Hybrid Verrucus Carcinoma of the Oral Cavity: A Case Report and Review of the Literature

Abstract

Introduction: Verrucous carcinoma (VC) of the oral mucosa is a rare type of non-metastatic, low-grade and well differentiated squamous cell carcinoma. The neoplasm is typically presented with a slow and superficial growth in elderly males. Various factors are known to implicate in its pathogenesis and affect the progression and prognosis of the neoplasm. When invasive atypical areas are present, VC is then described as hybrid verrucous carcinoma (HVC). Case Report: A 55-year-old woman was referred with an elevated leukoplakic verrucous lesion on the dorsal surface of the tongue, measuring 2 cm at its maximum diameter. The patient had been a smoker for ten years with no pertinent past medical history. An incisional biopsy had already been performed a month before referral with the histopathology report of an atypical verrucous papillary lesion. An excisional biopsy was performed at the referral and the lesion was resected with a spindle-shaped surgical incision circumcising the neoplasm within safety margins. The final histopathology report made the diagnosis of VC with multiple foci of microinvasive squamous cell carcinoma (verrucous carcinoma – hybrid type). Conclusion: Differential diagnosis of VC still remains a challenge and various clinical, histopathological and immunohistochemical parameters should be considered. The treatment of choice for VC is surgical excision within safety margins. A clinical follow-up should then be scheduled for these patients and they must remain alert for any changes of the oral mucosa for the future.