North American Journal of Medical Sciences

LETTER TO EDITOR
Year
: 2013  |  Volume : 5  |  Issue : 2  |  Page : 153--154

Verrucous carcinoma on the helix of pinna


Ashutosh Singh1, Nidhi Verma2, Beena Sachan3, Vivek Negi4,  
1 Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Meerut, India
2 Department of Pathology, Lala Lajpat Rai Memorial Medical College, Meerut, India
3 Department of Community Medicine, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
4 ENT, Lala Lajpat Rai Memorial Medical College, Meerut, India

Correspondence Address:
Ashutosh Singh
Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Meerut
India




How to cite this article:
Singh A, Verma N, Sachan B, Negi V. Verrucous carcinoma on the helix of pinna.North Am J Med Sci 2013;5:153-154


How to cite this URL:
Singh A, Verma N, Sachan B, Negi V. Verrucous carcinoma on the helix of pinna. North Am J Med Sci [serial online] 2013 [cited 2020 Nov 24 ];5:153-154
Available from: https://www.najms.org/text.asp?2013/5/2/153/107541


Full Text

Dear Editor,

Verrucous carcinoma is a variant of well differentiated squamous cell carcinoma with specific clinical, pathological, and behavioral peculiarities to justify its being regarded as specific tumor entity. [1],[2],[3] Various names are used in the literature to describe this entity, including Ackerman's tumor, Buschke-Loewemstein tumor, fibrid oral papillomatosis, epithelioma cuniculatum, and carcinoma cuniculatom. [4] It develops most frequently in the mucous membranes of the oral cavity and larynx. The development of this tumor in the ear is particularly rare. It presents as slow growing fungating mass or irregular elevated plaque. It is locally invasive and nonmetastasizing. Usually, verrucous carcinomas develop without sex-related predominance in the individuals aged 50-80 years. A full thickness biopsy is necessary to ensure the correct diagnosis. Treatment of choice is surgical excision because verrucous carcinomas are less radiosensitive than typical squamous cell carcinoma. A diagnosis of verrucous carcinoma should be considered in any patient with an auricular mass. [5] In this report, we describe a patient with a verrucous carcinoma of the auricula.

A 35-year-old male presented with an enlarging mass on left pinna. Physical examination revealed a round, lobulated mass approximated 1 × 1 cm on helix. The results of otologic examination, audiologic test, general blood test, liver function test, and chest X-ray findings were within normal limit. Oropharyngeal findings were unremarkable and the patient exhibited neither cranial nerves deficits nor lymphadenopathy but he had history of burn at same site 5 years back. As the lesion was small, the entire mass was surgically removed and histological examination confirmed the diagnosis of verrucous carcinoma [Figure 1]a and b. The patient has no postsurgical complications and at the time of this writing, he has been disease-free for more than 14 months.{Figure 1}

Risk factors for verrucous carcinoma are smoking, human papilloma virus 6, 11, 16, and 18, infections, trauma, poor hygiene, minor emissions of irradiations, immunodeficiency, exposure to sunlight, and old scars, etc., [4] Because of their anatomic location auriculae are often exposed to excessive sun and extremes of temperature. [6] No previous report of verrucous carcinoma of the ear has mentioned about cigarette smoking tobacco use in patients described, but chewing tobacco seems to be strongly associated with verrucous carcinoma at other sites. [7]

In this case, patient had history of burn scar on pinna, which was likely to be reason for verrucous carcinoma at younger age in this patient. The microscopic diagnosis of verrucous carcinoma may be difficult because of its well differentiated character. A superficial biopsy will show only hyperkeratosis, acanthosis, and benign appearing papillomatosis. Sections of an adequate biopsy show swollen and voluminous rete pegs that extend into the deeper tissues, where their pattern becomes quite complex. [8] Surgical excision was done in this case and histopathology confirms the diagnosis. Use of radiotherapy is controversial. According to some reports, it may alter the nature of the tumor to a highly malignant, rapidly metastasizing, poorly differentiated squamous cell carcinoma. [9]

Verrucous carcinoma of the ear is unusual, and the accurate diagnosis of that tumor depends on the results of full-thickness biopsy. Surgery is the treatment of choice; the role of radiotherapy remains controversial. A diagnosis of verrucous carcinoma should be considered in all patients with an auricular mass.

References

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4Schwartz RA. Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol 1995;32:1-21.
5Uguz MZ, Aydogdu V, Turk B, Demet E. Verrucous carcinoma of the auricula: An uncommon lesion. Mediterr J Otol 2007;3:173-5.
6Cassisi NJ. Neoplasms of the auricle. In: Cummings CW, editor. Otolaryngology-Head and Neck Surgery. 2 nd ed. St. Louis, MO: Mosby-Year Book; 1993. p. 2965.
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