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)

Lesiones tumorales en región oral: carcinoma verrucoso y carcinoma oral de células escamosas. Reporte de un caso / Tumor lesions in the oral region: verrucous carcinoma and oral squamous cell carcinoma. A case report

El carcinoma oral de células escamosas representa un problema en la salud pública a nivel mundial. Siendo la neoplasia maligna más frecuente en la cavidad oral y uno de los diez cánceres más comunes en todo el mundo. El carcinoma verrucoso es una variante del carcinoma oral de células escamosas que presenta un alto grado de invasión local y baja posibilidad de extenderse. Además, representa del 2 al 12% de todos los carcinomas orales, con una tasa de supervivencia de 5 años. El presente artículo reporta el caso de un paciente masculino de 79 años, después de realizados los exámenes extra e intraoral, así como los complementarios, se observa un aumento de volumen en la porción anterior de la mandíbula, crateriforme irregular, doloroso a la palpación. Se diagnosticó carcinoma verrucoso involucrando a los órganos dentarios 3.3-4.3 y la mucosa circundante. El tratamiento consistió en la remoción quirúrgica completa, sin alteración o daño a las zonas circundantes, con seguimiento postoperatorio. El conocimiento de este tipo de patología puede orientar al odontólogo a la sospecha de diferentes lesiones cancerígenas, lo que permitirá prevenir complicaciones y así brindar la mejor opción de tratamiento a los pacientes afectados.

Oral squamous cell carcinoma represents a worldwide public health problem. Being the most common malignant neoplasm in the oral cavity and one of the ten most common cancers worldwide. Verrucous carcinoma is a variant of oral squamous cell carcinoma that has a high degree of local invasion and low possibility of spreading. In addition, it represents 2 to 12% of all oral carcinomas, with a 5-year survival rate. This article reports the case of a 79-year-old male patient, after performing the extra and intraoral exams, as well as the complementary ones, an increase in volume is observed in the anterior portion of the mandible, irregular crateriform, painful on palpation. Verrucous carcinoma was diagnosed involving teeth 3.3-4.3 and the surrounding mucosa in the oral cavity. The treatment consisted of complete surgical removal, without alteration or damage to the surrounding areas, with postoperative follow-up. Knowledge of this type of pathology can guide the dentist to the suspicion of different cancerous lesions, which will prevent complications and thus provide the best treatment option for affected patients.

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.

Leucoplasia verrucosa proliferativa: a proposito de un caso / Proliferative verrucose leucoplasia: a purpose of a case

RESUMEN Las lesiones blancas de la mucosa oral son patologías relativamente frecuentes, siendo la leucoplasia oral (LO) motivo de consulta habitual en Estomatología. Existen muchas variantes de LO y la leucoplasia verrucosa proliferativa (LVP) es una de las menos frecuentes. La LVP es una enfermedad de pronóstico desfavorable, con características clínico-patológicas distintivas, de lento y progresivo crecimiento, de difícil diagnóstico temprano. La etiología permanece incierta aunque se han implicado hábitos tóxicos como el tabaquismo y agentes infecciosos como Papiloma Virus Humano, Candidaalbicans, Virus de Epstein Barr, entre otros. Suele afectar la encía y mucosa alveolar pero el compromiso puede ser de cualquier sitio de la boca. Inicialmente se observa como una placa blanquecina que se tornahiperqueratósicay genera placas irregulares con áreas rojas y zonas verrucosas, que podrían sufrir transformación maligna. Este artículo realiza una revisión bibliográfica de LVP a partir de un caso clínico.

ABSTRACT The white lesions of the oral mucosa are relatively frequent pathologies, being the oral leukoplakia (OL) reason for frequent consultation in Stomatology. There are many variants of OL and proliferative verrucous leukoplakia (PVL) is one of the least frequent. PVL is a disease with unfavorable prognosis, with distinctive clinical-pathological characteristics, of slow and progressive growth and difficult to diagnose early. The etiology remains uncertain although toxic habits have been implicated, like smoking and infectious agents such as Human Papilloma Virus, Candida albicans, Epstein Barr Virus, among others. It usually affects the gum and alveolar mucosa but any partof the mouth can be affected. Initially it is observed as a whitish plaque that becomes hyperkeratotic, generating irregular plaques with red and warty areas, which could undergo malignant transformation. This article performs a bibliographic review of PVL from a clinical case.

Carcinoma verrucoso en lengua de paciente geriátrica. Informe de caso clínico / Verrucous carcinoma in the tongue of a geriatric patient. Clinic case report

Resumen Se informa el caso de un paciente femenino de 80 años de edad, la cual presenta un crecimiento exofítico en el borde lateral izquierdo de la lengua con dolor a la masticación y deglución de alimentos y bebidas; es referida por el odontólogo del Hospital Primario del municipio de Villanueva, departamento de Chinandega, Nicaragua, al área de Diagnóstico en Patología Bucal de la Facultad de Odontología de la Universidad Nacional Autónoma de Nicaragua, León (UNAN-León). A la exploración clínica se observa lesión exofítica en la zona posterior del borde lateral izquierdo de la lengua de aspecto papilomatoso, y ocupa además el reborde alveolar del mismo lado. El diagnóstico definitivo histopatológico fue carcinoma verrucoso.

Abstract We report the case of an 80-year-old female patient, who presents an exophytic growth on the left lateral border of the tongue with pain when chewing and swallowing food and drinks; who is referred by the Dentist of the Primary Hospital of the municipality of Villanueva, department of Chinandega, Nicaragua to the area of Oral Pathology Diagnostics of the National Autonomous University of Nicaragua, Dental School León (UNAN-León). An exophytic lesion was observed in the posterior area of the left lateral border of the papillomatous aspect of the tongue, occupying in addition the alveolar ridge on the same side. The definitive histopathological diagnosis was Verrucous carcinoma.

Tumor de Ackerman perianal / Ackerman's perianal tumor

Introducción: El carcinoma verrucoso o tumor de Ackerman es una rara entidad relacionada con la infección por el virus del papiloma humano, comportándose como una variante menos agresiva del carcinoma epidermoide. Caso clínico: Presentamos el caso clínico de un paciente de sexo masculino de 45 años portador de una gran lesión perianal con compromiso del canal anal y el aparato esfinteriano. Discusión: Existen varias alternativas para el tratamiento del tumor de Ackerman. Sin embargo en casos como este, y sobre todo ante la ausencia de respuesta al tratamiento de quimioradioterapia, se requiere de una resección amplia y radical. Pese a ello, la recidiva es frecuente. Conclusiones: En el caso analizado se destaca la forma particularmente agresiva de esta patología, con extensa invasión local y pobre respuesta al tratamiento oncoespecífico inicial.

Introduction: Verrucous carcinoma or Ackerman's tumor is a rare entity related to human papillomavirus infection, behaving as a less aggressive variant of squamous cell carcinoma. Clinical case: We present the case of a 45-year-old male patient with a large perianal lesion with involvement of the anal canal and sphincter. Discussion: Ackerman tumor treatment admits different therapeutic modalities; however, in cases such as this, and especially in the absence of response to chemo-radiotherapy treatment, a broad and radical resection is required. Despite this, recurrence is frequent. Conclusions: The particularly aggressive form of this pathology, with extensive local invasion and poor response to the initial oncoespecific treatment, stands out in the analyzed case

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 at ileostomy site / Carcinoma verrucoso em local de ileostomia

ABSTRACT We describe of a case, a 50 year old male who was operated for carcinoma of the descending colon and diverting loop ileostomy, developed a fungating lesion in mucocutaneous junction of ileostomy after one year which on histology revealed to be a Verrucous carcinoma.

RESUMO Descrevemos um caso, homem, 50 anos, que foi operado para carcinoma de cólon descendente e ileostomia em alça para desvio. Transcorrido um ano, o paciente desenvolveu uma lesão vegetante na junção mucocutânea da ileostomia; a histologia revelou ser um carcinoma verrucoso.

Comorbidity between HTLV-1-associated adult T-cell lymphoma/leukemia and verrucous carcinoma: a case report / Comorbilidad entre carcinoma verrugoso y linfoma/leucemia de células T del adulto asociado con HTLV-1: un reporte de caso

Abstract Background: Adult T-cell Leukemia/Lymphoma (ATLL) is classified as a peripheral CD4+ T-cell neoplasm caused by the human T-cell lymphotropic virus type 1 (HTLV-1). Typical symptoms are associated with leukemic infiltration; however, atypical and exaggerated manifestations of verrucous carcinoma have also been described. Case report: We present here the case of a patient with multiple skin lesions, ischemic necrosis in the hallux and lymphadenopathies. Biopsies were taken, which showed verrucous epidermal carcinoma and cutaneous lymphoma. Splenomegaly and adenopathy in mesentery, retro peritoneum and lymph node chains in the limbs were observed. Bone marrow examination showed findings compatible with T-cell leukemia/lymphoma; and it was ELISA positive for HTLV-1/2. Treatment and outcome: The patient had a good initial response to a CHOP scheme (cyclophosphamide, doxorubicin, vincristine and prednisone) with filgrastim. However, the patient had a relapse and died before the second cycle. Clinical relevance: Comorbidity could lead to the associated risk factors model. According to this model, secondary immunodeficiency caused by HTLV-1 may induce the development of verrucous carcinomas; alternatively, the disease could be due to a correlation between HTLV-1 and the human papillomavirus (HPV).

Resumen Antecedentes: La leucemia/linfoma de células T del adulto se clasifica como una neoplasia de células T CD4+ periféricas desencadenada por el virus linfotrópico de células T humanas tipo 1 (HTLV-1). Los síntomas típicos se asocian a la infiltración leucémica; sin embargo, también se ha descrito la manifestación atípica y exagerada de carcinomas verrugosos. Caso clínico: Se presenta el caso de una paciente con lesiones múltiples en piel, necrosis isquemica del hallux y linfadenopatías. se realizaron biopsias que reportaron carcinoma epidermoide verrugoso y linfoma cutáneo. Se detectó esplenomegalia y adenopatías en mesenterio, región retroperitoneal, y cadenas ganglionares de las extremidades. la medula ósea presentó hallazgos compatibles con leucemia/linfoma de células T y ELISA positivo para HTLV-1/2. Tratamiento y resultado: La paciente presentó buena respuesta inicial al esquema CHOP (ciclofosfamida, doxorrubicina, vincristina, prednisona) con filgrastim. Sin embargo, presentó recaída de la enfermedad antes del segundo ciclo y falleció Relevancia clinica: La comorbilidad podría conducir al modelo de factores de riesgo asociados. De acuerdo con este modelo, la inmunodeficiencia secundaria causada por HTLV-1 puede inducir el desarrollo de carcinomas verrugosos; Alternativamente, la enfermedad podría deberse a una correlación entre el HTLV-1 y el virus del papiloma humano (VPH).

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)

Carcinoma verrucoso y miasis vaginal: a propósito de un caso / Verrucose carcinoma and vaginal myasis: about a case

La infestación de tumores del tracto genital inferior por parásitos o larvas vivas es un acontecimiento raro, pocas veces reportado en la literatura. Presentamos el caso de una paciente de 82 años que acude a la emergencia de ginecología por presentar tumor ulcerado localizado en el tercio inferior de la pared vaginal izquierda, colonizado por múltiples larvas vivas. Nos parece importante el caso debido a la naturaleza rara de la misma, ya que existen pocos reportes en la literatura a nivel mundial. Consideramos necesario educar a la comunidad femenina para que acuda a sus controles anuales de rutina, y más aún ante la presencia de masas a nivel vulvar o vaginal, ya que por su crecimiento lento e indoloro se le resta importancia a este evento.

The infestation of tumors of the inferior genital tract for parasites or alive larvas is an event extraordinarily strange, few times reported in the literature. We present the case of a 82 year-old patient that goes to the gynecology emergency for great ulcerated tumor located in the inferior third of wall vaginal left, colonized by multiple alive larvas. We find important the case due to the strange nature of the same one, since few reports exist in the literature, what corroborates the previously exposed thing. We consider necessary to educate to the feminine community so that she goes to their annual controls of routine, and stiller before the presence of masses at level vulvar or vaginal, since maybe for their slow and painless growth she is subtracted importance.