Ackerman's tumor (verrucous carcinoma) of the larynx. A clinicopathologic study of 77 cases

TLDR

Verrucous carcinoma of the larynx is a rare, locally invasive tumor that can appear clinically malignant yet histologically benign, requiring close collaboration between pathologists and clinicians for accurate diagnosis. The preferred treatment is surgical excision, as radiotherapy can induce anaplastic transformation and the tumor never metastasizes to cervical lymph nodes, making neck dissection unnecessary. In a series of 77 cases (median age 58), verrucous carcinoma presented as exophytic, papillary, locally invasive lesions composed of highly differentiated squamous cells with a thick keratinized layer and low‑grade malignancy.

Abstract

A series of 77 cases of verrucous carcinoma of the larynx is presented. The tumor is relatively rare and the present series has been selected from 2,398 primary and recurrent malignant neoplasms of the larynx and hypopharynx evaluated at the Department of Otolaryngology of Padua University during the period from January 1966 to December 1978. The median age of patients was 58 years. The tumor appears to be exophytic, broadly implanted and fungating in aspect, with papillary fronds and a locally invasive character. It is composed of highly differentiated epithelial squamous cells covered by a thick keratinized layer arranged in deeply invaginated folds. Cellular response in tumor stroma is marked, and the neoplasm has a low-grade malignancy. Close cooperation between the pathologist and the clinician is needed in order to establish the nature of the lesion, which looks clinically malignant but may appear histologically benign. Benign responses such as hyperkeratosis, acanthosis, or the presence of a benign papillomatous area necessitate further investigation with another biopsy examination from deeper layers. The elective treatment is surgery, as irradiation may cause anaplastic transformation with metastatic spread. Neck dissection is not indicated as this laryngeal tumor has so far never metastasized to cervical lymph nodes or to other organs.