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Penis and scrotum
Benign Tumors
Giant condyloma acuminatum
Editor: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (See Reviewers page)
Revised: 24 February 2010, last major update - February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Very rare, slow growing but locally destructive HPV-related verruciform tumor
Terminology
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● Also called Buschke-Löwenstein tumor
● Also called verrucous carcinoma by some authors, but most authors consider them to be separate entities
Epidemiology
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● Patients tend to be older than those with condyloma acuminatum
Sites
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● Usually involves foreskin and coronal sulcus, also glans, perianal region
Etiology
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● Low-risk genotypes (HPV-6 and 11) predominate
Clinical features
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● Associated with poor hygiene in uncircumcised men
● Intermediate properties between condyloma and warty carcinoma - tends to recur locally and destroy surrounding tissue
● Malignant transformation may occur after many years
Treatment
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● Radical surgical excision allows a complete histological examination and assessment of tumor-free resection margins (Dermatology 2009;218:56)
● Also chemoradiation, intralesional interferon, treatment for condyloma
Clinical images
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Fig 1: cauliflower-like Perianal tumor pre- and post Anogenital tumor
tumor intralesional interferon
Gross description (Macroscopy)
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● 5-10 cm cauliflower-like verruciform tumor with cobblestone surface
● Cut surface shows papillomatous growth with sharp demarcation from underlying stroma
● Cutaneous fistulae sometimes observed
Gross images
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AFIP fig 10-73: massive multinodular exophytic mass
involves the penis and extends to pubic skin
Micro description (Histopathology)
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● Resembles condyloma (papillae with prominent fibrovascular cores, koilocytosis, broad pushing base) but with more prominent bulbous expansion into underlying tissue
● Characteristically exhibits an endophytic pattern of growth and can invade deep anatomical tissues
● Atypia or malignant change (in situ or invasive squamous cell carcinoma) may also be present
Micro images
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Papillomatous tumor Features of condyloma
with occasional
koilocytes
Differential Diagnosis
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● Carcinoma cuniculatum: no koilocytosis, verrucous features, endophytic burrowing pattern of growth
● Papillary carcinoma: no koilocytosis, complex papillae with irregular fibrovascular cores, definite invasion
● Verrucous carcinoma: no koilocytosis, no prominent papillae with fibrovascular cores; pushing tumor base
● Warty carcinoma: probably related, has clearly malignant histology and jagged borders with stroma
Additional references
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End of Penis and scrotum > Benign tumors > Giant condyloma acuminatum
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