Well-Differentiated Squamous Cell Carcinoma with Verrucous Features – A Variant of Verrucous Carcinoma with Extremely Favorable Prognosis
Kalyani R Patel, Susan Muller, Rebecca Chernock, Samir El-Mofty, James S Lewis, Jr.. Washington University in St Louis, St Louis, MO; Emory University School of Medicine, Atlanta, GA
Background: Verrucous carcinomas (VC) of the head and neck (HN) are tumors which recur locally but do not metastasize, when not associated with any frank cellular dysplasia or an invasive squamous cell carcinoma (SCC) component. However, VC with dysplasia or focal invasion are treated just as conventional SCC. There has been no study on differences in biologic behavior between VC, VCs with dysplasia or limited invasion, and those with extensive invasion.
Design: All institutional HN VC cases were reviewed and categorized into 3 groups: pure VC, well differentiated SCC with verrucous features (SCC-VF), and SCC arising in VC (SCC-VC). SCC-VF was defined as VC with frank dysplasia or with minor invasive SCC (<2mm in depth). SCC-VC was defined as VC with major invasive SCC (>2mm). Cases were also matched with conventional SCC based on location, T and N stage. Clinical features were compared using one way ANOVA with multiple comparisons.
Results: Of 49 cases, 16 were VC, 20 SCC-VF and 13 SCC-VC. Forty nine conventional SCC served as matched controls. Follow up was 1-145 months (median 32) for the cases, and 21-134 months (median 51) for controls. Only 1/16 (6.3%) VC cases and 2/20 (10%) SCC-VF cases recurred locally versus 7/13 (53.8%) SCC-VC. All VC and SCC-VF cases were node negative at presentation whereas SCC-VC had nodal metastases in 2/13 (15.4%) cases. These differences were statistically significant (Table 1). No patients with VC or SCC-VF died with disease versus 5/13 (38.46%) patients with SCC-VC. Regional nodal recurrence and distant metastases were absent in pure VC and very uncommon among other groups and hence the differences were not statistically different. Stage matched conventional SCC cases were not statistically significantly different from any of the groups.
|VC versus SCC-VF||SCC-VF versus SCC-VC||VC versus SCC-SC||VC versus matched SCC||SCC-VF versus matched SCC||SCC-VC versus matched SCC|
|Overall disease recurrence||0.14||0.0073||0.0031||0.94||0.21||0.84|