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Description
A 28-year-old female presented to our outpatient department with a painless, well-circumscribed keratotic, exophytic lesion with broad base over the left lateral aspect of the tongue (figure 1). The lesion had a rough, shaggy, papillomatous surface with sharp finger-like surface projections with no surrounding induration (figure 2). She did not have any habits relevant to history. A biopsy performed at a different centre earlier to her visit here suggested of verrucous hyperplasia. Taking into consideration the history of lesion progression and the gross appearance of the lesion, a strong suspicion of verrucous carcinoma (VC) was made. A wide local excision of the lesion with 1-cm margin was done (figure 3). The histopathology showed a verrucoid lesion lined by hyperkeratotic, acanthotic and focally inflamed stratified squamous epithelium with papillomatosis and broad and fused rete with cells showing mild anisonucleosis, overlying fibrocollagenous stroma with dense eosinophilic and lymphoplasmacytic infiltrate and congested vessels, suggestive of VC.
Well-circumscribed keratotic, exophytic lesion with a broad base over the left lateral aspect of the tongue
The lesion showing rough, shaggy, papillomatous surface with sharp finger-like surface projections with no surrounding induration.
Intraoperative image showing the extent of the lesion (A). Post local excision specimen (B).
VC was first delineated as a clinic-pathological entity by Ackerman in 1948.1 This is a distinct variety, comprising about 2.5%–4% of all squamous cell carcinoma in oral cavity and is relatively uncommon. Its occurrence in tongue is rare.2 It most commonly occurs after fifth decade, in individuals with adverse habits of tobacco and alcohol. VC has excellent prognosis due to its benign indolent tumour behaviour and metastasis to regional lymph nodes is very rare.3 This lesion presenting in a young female without any habits in such a pure form has not been reported earlier. Also, the images shown in this report give the typical gross appearance of VC which may help in differential diagnosis in an unusual presentation such as this one.
Learning points
Although it has benign indolent tumour behaviour, multiple deep biopsies are recommended to distinct and distinguish from verrucous hyperplasia and other groups of squamous cell carcinoma showing verrucoid features.
The most appropriate treatment is surgical excision. In selected patients where surgery is not possible, radiotherapy may be attempted, but some authors have reported radiation-induced anaplastic transformation.
In patients with VC associated with leucoplakia or submucosal fibrosis, there may be ‘field cancerisation’ leading to multiple recurrences. Hence, a strict routine follow-up is recommended.
Footnotes
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.