Carcinoma verrugoso de Ackerman / Ackerman verrucous carcinoma

El carcinoma verrugoso, tumor de Ackerman o papilomatosis florida, es una variedad bien diferenciada del carcinoma de células escamosas. Fue descrito por primera vez en 1948 por Lauren Ackerman (Francia), el que observó que dicho tumor presentaba apariencia morfológica característica y un comportamiento clínico específico, por lo que debía ser separado de los otros carcinomas de células escamosas. Se lo atribuye al consumo del tabaco en sus diferentes formas, la responsabilidad en la aparición de esta lesión, sumándose otros factores irritntes crónicos locales. Actualmente se le otorga gran importancia al VPH (virus papiloma humano), principalmente al tipo 16, por estar presente en el 98 por ciento de las lesiones; queda por dilucidar si tiene función pirmaria en la etiología de la lesión o es un agregado posterior. Presentamos un caso de carcinoma verrugoso de Ackerman en la mucosa bucal, en un paciente varón de 51 años con historia de consumo de tabaco, alcohol y coqueo con bicarbonato de sodio durante larga data. Se describen las manifestaciones clínicas, histopatológicas y el control posterior a los 5 años.

[Immunohistochemical and ultrastructural study of basement membrane in oral verrucous carcinoma].

OBJECTIVE: To study the immunohistochemical alteration of basement membrane (BM) type IV collagen and laminin in oral verrucous carcinoma and its BM ultrastructural variations. METHODS: 16 cases of oral verrucous carcinoma (OVC), 10 cases of oral squamous cell carcinoma (OSCC) and 9 cases of oral mild to severe epithelial dysplasia (OMSD) were studied by using a immunohistochemical S-P method, and the results were analyzed by quantitative method. 3 cases of OVC were observed by TEM. RESULTS: The BM in OVC was thicker than in OSCC and OMSD. TEM found the basal lamina in some areas showed a marked reduplication. The BM in OVC was generally intact (13/16), whereas in OSCC it was mostly discontinuous (9/10), especially around the neoplasm front or the small cord consisted of a few cells, and mostly continuous in OMSD (6/9). There was a stromal inflammatory infiltration around tumor nests for all the oral lesions, but it was much heavier in OVC than that in OSCC and OMSD (P < 0.05). There was a positive correlation between intraepithelial lymphocytic infiltration and the BM continuity for OVC(P < 0.01). CONCLUSIONS: The more continuous BM and the heavier inflammatory infiltration in the connective tissue of OVC may be related to its biological behavior.

Ultrastructural analysis of the adjacent epithelium of oral squamous cell carcinoma.

Fifteen biopsies of the immediate adjacent epithelium of oral squamous cell carcinoma were examined under light and electron microscopy. Light microscopic examination of one micron thick sections revealed that the majority of lesions (67%) had hyperplastic or mildly dysplastic epithelium while the remaining (33%) had moderate to severe dysplasia. Ultrastructural observations showed that all these lesions had subcellular alterations similar to those seen in frank malignant oral tissue, particularly in the lower half of the epithelium. Important ultrastructural changes observed included bizarre nuclei of basal and lower spinal cells, enlarged and multiple nucleoli, presence of interchromatin and perichromatin granules, loss of desmosomes and marked spongiosis as well as disturbed cellular maturation sequences in the keratinocytes evidenced by abnormal and irregular distribution of maturation markers such as keratohyalin granules and tonofilaments. The present study thus shows the value of electron microscopy in the detection of malignant changes in the adjacent epithelium of oral squamous cell carcinoma.

Argyrophilic nucleolar organizer region associated proteins in human oral normal mucosa, verrucous carcinoma, and squamous cell carcinoma.

Silver-binding nucleolar-organizer regions (AgNORs) were counted in sections from formalin-fixed, paraffin-embedded blocks of 24 cases of well-differentiated squamous cell carcinoma, 6 cases of verrucous carcinoma, and 11 cases of normal oral mucosa. Two methods of AgNORs counting were used. The mean number of AgNORs/nucleus (mAgNORs) was used as indicator of the DNA content, and the percentage of cells containing five or more AgNORs/nucleus (pAgNORs) as indicator of the proliferative activity of the cells. These two methods were used to examine their possible contributory value as a diagnostic aid to distinguish between the types of carcinoma. The pooled mean counts were: normal oral mucosa mAgNORs 2.41 +/- 0.44 and pAgNORs 3.10 +/- 2.54 (mean +/- SD); verrucous carcinoma: mAgNORs 3.55 +/- 0.39 and pAgNORs 23 +/- 6.99; squamous cell carcinoma: mAgNORs 4.74 +/- 1.04 and pAgNORs 49.88 +/- 23.41. Although the differences of mAgNORs and pAgNORs counts were statistically significant, there was overlap of the counts between verrucous carcinoma and squamous cell carcinoma. These two methods of AgNORs counting cannot be used as a diagnostic aid to distinguish between these variants of squamous cell carcinoma.

Detection of human papillomavirus in laryngeal lesions by in situ hybridization.

Human papillomavirus (HPV) is associated with human neoplasms of squamous epithelium. Squamous papillomas and verrucous carcinomas are two types of squamous neoplasms of the larynx that present difficult problems in differential diagnosis. Using in situ hybridization with biotinylated DNA probes, we examined benign squamous papillomas and verrucous squamous carcinomas of the larynx for the presence of HPV. Forty-two biopsy specimens from 18 patients with laryngeal papillomas and 11 biopsy specimens from seven patients with verrucous carcinomas were obtained from the files of Pennsylvania Hospital, Philadelphia, PA. Tissue sections were hybridized with an HPV DNA cocktail. The HPV-positive cases then were subtyped further with DNA probes specific for HPV subtypes 6/11, 16/18, and 31/33/35. All benign squamous papillomas (42 of 42) were positive for HPV subtype 6/11. None of the verrucous carcinomas contained demonstrable HPV (none of 11). Some of the squamous papillomas were recurrences, which shows the persistence of the virus. These results indicate that laryngeal papillomas may be related to HPV, but verrucous carcinomas are not.

[Simultaneous laryngeal carcinomas: a case report and review of literature]. / Carcinomi laringei simultanei. Presentazione di un caso e revisione della letteratura.

The high incidence of second primary malignant neoplasms in patients under treatment for head and neck tumors has been well documented in literature. In these cases the second primary reappears still in the upper aero-digestive tract or in distant organs (lung, esophagus, stomach, skin,....). The Authors report a case of a male, 64 year old patient, a moderate drinker and smoker, with two distinct simultaneous laryngeal malignant neoplasms. One tumor, which arose on the laryngeal face of the epiglottis, was a verrucous carcinoma (Ackerman's tumor); the other neoplasm, on the right vocal cord, was a well differentiated squamous cell carcinoma. Microlaryngeal examinations and TC-scans revealed a normal, uninvolved right false vocal cord and the Morgagni's ventricle. After surgical therapy, serial laryngeal samples were removed and underwent immunohistochemical studies. Microscopic examination revealed that the anterior commissure, the pre-epiglottic and paraglottic spaces were intact, furthermore, monoclonal antibody studies proved that the two simultaneous laryngeal cancers were independent. In the discussion the Authors report some clinical considerations, a review of literature concerning multiple simultaneous laryngeal tumours and emphasize the concept of "field cancerization", first described with regard to the oral cavity by Slaughter.

Ultrastructure of oral squamous cell carcinoma: a comparative analysis of different histological types.

Twenty-five oral carcinomas and five normal oral epithelial specimens were studied using light and electron microscopy. All histological types (well differentiated squamous cell carcinoma, moderately differentiated squamous cell carcinoma, poorly differentiated squamous cell carcinoma, verrucous carcinoma and spindle cell carcinoma) were seen in the study sample. In addition, 1 case of carcinoma in situ was also present. The normal oral epithelium consisted of three keratinising types (gingiva) and two non-keratinising types (buccal mucosa). The ultrastructural features of oral carcinomas showed good correlation with the features seen in light microscopy. The differentiation status of the lesions showed a relationship with cell and nuclear size, tonofilament and keratin content as well as few other cellular abnormalities. It was also observed that the fine details revealed by electron microscopy were often a means of explaining the characteristic histopathological features of oral carcinoma.

[Verrucous carcinoma of the vulva]. / Carcinoma verrucoso de la vulva.

We reported a case of verrucous carcinoma of the vulva, (VCV) presented at an 71 year old caucasian woman, who was admitted to University of Chile Clinical Hospital, December 11, 1987. She had complained of vulvar itching, pain and a tumor at left labium mayor during the last ten years. The tumor was removed, and then a simple vulvectomy with bilateral superficial lymphadenectomy through separate groin incisions was performed. All the 27 inguinal nodes were free of metastasis, and the vulvar skin presented a mixed dystrophy with light atypia (VIN I). She is alive and well one year after surgical treatment.

Epitelioma cuniculatum

Se presenta un caso de epitelioma cuniculatum de localización plantar. Se hacen revisiones bibliográficas de esta tumoración. Se exponen conclusiones sobre el lugar de esta tumoración dentro del grupo de las carcinomas verrucosos y su interés para aclarar las carcinogénesis experimental de los tumores cutáneas.