Definition: Verrucous Carcinoma is a diffuse papillary, non metastasizing, well differentiated malignant neoplasm of the oral epithelium. Synonyms: Ackerman’s tumor. Etiology:
Most common: Gingiva, alveloar mucosa and buccal mucosa
Less common: Floor of the mouthVerrucous carcinoma
Differential Diagnosis:
Papillary hyperplasia
Verrucous leukoplakia
Squamous cell carcinoma
Chronic hyperplastic candidiasis
Clinical presentation:
Clinicalls it appears as a slow growing, exphytic, papillary growth having a white pebbly surface.
The surface fo the lesion is sometimes warty and it shows multiple rugae like folds with deep clefts in between.
Number: Can be Single or multiple
Leukoplakia may be seen
Mostly exophytic type but few lesions may be invasive type, invading into the underlying bone.
Lesions in the buccal mucosa are very extensive causing Pain and tenderness and dysphagia.
Lesions in the gingiva and alveolar mucosa become rapidly fixed to the periosteum and cause gradual invasion and destruction of the jaw bone.
regional lymph nodes are tender and
enlarged due to secondary infection.
Histopathology:
Hyperplastic epithelium with papillary surface covered by thick layer of para keratin.
Rete Ridges: Enlarged bulb like acanthotic invaginating into the underlying connective tissue. project into the underlying connective tissue at the same level called as “Pushing Margin” Verrucous Carcinoma histology
“Parakeratin plugging” is seen
The malignant cells are well differentiated and usually show normal level of maturation
Abnormal mitotic activity is found in these cells.