Verrucous Carcinoma with Dysplasia or Minimal Invasion: A Variant of Verrucous Carcinoma with Extremely Favorable Prognosis

Abstract

Verrucous carcinomas (VC) recur locally but do not metastasize in the absence of an invasive squamous cell carcinoma (SCC) component. Although excluded from the definition of pure VC, some tumors harbor only dysplasia or minimal invasion, findings of unknown clinical significance. Surgically resected VC cases from two institutions were collected and categorized into three types: VC, VC with dysplasia or minimal invasion (VCDMI), defined as SCC less than or equal to 2 mm in depth, and SCC arising in VC (SCC-VC) where the SCC was greater than 2 mm in depth. Cases were also matched with conventional SCC based on location and T and N-stages, and clinical follow up was obtained. Of the 58 total cases, 18 were VC, 26 VCDMI, and 14 SCC-VC. Only 1 of 18 (5.6 %) VC and 5 of 26 (19.2 %) VCDMI cases recurred locally (p = 0.37) versus 7 of 14 (50 %) SCC-VC (p = 0.01). All VC and VCDMI cases were node negative at presentation whereas SCC-VC had nodal metastases in 2 of 14 (14.3 %) cases. No patients with VC or VCDMI died from disease, whereas 5 of 14 (35.7 %) patients with SCC-VC died from disease. T-stage matched conventional SCC cases from institutional databases had worse outcomes than VC and VCDMI, but not after they were matched for both T and N-stages. Our findings suggest that dysplasia and/or minimal invasive SCC do not adversely affect outcomes in tumors otherwise showing diagnostic features of VC.

Recurrent verrucous carcinoma of the urinary bladder after transurethral resection followed by intravesical mitomycin, and a review of the literature

“…Although termed carcinomas, these tumours have a bland cytology and lack basement membrane invasion 2. Previously, they were also known as giant condyloma (GC)/Buschke-Lowenstein tumours, but they are now considered as separate entities 3.…”

“…However, in tumours that have locally invaded into the surrounding structures, radical cystectomy is required 3. Radiotherapy is reserved for inoperable cases or in those patients unfit for surgery 2. In VC with dysplasia or small foci of conventional SCC (hybrid lesions), which clinically behave more like pure VC, most authors still suggest they should be treated as conventional SCC of comparable stage 2…”

Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

“…Diagnosis is problematic because biopsies can mistakenly be read as papilloma due to inadequate sample depth. By not capturing the junction between the tumor and basement membrane, the well‐differentiated rete pegs at the base of the lesion with pushing epithelial nests can be missed, as well as the characteristic absence of true invasion of the basement membrane …”

“…True oral VC is rarely associated with regional or distant metastasis, which is a distinguishing feature from oral SCC. The exception to regional or distant metastasis is if there is a component of conventional SCC that arises within the VC . Wide local excision is the most effective treatment .…”

Data Set for the Reporting of Oral Cavity Carcinomas: Explanations and Recommendations of the Guidelines From the International Collaboration of Cancer Reporting

“…Hybrid lesions, such as verrucous carcinoma and squamous cell carcinoma, are recognized and may affect prognosis. 9 Subtypes should be assigned for both prognosis and cancer registry. [10][11][12] Minor salivary gland tumors and neuroendocrine tumors should be specified and classified according to the WHO classification.…”