Verrucous Carcinoma

Verrucous Carcinoma Definition:
Verrucous Carcinoma is a diffuse papillary, non metastasizing, well differentiated malignant neoplasm of the oral epithelium.
Synonyms:
Ackerman’s tumor.
Etiology:

• Tobacco Chewing
• Snuff dipping habits – Moistened smokeless tobacco

Clinical Features:
Age: Above 60 yrs
Sex: Males > Females
Site/Location:

• Most common: Gingiva, alveloar mucosa and buccal mucosa
• Less common: Floor of the mouth

Differential Diagnosis:

• Papillary hyperplasia
• Verrucous leukoplakia
• Squamous cell carcinoma
• Chronic hyperplastic candidiasis

Clinical presentation:

• Clinicalls it appears as a slow growing, exphytic, papillary growth having a white pebbly surface.
• The surface fo the lesion is sometimes warty and it shows multiple rugae like folds with deep clefts in between.
• Number: Can be Single or multiple
• Leukoplakia may be seen
• Mostly exophytic type but few lesions may be invasive type, invading into the underlying bone.
• Lesions in the buccal mucosa are very extensive causing Pain and tenderness and dysphagia.
• Lesions in the gingiva and alveolar mucosa become rapidly fixed to the periosteum and cause gradual invasion and destruction of the jaw bone.
• regional lymph nodes are tender and
• enlarged due to secondary infection.

Histopathology:

• Hyperplastic epithelium with papillary surface covered by thick layer of para keratin.
• Rete Ridges: Enlarged bulb like acanthotic invaginating into the underlying connective tissue. project into the underlying connective tissue at the same level called as “Pushing Margin”
  

  Verrucous Carcinoma histology

   

• “Parakeratin plugging” is seen
• The malignant cells are well differentiated and usually show normal level of maturation
• Abnormal mitotic activity is found in these cells.
• Cytologic atypia is absent
• Epithelial Pearls and Microcysts are seen.
• Well demarcated borders.
• Intact basement membrane and underlying connective tissues shows intense inflamatory cell infiltrate.

Treatment:
Surgical Excision and Laser Therapy
Prognosis:
Good