Verrucous carcinoma (Ackerman's tumor) of the larynx: Diagnostic and therapeutic considerations

Abstract

Verrucous carcinoma (Ackerman's tumor) is a low-grade malignant lesion with distinct clinical and pathologic features, distinguishing it from other well-differentiated squamous cell carcinomas. Much of the confusion surrounding its natural history, response to therapy, and anaplastic transformation may be ascribed to the failure of critically reviewing accepted diagnostic criteria. A series of 44 patients with verrucous carcinoma of the larynx is presented, 18 of these being updated results of previously reported patients. Ackerman's tumor, although not radioresistant, seems less radiosensitive than ordinary squamous cell carcinoma. The tumor's rounded, pushing margins and inability to metastasize would seem to favor endoscopic removal, saving partial laryngectomy procedures for those lesions that cannot be managed endoscopically. Extensive lesions that would require total laryngectomy for complete removal of the tumor should be treated by primary radiotherapy. It is our belief that total laryngectomy should only be performed in large lesions that fail to respond to radiotherapy and whenever medical considerations preclude partial laryngectomy procedures.

CO2 laser surgery for verrucous carcinoma of the larynx

“…Like others before us, we found an association of this lesion with elderly men, tobacco exposure [6,7], and with second primaries [2,11,15]. Laryngeal VC were predominately diagnosed at an early tumor stage [2,4,6,12,14,16]. These findings are consistent with our data presented here.…”

“…All except nine patients (data reported in five series to 6,8,[19][20][21] were treated with conventional surgery. Some authors prefer radical surgery for VC, e.g., partial laryngectomy in T1 and total laryngectomy in T2 lesions [2,14,16]. Others advocate more conservative treatment strategies, such as local excision, vocal cord stripping or tumor vaporisation in T1, cordectomy for T2 tumors, and total laryngectomy or radiotherapy in very extensive lesions [3,6].…”

“…Three patients (14%) in our series suffered temporary postoperative complications (see Table 1). Operative treatment should not include neck dissection, even though enlarged lymph nodes may be palpated or detected during sonography [2,8]. In our series, all patients except for one were followed up with neck sonography, revealing no progression of disease.…”

“…This tumor is a highly differentiated variant of the squamous cell carcinoma that may develop in any mucosal surface. The glottic region of the larynx is the preferential location in the upper airways [2]. The incidence of these uncommon malignant lesions accounts for ∼1-3.8% of all laryngeal carcinomas [3,4].…”

Temporal Bone Verrucous Carcinoma: Outcomes and Treatment Controversy

“…Reports of anaplastic transformation and an increase in nodal metastases come largely from earlier communications (prior to the early 1990s) [32][33][34][35]. More recent reports have not confirmed these results [3,9,23,36,37].…”