Carcinoma verrucous (overview) C44.L

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 09.05.2023

Synonym(s)

Ackerman tumor; carcinoma verrucosum; cutaneous verrucous carcinoma; mucosal verrucous carcinoma; verrucous carcinoma; Verrucous carcinoma; verrucous carcinoma of the mucosa; verrucous carcinoma of the skin

History
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Lauren Vedder Ackerman, 1948

Definition
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Name for a group of low-malignant, slowly exophytic, wart-like growing, highly differentiated spinocellular carcinomas with only a very low tendency to metastasize. The tumours originally described by Ackerman were all localised in the oral cavity(florid oral papillomatosis).

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Classification
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The following clinical pictures are considered to be variants of carcinoma verrucosum, differing in their localization but showing a comparable histological pattern and biological growth behavior:

Papillomatosis cutis carcinoides (= carcinoma verrucosum of the skin).
Florid oral papillomatosis (= carcinoma verrucosum of the oral cavity)
Condylomata gigantea (= carcinoma verrucosum of the genital region)
Carcinoma cuniculatum (= Carcinoma verrucosum of the sole of the foot/toe)

Other localizations are also possible, but less frequent (e.g. back, face, acral finger region, lower leg on the floor of a chronic leg ulcer).

Etiopathogenesis
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A causation of genital manifestations by HPV 16 is discussed.

Oral manifestations are favored by previous inflammatory diseases of the oral mucosa (e.g. lichen planus mucosae) and chronic "irritants", especially:

Chewing tobacco consumption
betel nut chewing ( oral submucous fibrosis)
Kath chewing (Somalia and Yemen).

In tropical countries, the occurrence in combination with schistosomiasis has often been described.

Histology
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Exophytic and endophytic growing epithelial tumor with pronounced acanthosis and papillomatosis. The surface is overlaid by ortho- and parakeratotic horn material. In the tumor parenchyma itself, duct-like or cystic structures filled with horn are visible, sometimes also filled with cell debris. The epithelium in the upper part of the tumor consists of well differentiated keratinocytes with preserved stratification and only a few mitoses. At the base of the tumour, clumsy epithelial strands of increasingly polymorphic keratinocytes are visible. Dyskeratoses and mitoses are also present. Displacement of the local connective tissue as a sign of invasiveness. Occasionally, solitary epithelial islands are also found in the middle of the local connective tissue. Moderate perilesional lymphocytic infiltrate. The histological picture is decisively influenced by the tumor localization (in case of localization at the sole of the foot, exophytic growth recedes into the background).

Therapy
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See below for the respective specificities Papillomatosis, florid oral; see below Condylomata gigantea.

Progression/forecast
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Tendency to recur in loco, rarely lymphogenic metastasis.

Note(s)
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For the histological evaluation of this carcinoma variant, an artificially unaltered excision biopsy of sufficient depth and width (the base of the tumor must be adequately recorded) is necessary to assess the necessary differential diagnostic criteria for assessing dignity (exo- and endophytic growth, invasiveness, cytomorphology), especially in the area of the tumor base.

Literature
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Ackerman LV (1948) Verrucous carcinoma of oral cavity. Surgery 23: 670-678
Heinzerling LM et al (2003) treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. Dermatology 207: 119-122
Ho J et al (2000) An ulcerating verrucous plaque on the foot. Verrucous carcinoma (epithelioma cuniculatum). Arch Dermatol 136: 547-548, 550-551
Lu S et al (2000) Anal verrucous carcinoma and penile condylomata acuminata. Dermatology 200: 320-323
Matoso A et al (2012) Verrucous carcinoma of the nail unit. At the JDermatopathol
34:e106-110
Mehta RK et al (2000) Treatment of verrucous carcinoma of vulva with acitretin. Br J Dermatol 142: 1195-1198
Pleat J et al (2001) Cutaneous verrucous carcinoma. Br J Plast Surgery 54: 554-555
Already MP et al (2000) Presternal verrucous carcinoma. dermatologist 51: 766-769
Schwartz RA (1995) Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol 32: 1-21
Terada T (2011) Verrucous carcinoma of the skin: a report on 5 Japanese cases. AnnDiagn
Catholic 15:175-180