Hybrid verrucous squamous cell carcinoma of sinonasal tract: a case report

Verrucous carcinoma is a variant of squamous cell carcinoma and should be distinguished from benign papilloma and well-differentiated nonverrucous squamous cell carcinoma. It is rare tumor of the sinonasal tract. Occasionally, conventional squamous cell carcinomatous components may be seen in verrucous carcinoma. This entity is called a hybrid verrucous squamous cell carcinoma. We report a case of hybrid verrucous squamous cell carcinoma occurring in the nasal cavity and paranasal sinus of a 67-year-old male. The removed mass shows the typical feature of verrucous carcinoma, but focally conventional squamous cell carcinomatous area is also noted. The treatment of this case follows verrucous carcinoma, but close follow up is mandatory because it may potentially spread to regional lymph nodes in contrast to pure form of verrucous carcinoma.     

Verrucous carcinoma of the oral cavity: management by radiotherapy and surgery

Verrucous carcinoma is a distinct nonmetastasizing variant of well differentiated squamous cell carcinoma. It is frequently found in the oral mucosa, often in association with the more common type of metastasizing squamous cell carcinoma. In many centres radiotherapy is not used to treat verrucous carcinoma because this tumour is thought to be radioresistant and because "anaplastic transformation" has been reported following such therapy. In a series of 37 patients, 30 received radiotherapy, either alone or combined with surgery. Anaplastic transformation was not encountered. The best results were obtained with aggressive treatment which included both surgery and radiotherapy.     

Possible involvement of differential splicing in regulation of the activity of Arabidopsis ANP1 that is related to mitogen-activated protein kinase kinase kinases (MAPKKKs)

Retrospective study about 10 verrucous carcinomas of the larynx surgically treated in a 20-year-term. This variety accounted por the 1.9 percent of the cancers seen in that period of time. Tabagism and alcoholism predominated in 8 and 6 patients respectively. Glottis was the localization and dysphony the paramount symptom. In the paper are emphasized the most important histologic features. Koilocytosis was present in 6 cases. Four patients developed a second tumor of epidermoid carcinoma type. No one exitus due to the verrucous growth. Only in 3 the death was attributed to the second malignancy.     

Changes in pain sensitivity during neurosis in rats]

OBJECTIVE: Few cases of verrucous carcinoma of the penis with foci of invasive squamous cell carcinoma have been reported and denominated "hybrid tumors". The accuracy of this term is discussed in this paper. METHODS/RESULTS: A huge penile mass in a patient that had undergone three previous operations for lesions diagnosed as verrucous carcinoma is reported. Partial penectomy was performed. Histological examination showed a very well-differentiated squamous cell carcinoma. PCR (polymerase chain reaction) did not detect any type of human papillomavirus (HPV) in the tumor. CONCLUSIONS: Verrucous carcinoma is a strictly-defined lesion with a different biological behaviour from that of squamous carcinoma. Preoperative deep biopsy may miss the squamous cell carcinoma. Definitive diagnosis can only be achieved by histological examination of the surgical specimen. In future, DNA studies could possibly support preoperative diagnosis of this lesion.     

Detection of human papillomavirus DNA with in situ hybridisation in oral squamous carcinoma in a rural black population

Intra-oral carcinoma is the third most common malignancy among men in developing countries, and carries a high mortality rate, particularly in Africa, where patients often present initially with lesions at an advanced stage. The present study was undertaken to determine the prevalence of human papillomavirus (HPV) DNA in oral squamous carcinoma in the west of the Northern Transvaal, an area where a large number of new cases has been diagnosed over the past few years. Paraffin blocks from 66 cases (51 men, 15 women; mean age 58.7 years) of oral squamous carcinoma were randomly selected. Blocks contained samples of both tumour and adjacent normal epithelium. The presence of HPV antigen was established by means of immunocytochemistry and HPV DNA by in situ hybridisation with radiolabelled probes for HPV-6, 11, 16 and 18. Immunocytochemistry for viral antigen was negative in all the specimens. HPV-18 was detected in normal epithelium adjacent to the tumour in one case only. It appears from our study that HPV is of limited importance in oral squamous cell carcinogenesis in the population studied.     

Systemic retinoid therapy of systematized verrucous epidermal nevus (with 1 colour plate)

In a patient with systematized verrucous epidermal nevus, marked improvement was obtained with oral administration of a new aromatic retinoid (Ro 10-9359). Mild cheilitis and thinning of scalp hair were the only side effects obser Withved. continuous treatment the good result was maintained for 10 months. Further investigation is needed to determine, whether long-term oral administration of this new drug is feasible.     

Keratoacanthoma centrifugum marginatum. Possible etiological role of papillomavirus and therapeutic response to etretinate

INTRODUCTION: Keratoacanthoma centrifugum marginatum is an uncommon keratoacanthoma of unknown etiology. We report a case suggesting a possible etiological role for a papillomavirus. Etretinate was an effective treatment. CASE REPORT: A 65-year-old woman had keratoacanthoma centrifugum marginatum of the antero-inferior aspect of the lower third of the right leg for 5 years. Fifteen years earlier, an infection had occurred at the same site after a trauma and was treated by oral antibiotics. Surgical exeresis was difficult due to the wide spread of the lesion. Etretinate given at an initial dose of 1 mg/kg/d for 6 weeks then reduced by half for 2 months led to nearly complete cure. DISCUSSION: Keratoacanthoma centrifugum marginatum, verrucous carcinoma and epidermal carcinoma have some histological characteristics in common, suggesting a possible common etiological agent which could be certain strains of the human papillomavirus (HPV). In our case etretinate provided cure, possibly due to its antitumoral activity and perhaps due to its antiviral activity. The presence of koilocytes suggested HPV infection which was confirmed by PCR. This test does not however provide proof of the etiological role of HPV. We are currently studying the presence of HPV in keratoacanthomas and their possible etiological role.     

Prevalence of human papillomavirus types 16 and 18 in penile carcinoma: a study of 41 cases using PCR

AIMS: To determine retrospectively the prevalence of human papillomavirus (HPV) types 16 and 18 in penile carcinomas. METHODS: Forty one surgically resected penile carcinomas from the archives at Queen Mary Hospital, Hong Kong, were reviewed and classified into verrucous carcinoma, and well, moderately, and poorly differentiated squamous cell carcinomas. Paraffin wax embedded tumour tissue was sectioned and analysed for HPV 16 and HPV 18 using the polymerase chain reaction with type specific internal probes. RESULTS: There were seven verrucous carcinomas, and 11 well, 17 moderately, and six poorly differentiated squamous cell carcinomas. Six of the 41 (15%) patients had penile carcinoma containing HPV 16 or HPV 18 DNA, or both, with HPV 16 found in four (10%) and HPV 18 in four (10%). The mean ages of HPV positive and HPV negative groups of patients were 68.5 and 57.6 years, respectively (p < 0.05). None of the seven verrucous and 11 well differentiated squamous cell carcinomas was positive for HPV. The mean age of patients who had these carcinomas was 52.4 years. As a group, these low grade carcinomas occurred in patients younger by more than a decade than those who had carcinomas of the higher grades (mean age 64.4 years; p < 0.01). CONCLUSIONS: Penile carcinomas had much lower rates of infection by HPV 16 or HPV 18 than cervical carcinomas in this Hong Kong population. Based on our findings and on data collated from published findings, it is concluded that penile verrucous carcinomas are not associated with HPV 16 and HPV 18. The overall low prevalence of HPV 16 and HPV 18 in penile carcinomas suggests that other HPV types might be important in the pathogenesis of these tumours.     

The sign of Leser-Trelat associated with esophageal carcinoma

A 79-year-old woman was admitted to our hospital with complaints of dysphagia and multiple verrucous papules that had developed over the previous year. The diagnosis of esophageal carcinoma was based on upper gastrointestinal radiography and endoscopic examination with biopsy. The clinical syndrome was consistent with the sign of Leser-Trelat associated with esophageal carcinoma. Although radiation therapy and chemotherapy were undertaken, the patient died 8 months later because of the sign of Leser-Trelat in association with squamous cell esophageal carcinoma.     

Primary oral squamous cell carcinoma: a review of 92 cases

PURPOSE: This is a retrospective review of 92 cases of oral squamous cell carcinoma treated by one department of oral and maxillofacial surgery. PATIENTS AND METHODS: The medical records of 92 patients with oral squamous cell carcinoma were reviewed, and standard epidemiologic data were obtained. In addition, cases were identified as to site, stage, risk behavior, histologic classification, primary and secondary surgical treatment, adjunctive therapy, and survival rates. RESULTS: The results indicate a higher-than-predicted 2-year survival rate. The association between alcohol and tobacco consumption and incidence of disease is supported. There was a correlation between tumor size and survival rate, but no correlation between histologic classification and prognosis. CONCLUSION: Mortality increases in relation to the stage at which the diagnosis of oral squamous cell carcinoma is made. Patients with stage III or IV lesions have a much poorer prognosis than those with stage I or II lesions. However, histologic classification and prognosis were not correlated.     

Verrucous carcinoma of skin: epithelioma cuniculatum plantare

Eight patients had plantar growths that were usually irregularly shaped, sharply outlined, verrucous, and several centimeters in greatest dimension. Clinical diagnoses included viral wart, deep mycosis, pyogenic granuloma, amelanotic melanoma, basal cell carcinoma, and eccrine poroma. The median age of the patients, and duration of the growth, were 52 and 16 years, respectively. Therapeutic modalities other than total excision were ineffective. The tumor, derived from surface epidermis, was composed of masses of pale-staining benign-appearing prickle cells, deeply invaginated by thick, compact, partially parakeratotic horn. Several lesions have recurred; amputation was required in one patient. This distinctive entity, apparently not described in the American literature, has been reported from Europe under such titles as epithelioma cuniculatum and papillomatosis cutis carcinoides. We believe that it is best interpreted as a form of verrucous carcinoma, the first cutaneous tumor--as opposed to lesions of mucous membranes and mucocutaneous junctions--to be so classified.     

Penile cancer in Taiwan--20 years' experience at National Taiwan University Hospital

To analyze the characteristics and prognostic factors of penile cancer in Taiwanese, we retrospectively reviewed the clinical data of patients with a diagnosis of penile cancer treated during a 20-year period (1977-1996) at National Taiwan University Hospital (NTUH). Of 71 patients treated for penile cancer during the study period, 17 were referred from other hospitals or clinics. Our analyses focused on the 54 previously untreated patients. Growth on the penis was the main symptom in all cases. Palpable inguinal lymph nodes were found only in 14 patients. All 54 patients with primary tumors were treated surgically. Pathologic examination showed squamous cell carcinoma (SCC) in 43 cases, extra-mammary Paget's disease in three, verrucous carcinoma in three, Bowen's disease in two, cutaneous lymphoma in two and basal cell carcinoma in one. Twenty-six (48%) patients had stage I penile cancer, 13 (24%) had stage II, seven (13%) had stage III, and eight (15%) had stage IV cancer. The five-year survival rate was 78% among patients with SCC and 84% among those with nonsquamous malignancies (p = 0.80). The five-year cumulative survival rates according to Jackson's cancer stage were 100% for patients with stage I, 88.9% for those with stage II, 66.7% for those with stage III, and 0% for those with stage IV (p < 0.001). Tumor staging (p = 0.027) and adjuvant chemotherapy (p = 0.042) were found to be the most significant prognostic factors. Penile cancer accounted for 0.254% of all malignancies among male patients at the NTUH during the study period. Our findings indicate that penile cancer is uncommon in Taiwanese and its prognosis is closely related to tumor staging and management. Early diagnosis and appropriate treatment may lead to prolonged survival.     

Histological appearances and nuclear DNA content of verrucous squamous cell carcinoma of the larynx

Of the 12 cases of verrusous squamous cell carcinoma of the larynx encountered since 1968 at the Department of Otolaryngology of Padua University (including the Verona Section) and the Department of Pathologic Anatomy of the University of Trieste, three are reported, together with an investigation of the nuclear DNA content of the tumour cells. It is suggested that such a study may assit with early detection of verrucous carcinoma. The laryngeal localization of the neoplasm has been evidenced only in some centres. The difficulties in establishing a correct diagnosis for this variant of squamous cell carcinoma are emphasized and the pathomorphological features, as well as the microscopic and macroscopic appearances, are discussed. The prognosis is excellent and the therapy of choice must be only surgical, as radiation has not only proven ineffective, but in some cases has induced anaplasia, leading to a rapid dissemination of the tumour.     

Malignant tumors of the oral cavity. Epidemiologic study of 294 cases observed during the decade 1984-1994

MATERIALS AND METHODS: The research has been carried out with the cooperation of Department of Otorhinolaryngology of the "Ospedale S.S. Trinita" in Cagliari, on 294 patients suffering from oral malignant tumours between 1984 and 1994. This kind of disease was studied in relation to age, sex, histological type, and afterwards the examination results were compared to other researchers' studies. All the 294 patients were recorded in the operating theatre's registers. Oral malignant tumours amount to about 45% of the neoplastic systemic pathology. Use and misuse of alcohol, smoking, repeated blows resulting in pre-cancerous lesions including leukoplakia, might be considered the main causes of the origin of oral tumours. RESULTS: Male patients (237) amount to 80.7% of the examined sample, while female ones (57) reach only 19.3%. The part most frequently involved is the tongue (97 cases, 33%), then the area of the lower lip (69 cases, 23.5%), and finally the lower part of the oral space (47 cases, 15.58%). CONCLUSIONS: From the histological point of view, the squamous carcinoma is found more often in the tongue, in the lower oral space and in the lips, while the basal carcinoma in the lower lip rather then in the upper one. A remarkable increase in the squamous carcinoma and a grow in the areas of the tongue has been observed.     

Congenital homolateral epidermal hyperplasia and hypoplastic hemidysplasia (splitting of the Solomon's syndrome) (author's transl)

The observation of a 16-year-old girl born with an ectromelia and an ipsilateral inflammatory verrucous epidermal nevus led us to a synthetic study of 17 similar cases already published since 1927: all these cases concern female patients and are characterized by a unilateral hypoplastic dysplasia, most often of limbs, and inflammatory epidermal hyperplastic lesions described as ichthyosiform, psoriasiform or verrucous, usually distributed on the same side on the skin overlying the dysplastic body areas. The skin lesions may be partly regressive after birth and their histological features are suggestive of inflammatory linear verrucous epidermal nevus (I. L. V. E. N.). These associations may be representative of a special form of Solomon's syndrome whose heterogeneity has be recently emphasized. We propose to subdivide it in 3 forms: the epidermal nevus syndrome (Solomon's syndrome)--the organoid nevus syndrome (Schimmelpenning's syndrome)--the I. L. V. E. N. syndrome, probably X-linked dominant inherited (lethal for hemizygous males), associated with ipsilateral hypoplastic body lesions and, however less frequently than in the epidermal nevus syndrome, with ocular and nervous abnormalities. The distribution of cutaneous lesions has some similarities with the pattern of skin symptoms of X-linked dominant traits such as chondrodysplasia punctata, focal dermal hypoplasia or incontinentia pigmenti. The most typical feature of this syndrome is the strong inflammatory aspect of the epidermal nevus erroneously described in previous cases as unilateral psoriasis or ichthyosiform erythroderma.     

Postmenopausal bleeding (author's transl)

In the study reported here, 554 cases of postmenopausal bleeding were analyzed, i.e. 4.1% of the gynecological cases admitted during the 11 years from 1961 to 1971. In over one-third of these cases (35.3%) bleeding was caused by genital carcinoma. Among nonmalignant causes, endometrial atrophy was the most common (28.5%) followed by uterine polyposis (21.2%). As expected, corpus carcinoma (51%) was the most commonly found malignant genital disease, followed by cervical cancer (38%) which, surprisingly, is almost as common. The time-lapse between onset of bleeding and hospitalization with diagnosis is alarmingly long. In our patients it averages 19.2 weeks, is 36.3 weeks in corpus carcinoma cases and 16.3 weeks in women with cervical cancer.     

Regional epidemiological features of lip, oral cavity, and oropharyngeal cancer

Lip, oral cavity, and oropharyngeal cancer are among the most common forms of the disease in the world. These types of cancer display significant geographic, ethnic, and socioeconomic variations. We examined the cases of cancer of the lip, oral cavity, and oropharynx diagnosed in the Department of Otolaryngology at the University of Uluda? School of Medicine during the last 5 years, July 1990 to June 1995, and recorded the epidemiological features of these tumors. The Department of Otolaryngology treated a total of 26,225 in- and outpatients during the 5-year period. 320 of these patients (1.2%) were seen for head and neck cancer. 42 of the 320 patients (13.1%) were diagnosed with cancer of the lip, oral cavity, and oropharrynx. After the larynx, this was the second most frequent location of malignant head and neck tumors. We discovered the following epidemiological and pathological features: (1) The incident rate was highest in patients between 41 and 60 years of age. (2) 70% of the patients were male, and 76% of them had a history of tobacco/alcohol use. (3) Occupation had no apparent relevance (four of the patients were farmers). (4) Approximately one third of the patients had undergone medical therapy prior to diagnosis. (5) One third of the patients had initially seen a dentist for treatment, and approximately half had poor dental and oral hygiene. (6) The most frequent symptom was ulceration. (7) Histopathological examination revealed squamous cell carcinoma in 88% of the cases. (8) The cancer was localized to the lip in 31% of cases, oral cavity, 50%, and oropharynx, 19%. (9) Almost half of the cancer cases were diagnosed in advanced stage (stages III and IV).     

Management of the pancreatic metastases from renal cell carcinoma: report of four resected cases

The pancreas is an uncommon site for metastasis from renal cell carcinoma. In most cases, pancreatic metastases occur as part of widespread nodal and visceral involvement, and there is thus evidence of metastatic disease elsewhere in the body. We present 4 cases with resectable pancreatic metastases arising from renal cell tumors without involvement of the regional lymph nodes at the operation. Three cases out of 4 were asymptomatic and the pancreatic metastases were detected by routine follow-up examination of renal cell carcinoma. Aggressive surgical treatment for the solitary metastatic lesion is advocated. Spread of renal cell carcinoma to the pancreas is, however, via the hematogenous route, and even solitary pancreatic metastasis may be one of the manifestations of the systemic metastasis of renal cell carcinoma. No pancreatic regional lymph nodes metastases were noted. Pancreatectomy should be undertaken to remove the tumor with adequate resection margins while preserving as much of the gland as possible. The prognosis of pancreatic metastases arising from a renal cell carcinoma is discussed with a review of the literature. Adjuvant chemo- and endocrine therapy should also be considered in these cases.     

Treatment policy for maxillary sinus carcinoma

Some 908 cases of malignant tumors of the nose and paranasal sinuses treated from 1957 through 1974 were statistically analysed. The most common tumor site was the maxillary sinus (91.4%) and the most common histological figure was carcinoma (92.4%). The crude and relative survival rates for each treatment mode were calculated in January 1975. The number of cases and the 5 year relative survival rates of the main groups were as follows: I. Primary cases of malignant tumors (761 cases) 29.2% A. Carcinoma (709 cases) 29.3% B. Sarcoma (45 cases) 27.4% II. Primary cases of maxillary sinus carcinoma (561 cases) 26.1% A. Period 1957-66 (282 cases) 22.8% 1. Combination of irradiation and surgery (114 cases) 36.9% 2. Irradiation alone (168 cases) 12.7% B. Period 1967-69 (130 cases) 34.5% 1. Irradiation with 5-FU intra-arterial infusion (25 cases) 36.1% 2. Irradiation with intra-arterial infusion of other radiosensitizers (35 cases) 35.7% 3. Irradiation only without infusion (45 cases) 35.2% C. Period 1970-71, Linac X-ray irradiation (61 cases) 15.9% D. Period 1972-73, Irradiation with 5-FU infusion (80 cases), 3 year relative survival rate 39.3% The stage-grouping of maxillary sinus carcinoma based on the classification of tumor spread in the TNM system was recommended for the comparison of survival rates. The best mode of treatment in our experience is the combination of Co-60 gamma-ray irradiation and continuous intrarterial infusion of 5-FU. A curettage during irradiation is recommended. A maxillectomy should be performed only for irradiation failure cases.