Ackerman's Tumour - A Case Report

Abstract

Ackerman's tumour or Verrucous Carcinoma (VC) is a distinct form of Squamous Cell Carcinoma (SCC). It is predominantly seen in elderly men and strongly associated with the use of tobacco. In oral cavity it occurs predominantly in buccal mucosa followed by gingiva, palate and floor of the mouth. Clinically it manifests as proliferative finger like projections resembling a cauliflower which is characteristic of its diagnosis. Histologically, papillary or verruciform surface and parakeratin plugs between the surface projections are seen with an intense infiltrate of chronic inflammatory cells in the connective tissue thus it requires enormous expertize for diagnosis. Although VC is illustrated as a benign lesion with minimum aggressive potential over a period of time it can evolve into SCC. Hence most appropriate management of Ackerman's tumour is early diagnosis and surgical excision of the lesion. With this above background, we hereby report an enticing case of verrucous carcinoma in a left retromolar trigone extending into lower alveolar ridge in a 52-year-old male patient.

Keywords: Para keratin plugs; Proliferative papillary like projections; Squamous cell carcinoma; Verrucous carcinoma.

[Table/Fig-1]:

Frontal view of the patient.

[Table/Fig-2]:

Exophytic sessile growth with keratotic proliferative finger like projections over the left retromolar trigone

[Table/Fig-3]:

Orthopantomogram (preoperative)

[Table/Fig-4a-c]:

Axial section of CT showing irregular polypoidal submucosal thickening of left retromolar trigone, with No evidence of lyitc/destructive lesion in underlying bone and multiple level 1B lymph nodes on left side

[Table/Fig-5]:

OPG reveals segmental resection of posterior mandible irt (36,37)

[Table/Fig-6a]:

Intraoperative markings over the neck and submental area to plan incision

[Table/Fig-6b]:

Pedicled submental flap raised and prepared

[Table/Fig-6c]:

IReconstruction done using submental flap

[Table/Fig-7]:

Gross specimen

[Table/Fig-8a]:

Photomicrograph showing hyperplastic parakeratinised stratified squamous epithelium with papillary projections (thin arrow); keratin plugging with cleft formation and pushing margins into connective tissue (arrow head) (4X)

[Table/Fig-8b]:

Photomicrograph revealing higher magnification (10X) of marked area wherein wide and elongated rete ridges with keratin plugging (thick arrow) are evident

[Table/Fig-9a]:

Postoperative view (Lateral view)

[Table/Fig-9b]:

Postoperative intraoral view (after 6months)