Oral cavity & oropharynx

Oral cavity squamous cell carcinoma


Topic Completed: 1 November 2013

Minor changes: 1 April 2021

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PubMed Search: Verrucous carcinoma[TI] oral cavity[mh]

Nat Pernick, M.D.
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Cite this page: Pernick N. Verrucous. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavityverrucous.html. Accessed December 2nd, 2021.
Definition / general
  • Also called Ackerman tumor
  • Locally invasive, may recur (as nonverrucal types) but nonmetastasizing
  • 5% of intraoral carcinomas
  • Men, ages 60+ years; associated with chewing tobacco, snuff dipping or heavy smoking
  • Not associated with alcohol abuse; HPV found in 28% but unclear if relevant
  • 20% coexist with typical squamous cell carcinoma - these cases have risk of metastasis
  • Enlarged lymph nodes are reactive, due to trauma or infection
  • Buccal mucosa, gingiva, tongue, palate and tonsillar pillar
  • Surgical excision, radiation therapy if poor surgical candidate (although 30% of radiated tumors become poorly differentiated and aggressive)
Gross description
  • Exophytic, warty or plaque-like
  • Granular, red-white, hyperkeratotic; 1 - 10 cm
  • May invade adjacent soft tissue and bone
Microscopic (histologic) description
  • Well differentiated hyperplastic squamous epithelium with orderly maturation (upwards and downwards), hyperplastic surface papillae with keratin also in invaginations; broad, blunt, downward pushing rete pegs
  • Minimal atypia; mitotic activity is present; lymphoplasmacytic infiltrate in lamina propria
  • Per Ackerman "if it looks like carcinoma cytologically, is not verrucous carcinoma"
Microscopic (histologic) images

Contributed by Asmaa Gaber Abdou, M.D.

Various images

Differential diagnosis
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