Verrucous carcinoma with foci of invasive squamous cell carcinoma: Report of a case and discussion of current concepts
DOI:
https://doi.org/10.5935/2525-5711.20170019Keywords:
Carcinoma, Verrucous, Squamous Cell., Ki-67 Antigen.Abstract
Verrucous carcinoma (VC) is an uncommon type of low-grade, well differentiated and non-invasive squamous cell carcinoma (SCC). The development of invasive SCC within a VC is rare and distinction from the classical oral SCC is a frequent dilemma for pathologists. We report a case of a 78 years old male former smoker, alcoholic, presenting a painless leukoplastic verrucomatoous lesion in mandibular alveolar ridge measuring approximately 4cm diameter, with 2 months evolution. Histological examination of the incisional biopsy revealed proliferation of well-differentiated squamous epithelium forming high exophytic hyperkeratinized papillary projections and deep blunt buds. In focal areas, invasive tumor epithelial nests with more apparent cytologic atypia were observed. Immunohistochemical analysis showed intense expression of p16 but weak positivity for ki-67. The diagnosis was VC with microinvasive SCC areas. The patient underwent surgery with a safety mar- gin and is under follow-up. “Hybrid” lesions composed of typical VC and invasive SCC accounts for about 20% of oral VC. A discussion on the criteria of differential diagnosis and biological behavior of these lesions is also provided.
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