digestivas superiores (VADS) es el carcinoma de células escamosas (>90%). Es difícil precisar la prevalencia de las denominadas variantes del carcinoma de células escamosas (CCE). El diagnóstico diferencial es necesario dadas sus diferencias no sólo en el manejo sino también en su pronóstico. El carcinoma verrucoso es una de las variantes del carcinoma de células escamosas bien diferenciado no metastizante, caracterizado por ser una neoplasia de un crecimiento lento, de patrón exofítico verrucoso. El rol de la radioterapia (RDT) en el tratamiento del carcinoma verrucoso es motivo de discusión por su posible transformación en carcinoma anaplásico. A través de la siguiente revisión bibliográfica se busca aclarar dicha controversia.

Squamous cell carcinoma is the most common upper aerodigestive tract (UAT) carcinoma (>90%). Precising the prevalence of the so-called varieties of squamous cell carcinoma has proved difficult. Differential diagnosis is necessary, on account of the differences between varieties both in management and prognosis. One of such varieties, verrucous carcinoma of the larynx, is a well-defined, no-metastatic tumor, characterized as a slow-growth neoplasm, of verrucous exophyitic pattern. Since laryngeal verrucous cancer may transform into anaplastic carcinoma, the role of radiotherapy in its treatment has been discussed. The aim of the present literature review was to shed light on this controversy.

Human papillomavirus in oral lesions / Virus papiloma humano en lesiones orales

Growing evidence suggests a role for human papillomavirus (HPV) in oral cancer; however its involvement is still controversial. This study evaluates the frequency of HPV DNA in a variety of oral lesions in patients from Argentina. A total of 77 oral tissue samples from 66 patients were selected (cases); the clinical-histopathological diagnoses corresponded to: 11 HPV- associated benign lesions, 8 non-HPV associated benign lesions, 33 premalignant lesions and 25 cancers. Sixty exfoliated cell samples from normal oral mucosa were used as controls. HPV detection and typing were performed by polymerase chain reaction (PCR) using primers MY09, 11, combined with RFLP or alternatively PCR using primers GP5+, 6+ combined with dot blot hybridization. HPV was detected in 91.0% of HPV- associated benign lesions, 14.3% of non-HPV associated benign lesions, 51.5% of preneoplasias and 60.0% of cancers. No control sample tested HPV positive. In benign HPV- associated lesions, 30.0% of HPV positive samples harbored high-risk types, while in preneoplastic lesions the value rose to 59.9%. In cancer lesions, HPV detection in verrucous carcinoma was 88.9% and in squamous cell carcinoma 43.8%, with high-risk type rates of 75.5% and 85.6%, respectively. The high HPV frequency detected in preneoplastic and neoplastic lesions supports an HPV etiological role in at least a subset of oral cancers.

Crecientes evidencias sugieren que el virus Papiloma humano (HPV) tiene un rol en el cáncer oral; sin embargo su participación es todavía controvertida. Este estudio evalúa la frecuencia de ADN de HPV en una variedad de lesiones orales de pacientes de Argentina. Se seleccionaron 77 muestras de tejido oral de 66 pacientes (casos); el diagnóstico histo-patológico correspondió a: 11 lesiones benignas asociadas a HPV, 8 lesiones benignas no asociadas a HPV, 33 lesiones premalignas y 25 cánceres. Como controles se usaron 60 muestras de células exfoliadas de mucosa oral normal. La detección y tipificación de HPV se realizó por PCR empleando los primers MY09,11, seguida de RFLP, o PCR usando los primers GP5+, 6+ seguida de hibridación en dot blot. HPV fue detectado en 91% de las lesiones benignas asociadas a HPV, 14.3% de las lesiones benignas no asociadas, 51.5% de preneoplasias y 60% de cánceres. Ninguna muestra control resultó HPV positiva. En las lesiones benignas, 30% de las muestras HPV positivas correspondieron a tipos de alto riesgo, mientras que en las lesiones preneoplásicas la positividad ascendió a 59.9%. En cánceres, la detección de HPV en carcinomas verrugosos fue 88.9% y en carcinomas escamosos 43.8%, con 75.5% y 85.6% de tipos virales de alto riesgo, respectivamente. La alta frecuencia de HPV detectada en lesiones preneoplásicas y cánceres apoya un rol etiológico del HPV en, al menos, un subgrupo de cánceres orales.

Evaluation of mean AgNors in squamous cell carcinomas verrucous carcinomas of oral mucosa

Squamous cell carcinoma [SCC] of oral mucosa is the most prevalent malignant tumor among oral cancers with 95% incidence. Verrucous Carcinoma of oral mucosa is a unique and well differentiated form of SCC which is diagnosed with some difficulty from SCC specially when SCC shows warty appearance and/or, shows high differentiation in histopathologic view. In addition when verrucous carcinoma shows higher displasia, it must be differentiated from early invasive SCC. So, when verrucous carcinoma is diagnosed before changing to SCC, unnecessary treatments can be avoided. The aim of this study was to evaluate the mean number of Argirophilic nuclear organized regions [mAgNor] in SCC and Verrucous carcinoma for differential diagnosis between them. Twenty formalin fixed parrafin embeded blocks including ten SCC and ten Verrucous, were analyzed for AgNor parameters. AgNOR expression was measured by microphotometry by silver stain. T and Mann -whitney U tests were used to compare the data. mAgNor in SCC patients was 2.80 +/- 0.48 comparing with 1.95 +/- 0.28 in Verrucous carcinoma patients [P<0.001]. Since the mAgNor in SCC was statistically more than the mAgNor in Verrucous carcinoma, so, the AgNor staining technique can be applied for early diagnosis of Verrucous carcinoma from well differentiated SCC

[Histopathological differentiation between well differentiated oral squamous cell carcinoma and oral verrucous carcinoma with special staining of basement membrane]

Microscopic differentiation between well differentiated squamous cell carcinoma and verrucous carcinoma is very difficult. As these lesions have different clinical course and treatment a reliable method to help distinguish between them is necessary. The basement membrane in oral verrucous carcinoma is generally intact whereas in oral squamous cell carcinoma is mostly discontinuous. This structure can be studied by different methods. The aim of this study was to differentiate these lesions with special staining of basement membrane. In this tests evaluation study, a total of 26 cases consisting of 15 oral squamous cell carcinomas and 11 oral verrucous carcinomas were retrieved from Cancer Institute of Imam Khomeini hospital archive of pathology and their paraffin blocks were cut and stained with Periodic Acid Schiff method. Slides were studied with light microscope to evaluate the continuity of basement membrane. Sensitivity and specificity of this method were calculated. The sensitivity of this method for differentiating oral squamous cell carcinoma from oral verrucous carcinoma was 100% whereas the specificity was 90.9%. Positive predictive value was 93.75% and negative predictive value 100%. Based on the results of this study, the sensitivity of this test for diagnosis of oral squamous cell carcinoma was high [100%]. Further studies are needed to evaluate the use this method for distinguishing oral verrucous carcinoma from oral squamous cell carcinoma

Carcinoma verrucoso cérvico uterino en una mujer jóven / Verrucous carcinoma of the cervix in a young woman

Se describe el hallazgo de un carcinoma verrucoso en el cuello uterino, de una mujer joven (21 años). Se discute los aspectos clínicos y anátomo-patológicos, además se analiza la conducta terapéutica realizada

Carcinoma verrugoso de Ackerman: revisión de la literatura y presentación de un caso / Ackerman's verrucous carcinoma: review of the literature and report of a case

El carcinoma verrugoso o tumor de Ackerman es considerado una variedad especial del carcinoma espinocelular bien diferenciado que se caracteriza por su bajo grado de malignidad, comportamiento clínico específico y un pronóstico favorable. Este tumor, asociado desde siempre con el consumo de tabaco masticable, higiene bucal deficiente y prótesis mal adpatadas, se ha visto relacionado últimamente con la infección por el virus de papiloma humano. Presentamos un caso de carcinoma verrugoso en mucosa de cavidad bucal con historia de prótesis mal adaptadas y consumo de tabaco masticado en una mujer blanca de 60 años. Puesto que el diagnóstico de esta lesión suele ser confundido, el examen clínico e histopatológico del carcinoma verrugoso son indispensables, ya que de ellos depende la identificación del tumor y posterior planificación del tratamiento