A 62-year-old male smoker presents with hoarseness. Endoscopy shows a broad-based, warty, white exophytic mass over the left vocal cord with intact mobility. Biopsy shows papillary fronds of well-differentiated squamous epithelium with marked keratinisation, pushing rather than infiltrating margins, and no stromal invasion. Which statement about this tumour is correct?

• A Radiotherapy is the treatment of choice because the tumour is highly radiosensitive
• B Wide surgical excision is preferred, as radiotherapy may induce anaplastic transformation ✓
• C It metastasises early to level III nodes despite its benign histology
• D It is caused by Epstein-Barr virus and responds to antiviral therapy

Explanation

This is verrucous carcinoma (Ackerman tumour), a low-grade variant of squamous cell carcinoma that grows by pushing margins with minimal atypia and virtually never metastasises. Surgery is the mainstay. Irradiation is avoided because reported cases of anaplastic transformation after radiotherapy led to the belief that radiation is contraindicated. The absence of stromal invasion distinguishes it from conventional keratinising squamous cell carcinoma, which is the tempting distractor given the smoking history.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.