Verrucous carcinoma

Author: Ashwyna Sunassee, M.D. (see Authors page)
Editor: Ryan Askeland, M.D.

Revised: 27 August 2015, last major update August 2015

Copyright: (c) 2003-2015, PathologyOutlines.com, Inc.

PubMed Search: Verrucous carcinoma [title] cervix
Definition / General
  • Rare; diagnosis of exclusion (Ann Diagn Pathol 2009;13:344)
  • Slow growing, locally aggressive
  • More common in vulva
  • Diagnosis is difficult with superficial biopsies
  • Invades locally (may extend into endometrial cavity), and up to 50% recur, but metastases are unlikely
  • HPV may be a possible etiology (Ann Diagn Pathol 2009;13:344, Anticancer Res 2007;27:4491)
  • Clinical Features
  • Vaginal bleeding
  • Exophytic tumorous mass
  • Radiology
  • Ultrasonography with color
  • Doppler:
    • Hyperechogenic mass with honeycomb appearance and hypervascularization of the tumor
  • MRI:
    • Homogenous intensity on T1 weighted images
    • Heterogenous intensity on T2 weighted images
  • After administration of contrast medium, tumor exhibits lower signal intensity than surrounding cervical stroma (J Reprod Med 2007;52:441)
  • Case Reports
  • 32 year old woman with cervical verrucous carcinoma involving endometrium (Eur J Gynaecol Oncol 1999;20:35)
  • 38 year old woman with pelvic abscess with fistula to the abdominal wall due to verrucous carcinoma (Gynecol Oncol 1999;74:115)
  • 65 year old woman with angiogenesis in metastatic verrucous carcinoma of the uterine cervix (Oncol Rep 2000;7:1079)
  • 86 year old woman with verrucous carcinoma of the cervix with uterine prolapse (Ann Diagn Pathol 2009;13:344)
  • 85 year old woman with serous adenocarcinoma of the fallopian tube, associated with verrucous carcinoma of the uterine cervix (World J Surg Oncol 2009;7:20)
  • Multicentric verrucous carcinoma of the female genital tract (Gynecol Oncol 2003;90:478)
  • Treatment
  • Usually surgical excision
  • Radiation may induce anaplastic transformation with subsequent regional and distal metastasis
  • Further surgical excision (even exenteration) is required for recurrent tumors (Zhonghua Yi Xue Za Zhi (Taipei) 2000;63:765)
  • Gross Description
  • Large, exophytic, warty lesion resembling condyloma
  • Cut surface shows sharply circumscribed deep margin
  • Micro Description
  • Thickened, acanthotic papillary squamous epithelium with mild dysplasia and diffuse parakeratosis
  • Fibrovascular cores limited to superficial part of tumor (in contrast to benign condyloma, where fibrovascular cores extend from a deep layer to the surface)
  • Well differentiated bulbous rete ridge pattern at the base of the lesion (helps to distinguish from a well differentiated squamous carcinoma, that forms keratin superficially but may be relatively anaplastic and infiltrating in deeper layers)
  • Blunt pattern of invasion, with minimal nuclear atypia at epithelial-stromal interface
  • May be exophytic and endophytic
  • May have intense inflammatory infiltrate
  • No / rare mitotic figures (Anticancer Res 2007;27:4491, Ann Diagn Pathol 2009;13:344)
  • Micro Images
    Missing Image Missing Image

    Various images

    Missing Image

    Squamous cells with central keratinization

    Missing Image

    Bland epithelium with at most mild atypia

    Missing Image

    Pushing margin

    Cytology Description
  • Atypical polygonal and spindle cells
  • Abundant and keratinizing cytoplasm with vacuoles
  • Atypical squamous cells with keratin pearls (Acta Cytol 2003;47:1050, Acta Cytol 1983;27:540)
  • Molecular / Cytogenetics Description
  • High risk HPV by PCR (Anticancer Res 2007;27:4491)
  • Differential Diagnosis
  • Condyloma accuminatum: more delicate architecture, distinct fibrovascular cores that extend from a deep layer to the surface
  • Squamous cell carcinoma with papillary growth pattern: usually has finger-like invasive tongues, marked nuclear atypia
  • Warty / condylomatous carcinoma: prominent cytoplasmic halos around tumor cells