Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Tumours of the Oral Cavity and Mobile Tongue.

The fifth chapter of the upcoming fifth edition of the 2022 World Health Organization Classification of Tumours of the Head and Neck titled Tumours of the oral cavity and mobile tongue, has had some modifications from the 2017 fourth edition. A new section "Non-neoplastic Lesions", introduces two new entries: necrotizing sialometaplasia and melanoacanthoma. The combined Oral potentially malignant disorders and Oral epithelial dysplasia section in the 2015 WHO has now been separated and submucous fibrosis and HPV-associated dysplasia are also discussed in separate sections. Carcinoma cuniculatum and verrucous carcinoma are described in dedicated sections, reflecting that the oral cavity is the most common location in the head and neck for both these entities which have distinct clinical and histologic features from conventional squamous cell carcinoma. This review summarizes the changes in Chapter 5 with special reference to new additions, deletions, and sections that reflect current clinical, histological, and molecular advances.

[Pathology and histopathological evaluation of penile cancer]. / Pathologie und histopathologische Begutachtung des Peniskarzinoms.

BACKGROUND: Penile cancer is rare in Germany and in western European countries. Our understanding of the pathogenesis and pathology of this malignancy has increased considerably in recent years. OBJECTIVES: Clinical management has become more complex, with organ-preserving strategies being increasingly favored. Associated with these developments, the demands on the pathology reports of biopsies and surgical specimens from the penis have also increased. MATERIALS AND METHODS: According to guidelines and the relevant literature, this review outlines the most important aspects that must be considered in the classification and pathological reporting of penile cancer. RESULTS: Correct histological subtyping of penile cancer is important for prognostic and therapeutic considerations. There are also some peculiarities with the current TNM classification system of this tumor compared to other entities. CONCLUSION: Handling of specimens and histopathological typing must be performed by experienced pathologists according to recent developments in the pathogenesis, classification, and therapeutic strategies of penile cancer.

Carcinoma cuniculatum: not a verrucous carcinoma.

BACKGROUND: Carcinoma cuniculatum and verrucous carcinoma are both very well differentiated forms of squamous carcinoma and thus difficult to separate histologically from pseudocarcinomatous hyperplasia. The diagnosis of each often requires clinical-pathologic correlation. METHODS: We reviewed the literature on cases reported as carcinoma cuniculatum and compared these to the cases originally reported by Aird et al. In addition, we report an additional case of this entity that we encountered in our practice. RESULTS: In reviewing the literature it is evident that most authors consider carcinoma cuniculatum and verrucous carcinoma to be synonymous even though Aird's original two cases had no verrucous features. The lack of a clear conceptual distinction between these two entities may cause diagnostic confusion. CONCLUSION: The purpose of this report is to record a case of carcinoma cuniculatum which the authors believe to be similar to those reported by Aird et al., to emphasize the differences between carcinoma cuniculatum and verrucous carcinoma, and to explain how the lack of a clear conceptual distinction between these two tumors can lead to further delay in an already difficult diagnosis.

Stereology study of oral verrucous carcinoma.

PURPOSE: Squamous cell carcinoma (SCC) is the most prevalent malignant neoplasm of the oral cavity and oral verrucous carcinoma (OVC) is a verrucous variant of SCC. The purpose of this study was to examine the clinical classification of OVC and see for any difference in the biological behavior between OVC and CSS. METHODS: OVC and SCC were divided into 5 groups: the exogenic type of OVC (eOVC), cystoid type of OVC (cOVC) and infiltrative type of OVC (iOVC); well differentiated SCC (wdSCC), and medium/poorly differentiated SCC (m/pdSCC). A normal mucosa (NM) group was also created and studied. Stereology was used to measure and describe the morphological parameters of the nucleus to cytoplasm ratio (Vnp), desmosomes, mitochondria, etc. Analysed were also the nucleus volume density (Vv), Vnp, desmosomes and intracellular desmosomes number density (Nv), which were observed by stereology. RESULTS: We noticed some statistically significant differences in the morphological parameters among the 6 groups including the Vv (p<0.05), the Vnp (p<0.05), the number density of desmosomes (p<0.05), and the Nv (p<0.05). CONCLUSION: This study provides a theoretical basis for the clinical diagnosis and therapy of OVC.

The role of whole-body FDG-PET in preoperative assessment of tumor staging in oral cancers.

OBJECTIVE: The aim of this study is to clarify the clinical utility of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) in determining the TNM classification in patients with oral cancer. METHODS: Twenty-five consecutive patients (14 male and 11 female; age range, 40 yr to 86 yr) with oral cancer were included in this study. The diagnostic accuracy for detecting cervical lymph nodes was investigated by comparing the results of CT and/or MRI and physical findings. For the semi-quantitative analysis, the tumor standardized uptake value (SUV) and tumor to background SUV ratio (T/B ratio) were assessed in primary tumors and cervical lymph nodes. RESULTS: All primary lesions were visualized on FDG-PET images. Even though artifacts from dental materials near the lesion hampered the delineation of primary tumors on CT/MRI, the extent of primary tumors was accurately assessed by FDG-PET. The SUV and T/B ratio in the primary tumor classified in higher T grade (T3 and T4) was significantly higher than that in lower T grade (T1 and T2) (mean +/- SD of SUV; 8.32 +/- 2.99 vs. 5.15 +/- 3.77, p < 0.01, mean +/- SD of T/B ratio; 6.96 +/- 3.23 vs. 3.61 +/- 2.76, p < 0.01). The SUV and T/B ratio of metastatic lymph nodes were also significantly higher than those of normal lymph nodes (mean +/- SD of SUV; 3.39 +/- 1.69 vs. 1.55 +/- 0.57, p < 0.001, mean +/- SD of T/B ratio; 2.46 +/- 1.08 vs. 1.03 +/- 0.22, p < 0.001). Among these three methods, FDG-PET in conjunction with CT/MRI showed the highest accuracy of 92%, but there were no significant differences in diagnostic accuracy among the three methods. For the semi-quantitative analysis, a threshold SUV of 2.0 provided 100% sensitivity, 82% specificity, and 88% accuracy. Furthermore, a threshold T/B ratio of 1.5 provided 100% sensitivity, 100% specificity, and 100% accuracy. Regarding the detection of distant metastasis, there was one positive result in FDG-PET showing distant pulmonary metastasis. CONCLUSIONS: Whole-body FDG-PET is an effective and convenient diagnostic tool for the evaluation of tumor staging in patients with oral cancer. Tumor staging by whole-body FDG-PET may, in fact, supplement the conventional staging by means of CT/MRI and physical findings.

High-resolution DNA flow cytometry in oral verrucous carcinoma.

The classification of verrucous carcinoma as an entity unto itself or as a variant of well differentiated squamous cell carcinoma is controversial. To contribute new insights into the biological behavior of this rare tumor, we applied DNA flow cytometry to three node-negative verrucous carcinomas of the oral cavity. All tumors expressed a single aneuploid cell population. One of the patients experienced three courses with local recurrence. All secondary tumors retained the initially established aneuploid clone. The development of aneuploidy is thus a cytogenetic event common to both verrucous and squamous carcinoma of the oral cavity.

Squamous cell carcinoma of the penis.

Penile tumors, although not frequent, represent a difficult diagnostic and therapeutic challenge. Of the malignant penile neoplasms, the most frequent is penile carcinoma, which includes squamous cell carcinoma and its well-differentiated variant, verrucous carcinoma. Current concepts about classification, epidemiology, pathogenesis, histopathology, diagnosis, staging, prognosis, and treatment are presented.

Verrucous carcinoma of the skin and mucosa.

The concept of verrucous carcinoma as a clinicopathologic variant of squamous cell carcinoma is worthy of recognition. It is known by a confusing array of names, such as Ackerman's tumor, Buschke-Loewenstein tumor, florid oral papillomatosis, epithelioma cuniculatum, carcinoma cuniculatum, and cutis papillomatosis carcinoides of Gottron. Its apparent clinical benignity may lead to lengthy periods of misdiagnosis, during which it is likely not to spread to distant lymph nodes, but rather to destroy a nose, mandible, or penis as it slowly but relentlessly extends into underlying tissue. Morphologically warty or verrucous, its relatively bland histologic features are often more suggestive of a verruca vulgaris or pseudoepitheliomatous hyperplasia than of squamous cell carcinoma to those unfamiliar with the diagnosis. Alternatively, when it extends into underlying tissues, it may be mistaken histologically for a benign adnexal tumor or even an epidermoid cyst. Therapy may also be challenging because recurrences are common and concerns about potential anaplastic transformation after radiotherapy are often expressed.

[Verrucous carcinoma. Nosologic aspects, apropos of 4 cases]. / Le carcinome verruqueux. Situation nosologique, à propos de quatre cas.

INTRODUCTION: The nosology of verrucous carcinomas is a complicated problem. The name given to each manifestation may vary with localization. We report our findings in four cases with this skin disease. CASE REPORTS: Four patients, 76, 52, 76 and 55 years of age, presented with verrucous carcinoma. In the first case, the disease began with a chronic varicose ulceration localized on the anterolateral aspect of the right leg. In the second, the lesion was localized on the lateral aspect of the right leg facing a zone showing signs of repeated microtraumatisms. HPV-18 was isolated in this patient. The third case had a vegetating lesion on the dorsal aspect of the right hand, simulating a wart. The fourth case is a historic case in which a voluminous tumour developed over several years on an ulceration of the medial aspect of the left malleole, associated with trauma and venous insufficiency. COMMENTS: The three recent cases did not raise any particular problem with diagnosis. The diagnosis in the historical case, published in 1969 as a vegetating pyoderma, was corrected later. This illustrates the nosology problems raised in this particular form of epidermoid carcinoma which often has an impressive clinical presentation and a reassuring histology. The group of verrucous carcinomas include different skin or mucosal lesions formerly designated as oral florid papillomatosis, Buschke-Löwenstein acuminate condyloma or pseudo-epitheliomatous vegetating pyoderma. Cuniculatum epithelioma was added to this group for simplification although this rarely observed lesion is a separate entity. CONCLUSION: The pathology diagnosis of verrucous carcinoma requires large and deep biopsy. Treatment is surgical and regular follow-up is needed as for all malignant tumours.