A 45-year-old male patient, presenting a verrucous lesion in the left vestibular region with onset 6 months ago and continuous growth. Due to the lesion, the patient reports the appearance of ipsilateral nasal obstruction associated with minor epistaxis. Denies comorbidities.
The removal of the entire lesion was performed, with a 0.5-cm margin under general anesthesia without intercurrences (Figure 1). The anatomopathological examination evidenced the diagnosis of Verrucous Carcinoma (free margins). The patient is in follow-up after one year of the procedure, without signs of local recurrence.
Figure 1. Verrucous lesion in the left vestibular region
Malignant lesions of the nasal cavity and paranasal sinuses are rare, accounting for 3% of the neoplasms of the head and neck, and 0.2% to 0.8% of neoplastic diseases in general [1-7]. The risk factors are poorly known, however there is an association with exposure to wood powder, nickel and chemical solvents [2,4,8]. Furthermore, the coexistence of inverted papilloma, previous radiotherapy and immunosuppression increase the risk of developing squamous cell carcinoma [8].
Squamous cell carcinoma is the type of tumor that arises more frequently at head and neck level and is currently a public health problem on a global scale, with high mortality and morbidity rates and an incidence of approximately 600,000 cases per year, with a survival rate of 50% to 5 years, being classified as the sixth most common type of cancer worldwide [9].
Verrucous carcinoma, also known as Ackerman's tumor, was first described by Ackerman in 1948 as a well differentiated clinical and histological variant of squamous cell carcinoma, which is distinguished by its proliferative growth, locally invasive, nevertheless with low metastatic potential [10]. It has a good prognosis, rarely determining regional metastases, and does not cause distant metastases [11-13]. Its three most common forms are represented by: anogenital verrucous carcinoma, plantar verrucous carcinoma and verrucous carcinoma of the oral cavity [14].
The etiology of verrucous carcinoma is primarily associated with HPV (subtypes 2, 6, 11, 16, 18 and 34), and also with smoking, the latter having a greater relation with oral cavity neoplasia. It is essential to relate this type of carcinoma in the differential diagnosis of common wart that does not respond to the usual treatment [14].
According to the literature, early stage tumors cause discrete symptoms that simulate chronic rhinosinusitis [2,4,13]. With the evolution of the disease, the symptoms become related to the site of origin of the lesion and the adjacent tumor extension, since, due to indolent growth, the tumor can reach deep tissues late [14].
The reported case aimed to contribute to the literature on malignant tumors located in the nasal cavity, especially on verrucous carcinoma and its rare location in this anatomical site.
- Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T (2001) Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 92: 3012-3029. [Crossref]
- Weber AL, Stanton AC (1984) Malignant tumors of the paranasal sinuses: radiologic, clinical, and histopathologic evaluation of 200 cases. Head Neck Surg 6: 761-776. [Crossref]
- Ahluwalia H, Gupta SC, Gupta SC (1996) Spindle-cell carcinoma of the nasal septum. Pathology in focus. J Laryngol Otol 110: 284-287. [Crossref]
- Bush SE, Bagshaw MA (1982) Carcinoma of the paranasal sinuses. Cancer 50: 154-158.
- Hermans R, De Vuysere S, Marchal G (1999) Squamous cell carcinoma of the sinonasal cavities. Semin Ultrasound CT MR 20: 150-161. [Crossref]
- Katz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, et al. (2002) Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck 24: 821-829. [Crossref]
- Pothula VB, Jones HS (1998) Verrucous squamous carcinoma of the nasal septum. J Laryngol Otol 112: 172-173. [Crossref]
- Som PM, Brandwein M (2003) Sinonasal cavities: tumors and tumor-like conditions. Head and neck imaging 2003: 261-373.
- Hosseinpour S, Mashhadiabbas F, Ahsaie MG (2016) Diagnostic biomarkers in oral verrucous carcinoma: A systematic review. Pathology & Oncology Research 23: 19-32. [Crossref]
- Ogawa A, Fukuta Y, Nakajima T, Kanno SM, Obara A, et al. (2004) Treatment results of oral verrucous carcinoma and its biological behavior. Oral Oncology 40: 793-797. [Crossref]
- Spiro RH (1998) Verrucous carcinoma, them and now. Am J Surg 176: 393-396.
- Batsakis JG, Suarez P, El-Naggar AK (1999) Proliferative verrucous leukoplakia and its related lesions. Oral Oncology 35: 354-359.
- Bhattacharyya N (2002) Cancer of the nasal cavity: survival and factors influencing prognosis. Arch Otolaryngol Head Neck Surg 128: 1079-1083. [Crossref]
- Azulay RD, Azulay DR, Azulay-Abulafia L (2015) Azulay dermatology. 6. Ed. Rio de Janeiro: Guanabara Koogan. 2015.