Verrucous carcinoma of the face with a massive neutrophil infiltrate. Analysis of leucocyte chemotactic activity in the tumour extract

Abstract

An unusual case of verrucous carcinoma of the face with a massive infiltration of neutrophils was found in a 60‐year‐old Japanese man who presented with a scaly, crusty tumour studded with pustules of 3 years duration on the left check. Historical examination showed a proliferation of deceptively benign‐looking epidermal cells with an intact basement membrane, accompanied by a dermal infiltration of neutrophils and mononuclear cells and formation of microabscesses containing multinucleate giant cells, suggesting deep fungal infection or blastomycosis‐like pyoderma. The lesion, however, was unresponsive to antifungal or antibacterial treatments and ultimately attained a considerable size in the following months. Based on the findings of repeat biopsy conducted 4 months later indicating further deeper invasion, a diagnosis of verrucous carcinoma of the face was made, and a total excision of the tumour and left cervical lymph node dissection were finally carried out. It can be speculated that aberrant production of leucocyte chemotactic cytokines such as interlcukin‐8 by dysplastic keratinocytes, subsequent neutrophil infiltration/serum permeation, generation of leucotactic anaphylatoxin C5a from serum through complement activation and of lipid chemotactic factors (leukotriene B4 and 12‐hydroxy‐cicosatetraenoic acid) by infiltrating leucocytes and/or dysplastic keratinocytes provoked the characteristic accumulation of neutrophils in the verrucous carcinoma of this case. Copyright © 1994, Wiley Blackwell. All rights reserved