International Journal of Scientific and Research Publications, Volume 4, Issue 11, November 2014 1 ISSN 2250-3153 www.ijsrp.org Ackerman’s Tumour of Mouth: Review with Case Reports Nagalaxmi V, Swetha Reddy A, Srikanth K, Faisal Zardi, Anshul Singh Department of Oral medicine and Radiology, Sri Sai College of Dental Surgery, Vikarabad Abstract- Verrucous carcinoma is the uncommon variant of squamous cell carcinoma characterized by exophytic overgrowth. It constitutes 1-10% of cases of squamous cell carcinoma. It is locally invasive with low metastatic potential. It usually occurs in 6 th – 7 th decade of life. Larynx and oral cavity are the common sites of involvement in head and neck region, with buccal mucosa frequently involved in oral cavity. Tobacco is considered as chief etiological agent in this disease entity. Many treatment modalities are currently available, surgery being the most preferred treatment modality. In this article, we report case series of verrucous carcinoma seen in older female patients who gives history of chronic usage of tobacco along with review of literature. Index Terms- CARCINOMA, PAPILLARY, PROJECTIONS, TOBACCO, VERRUCOUS I. INTRODUCTION errucous carcinoma(VC)was first described by Ackerman in 1948 as a distinct clinicopathological entity. 1 It is defined as “ A warty variant of squamous cell carcinoma characterized predominantly by exophtic growth of well differentiated keratinising epithelium having minimal atypia and with locally destructive pushing margins at its interface with underlying connective tissue”. 2 It is also called as Ackerman’s tumor, snuff dipper’s tumor, buscke Lowenstein tumor, florid oral papillomatosis, epitheliomacuniculatum or carcinoma cuniculatum. 3 It is seen at several extraoral sites such as skin, from the breast , axilla, earcanal, soles of feet, vaginal and rectal mucosa. 4 The mucosal membrane of head and neck are sites of predilection, with oral cavity and larynx being at risk. 5 Male predilection is seen and usually occurs in 6 th - 7 th decade of life. Tobacco is considered as one of the major risk factor for verrucous carcinoma of oral cavity. 7 II. CASE REPORT 1: A 70 year female patient reported to the department of Oral Medicine and Radiology, SSCDS, Vikarabad with a chief complaint of pain in the upper right back tooth region since 2 months. The patient had paanchewing habit for 20 years. She used to have 2-3 paancontaining betel nut, zarda and slaked lime per day and placed the quid in the right buccal mucosa. On inspection, a proliferative exophytic growth was seen in maxillary right posterior alveolus and posterior hard palate, of approximately size 3×4 cms. It extendedanteroposteriorly from distal surface of 1 st molar to maxillary tuberosity area and mediolaterally from 1.5 cms away from the midpalatine raphe towards the alveolus. Colour was white interspersed with red areas. Surface is rough and pebbly. On palpation, the growth was firm in consistency with rough surface and nontender. Borders were raised, no bleeding / discharge was seen. . Lymphnodes were not palapable. Incisional biopsy was performed. Verrucous carcinoma was confirmed histopathologically and patient was sent for surgical excision and was kept under regular follow up. Figure 1: Verrucous carcinoma of right alveolus and right posterior palate III. CASE REPORT 2 A 60 year female patient reported to the department of Oral Medicine and Radiology, SSCDS, Vikarabad with a chief complaint of growth in the left side of cheek since two months. The patient had paan chewing habit from the past 30 years. She used 2-3 pan per day containingzarda, slaked lime and betel nut. On inspection, a diffuse exophyticgrowth was seen in the left buccal mucosa of approximately 2×2 cms in size at the level of occlusion extending anteroposteriorly 2cms beyond the corner of the mouth to 2cmd behind and superoinferiorly 1cm above and below the level of occlusion. Surface appeard to be rough withcolor same as that of adjacent mucosa interspersed with keratotic areas. On palpation, the surfacewas rough and raised, borders were well demarcated with induration present in the anterior border, mobile over the underlying structures A white plaque was seen in the posterior buccal mucosa on left side approximately of size 3×3 cms. Surface appeard to be V