VERRUCOUS CARCINOMA OF THE FACE WITH A MASSIVE NEUTROPHIL INFILTRATE - ANALYSIS OF LEUKOCYTE CHEMOTACTIC ACTIVITY IN THE TUMOR EXTRACT

An unusual case of verrucous carcinoma of the face with a massive infi ltration of neutrophils was found in a 60-year-old Japanese man who pr esented with a scaly, crusty tumour studded with pustules of 3 years d uration on the left cheek. Histological examination showed a prolifera tion of deceptively benign-looking epidermal cells with an intact base ment membrane, accompanied by a dermal infiltration of neutrophils and mononuclear cells and formation of microabscesses containing multinuc leate giant cells, suggesting deep fungal infection or blastomycosis-l ike pyoderma. The lesion, however, was unresponsive to antifungal or a ntibacterial treatments and ultimately attained a considerable size in the following months. Based on the findings of repeat biopsy conducte d 4 months later indicating further deeper invasion, a diagnosis of ve rrucous carcinoma of the face was made, and a total excision of the tu mour and left cervical lymph node dissection were finally carried out. It can be speculated that aberrant production of leucocyte chemotacti c cytokines such as interleukin-8 by dysplastic keratinocytes, subsequ ent neutrophil infiltration/serum permeation, generation of leucotacti c anaphylatoxin C5a from serum through complement activation and of li pid chemotactic factors (leukotriene Bq and 12-hydroxy-eicosatetraenoi c acid) by infiltrating leucocytes and/or dysplastic keratinocytes pro voked the characteristic accumulation of neutrophils in the verrucous carcinoma of this case.