A Case of Hybrid Verrucous Carcinoma With Lymph Node Metastasis: A Rare Case Report

Abstract

V errucous carcinoma (VC) was first described by Ackerman in 1948. It forms almost 2-12% of all oral malignancies. By strict definition, VC lacks dysplastic cytological features [1]. Few cases of VC were reported associated with dysplasia/minimal invasion and regarded as "in-between" variety of VC. Since there is not enough literature regarding this entity, their clinical, histopathological, and prognostic behavior are unclear [2]. Here, we report a case of "in-between" variety of VC, along with its clinical, pathological, and management aspects.

Hybrid Verrucous Carcinoma: A Wolf in Sheep’s Clothing Case Report and Integrative Review of 280 Cases

“…As we have seen in our case, invasive neoplastic foci with cells exhibiting dyskeratosis and atypical mitoses, as in SCCs, may be evident. This combination of features defines the HVC and explains its ability to disseminate (Oliveira et al, 2006;Gokavarapu et al, 2014;Patel et al, 2015;Cunha et al, 2017;Sharma et al, 2020), especially because of the rupture of the basement membrane (BM).…”

“…Considering the natural history of VC and the potential to change biological behavior, for a long time it was thought that it could lose differentiation and invade, but only when submitted to radiotherapy (Perez et al, 1966;Batsakis et al, 1999). Over time, publications began to report that this change occurred in non-irradiated lesions (Kolokythas et al, 2010;Bande et al, 2015;Surana et al, 2018;Sharma et al, 2020).…”

“…In fact, microscopic characteristics of both are present: CV (a lot of keratin, discreet atypia, and no invasion) and SCC (less keratin, more atypia, and invasion), but not in a real hybrid pattern. There are reports of lesions that began as VC, which transformed into HVC, and ultimately became SCC (Terada, 2012;Bande et al, 2015;Patel et al, 2015;Sharma et al, 2020). For VC, there may be a natural tendency for transformation to occur.…”