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In 1948, Ackerman (1), first described verrucous squamous cell carcinoma (VSC) as a variant of oral squamous cell carcinoma. Fewer than 20 cases have been reported. These tumors are slow growing, well-differentiated, irregular wartlike masses with a propensity for local invasion into surrounding tissue. They have been described in the mouth, nasal cavity, larynx, glans penis, scrotum, vulva, vagina, cervix, endometrium, urinary bladder, and anorectal region. VSCs are typically associated with chronic mucosal irritation or a long-term local disease process. Symptoms are insidious and are usually present for a long time before the diagnosis is made. Dysphagia and weight loss are typical at presentation, and usually there is a long delay between the onset of symptoms and detection of the lesion. These tumors uniformly respond well to surgical excision if they are diagnosed before invasion of local tissue. Endoscopically, VSC of the esophagus has a shaggy, white, exophytic, wartlike appearance (hence the name “verrucous”). A conclusive diagnosis of VSC is difficult to make because superficial biopsies tend to show only nonspecific acanthosis, parakeratosis, or hyperkeratosis, with associated acute and chronic inflammation. Deeper, full-thickness biopsies or a fully resected specimen is often needed to detect invasion through the superficial epithelium which is the distinguishing diagnostic feature of VSC. Morbidity and mortality are usually due to complications from local invasion. Metastasis is considered to be exceptionally rare (2). Without esophageal resection, mortality is very high, and patients often die within days |
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