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Verrucous Carcinoma with Dysplasia or Minimal Invasion: A Variant of Verrucous Carcinoma with Extremely Favorable Prognosis

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Abstract

Verrucous carcinomas (VC) recur locally but do not metastasize in the absence of an invasive squamous cell carcinoma (SCC) component. Although excluded from the definition of pure VC, some tumors harbor only dysplasia or minimal invasion, findings of unknown clinical significance. Surgically resected VC cases from two institutions were collected and categorized into three types: VC, VC with dysplasia or minimal invasion (VCDMI), defined as SCC less than or equal to 2 mm in depth, and SCC arising in VC (SCC-VC) where the SCC was greater than 2 mm in depth. Cases were also matched with conventional SCC based on location and T and N-stages, and clinical follow up was obtained. Of the 58 total cases, 18 were VC, 26 VCDMI, and 14 SCC-VC. Only 1 of 18 (5.6 %) VC and 5 of 26 (19.2 %) VCDMI cases recurred locally (p = 0.37) versus 7 of 14 (50 %) SCC-VC (p = 0.01). All VC and VCDMI cases were node negative at presentation whereas SCC-VC had nodal metastases in 2 of 14 (14.3 %) cases. No patients with VC or VCDMI died from disease, whereas 5 of 14 (35.7 %) patients with SCC-VC died from disease. T-stage matched conventional SCC cases from institutional databases had worse outcomes than VC and VCDMI, but not after they were matched for both T and N-stages. Our findings suggest that dysplasia and/or minimal invasive SCC do not adversely affect outcomes in tumors otherwise showing diagnostic features of VC.

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Acknowledgments

We would like to thank Sue Pagano for her assistance in retrieving and organizing the slides on the study cases. We also thank Jingqin (Rosy) Luo, PhD, for her assistance with the kappa statistic calculations.

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Authors and Affiliations

  1. Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO, 63110, USA

    Kalyani R. Patel, Rebecca D. Chernock, Samir K. El-Mofty & James S. Lewis Jr.

  2. Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Rebecca D. Chernock, Parul Sinha, Samir K. El-Mofty & James S. Lewis Jr.

  3. Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Susan Müller

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  1. Kalyani R. Patel
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  2. Rebecca D. Chernock
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  4. Susan Müller
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  6. James S. Lewis Jr.
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Correspondence to James S. Lewis Jr..

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Patel, K.R., Chernock, R.D., Sinha, P. et al. Verrucous Carcinoma with Dysplasia or Minimal Invasion: A Variant of Verrucous Carcinoma with Extremely Favorable Prognosis. Head and Neck Pathol 9, 65–73 (2015). https://doi.org/10.1007/s12105-014-0551-7

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  • DOI: https://doi.org/10.1007/s12105-014-0551-7

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