Verrucous Squamous Cell Carcinoma

Verrucous Squamous Cell Carcinoma
Lester D. R. Thompson, MD
Key Facts
Terminology
  • Highly differentiated, low-grade SCC variant characterized by exophytic growth with pushing borders and cytologically bland, amitotic squamous epithelium
Etiology/Pathogenesis
  • Strong association with tobacco and alcohol abuse, occasionally with HPV
Clinical Issues
  • Affects glottis, specifically anterior true vocal cords
  • Surgery alone seems to yield best outcome
  • ˜ 20% recurrence/persistence rate overall (treatment dependent)
  • Pure VSCC does not metastasize
Macroscopic Features
  • Warty, exophytic, papillary or fungating tumor
  • Biopsy large enough to include deep margin and sufficient amount to make an accurate diagnosis
Microscopic Pathology
  • Multiple filiform, finger-like projections of well-differentiated squamous epithelium, maturing to surface
  • Abundant keratosis (ortho– and parakeratosis), “church spire” keratosis, with parakeratotic crypting
  • Broad pushing border of infiltration with dense inflammatory response
Top Differential Diagnoses
  • Verrucous hyperplasia, exophytic/papillary SCC, squamous papilloma, verruca vulgaris
A low-power view shows a highly differentiated, exophytic, warty squamous neoplasm with pushing borders. There are papillary projections associated with extensive keratosis. This is an adequate biopsy.
Broadly implanted, blunt-based, club-shaped papillae show maturation toward the surface. There is significant keratosis image, with a dense lymphoplasmacytic inflammatory basal response image.
TERMINOLOGY
Abbreviations
  • Verrucous squamous cell carcinoma (VSCC)
Synonyms
  • Ackerman tumor
  • Verrucous acanthosis
Definitions
  • Highly differentiated, low-grade squamous cell carcinoma variant characterized by exophytic, warty neoplasm with pushing borders and cytologically bland, amitotic squamous epithelium
ETIOLOGY/PATHOGENESIS
Environmental Exposure
  • Strong association with tobacco and alcohol abuse
Infectious Agents
  • Human papillomavirus (HPV) genotypes 16 and 18 (rarely 6 and 11) are identified in some VSCC
CLINICAL ISSUES
Epidemiology
  • Incidence
    • Comprises up to 4% of all laryngeal SCC
  • Age
    • Mean: 6th and 7th decades
  • Gender
    • Male > Female (4:1)
      • In oral cavity, Female > Male (3:2)
Site
  • Larynx is 2nd most common site of VSCC
    • Oral cavity is most commonly affected (56%), then larynx (35%), sinonasal tract, and nasopharynx
    • Accounts for 15-35% of all VSCC
  • Glottis, specifically anterior true vocal cords
    • Supraglottis, subglottis, hypopharynx, and trachea uncommonly affected
Presentation
  • Long-lasting hoarseness is most common symptom
  • Other symptoms include airway obstruction, weight loss, dysphagia, and throat pain
  • Enlarged lymph nodes are common, but they are reactive rather than neoplastic
Endoscopic Findings
  • “Benign” papilloma-like appearance makes initial diagnosis difficult and may delay treatment
  • Broad-based, fungating, firm mass
  • May have extensive surrounding leukoplakia
  • Surface ulceration uncommon
Treatment
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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Verrucous Squamous Cell Carcinoma

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