A 70 year old male who has been chewing tobacco for the past 50 years presents with a six months history of a large, fungating, soft papillary lesions in the oral cavity. The lesion has penetrated into the mandible. Lymph nodes are not palpable. Two biopsies taken from the lesion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is -
Ans. is 'c' i.e., Verrucuous carcinoma Verrucuous carcinomas also referred to as giant condyloma accuminatum or Buschke-Lowenstein tumor are considered an intermediate lesion between candyloma accuminatum and invasive squamous cell carcinoma. It is impoant to distinguish verrucuous carcinoma from squamous cell carcinomas as these tend to remain localized and are cured by wide excision, however they may undergo malignant transformation in to invasive squammous cell carcinomas. Features of verrucuous carcinomas o Prediliction for males > 50 years o Predisposed in tobacco users, poor oral hygiene Gross Microscopic o Large o Cytological features of malignancy are absent or minimal and rare o Soft o Epithelium is thickened and thrown into papillary folds o Wa like lesions/ o The folds project both above and below the level of surrounding mucosa o Papillomatus and crypt like surface grooves exhibit marked, prekeratin plugging o Fungation may be present (hyperkeratosis ?) ? o The rete projections are broad, bulbous and relatively smooth bordered and there may be chronic inflammatory infiltrate in the subjacent lamina propria. o The deep border of epithelial projections is 'pushing' and not infiltrative. The patient in question is an elderly male (70 years) with a chronic history of tobacco use. Gross features of a 'large', `soft','papillary' lesion that has undergone fungation' are all consistent with the diagnoses of verrucuous carcinoma. Benign appearing `papillomatoses' with 'hyperkaratosis' fuher suppos the diagnosis. Contiguous structures may be involved as the tumor grows. Tumor of the buccal mucosa can grow to become fixed to the periostium of mandible and with continued growth may eventually destroy the periostium and directly invade the mandible.
Squamous cell papilloma
Squamous cell carcinoma
Verrucous carcinoma
Malignant mixed tumour