Variants Of Sq.c.c. Flashcards
Verrucous carcinoma represents ….%of sq.c.c
Epidemiology→ 1% to 10% of all oral SCC.
Etiology of verrucous
o Chewing tobacco or snuff (80%).
Oncogenic virus (HPV 16, 18) in 20% of cases.
Site of verrucous
(3.) Site:
At the site of chronic tobacco placement (mandibular
vestibule, the buccal mucosa and the palatal mucosa).
May be extraoral at skin & lip (not due to tobacco chewing).
Signs & symptoms of verrucous
:
shape:
Thick white folded plaque with deep cleft-like
spaces between the folds.
Exophytic warty papillary lesion.
White or erythematous or pink depending on:
The amount of keratin.
The degree of inflammatory response to the tumor.
Painless, slowly growing and erodes the adjacent soft tissues and bone relatively late in its
growth,
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Regional lymph nodes are enlarged & tender due to infection not due to local metastasis.
Ttt and prognosis of verrucous carcinoma
Mention effect of chronic and radio therapy safety margin and metastasis also neck dissection
Treatment:
o Surgical excision without radical neck dissection.
o Surgery needs not to be extensive as that required for routine SCC of similar size.
Ⓒ Radiotherapy may lead to anaplastic transformation of verrucous carcinoma as it may causes
dedifferentiation. o Chemotherapy may temporarily reduce the size of verrucous carcinoma but it is not considered a
definitive treatment.
Prognosis good as metastasis is extremely rare and very late (0.1%).
Etiology of spindle cell carcinoma
Etiology 1/3 of all mucosal cases develop as recurrences after radiotherapy for a more
differentiated SCC, a phenomenon known as dedifferentiation.
Clinical of spindle cell carcinoma
Clinical features:
- Age old age (mean age 57 years).
- Sex No sex predilection.
- Site:
o Mainly in the upper aerodigestive tract (larynx, esophagus).
o Intraorally, the lower lip, lateral posterior tongue, and alveolar ridges are common sites, but other areas may be involved.
- Signs & symptoms:
o Two forms:
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Pedunculated or sessile polypoid nodular or fungating mass (exophytic).
Ulcer shows the criteria of malignant ulcer (endophytic).
o Rapidly growing tumor & may invade bone and underlying tissues.
Pain & parathesia are prominent features especially in lower lip cases as they have a tendency to travel along nerves through the mental foramen and into the mandibular canal.
o The tumor show early metastasis and is typically diagnosed in a late stage (stages III &IV).
Most recently discovered variant of sq.c.c
Basaloid
Survival of basaloid sq c c
23m
Ttt of basaloid sq c c
Surg +radio and chemotherapy
Histology of basaloid Sq.c.c
-superfacial mod. Sq c c Deeper lobules of basaloid cells with hyperchromatic nucleus With Peripheral palisading Central necrosis
