Penis & scrotum
Squamous cell carcinoma and variants
Verrucous carcinoma


Topic Completed: 1 May 2010

Minor changes: 28 October 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Verrucous carcinoma[TIAB] penis

Alcides Chaux, M.D.
Antonio L. Cubilla, M.D.
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Cite this page: Chaux A, Cubilla AL. Verrucous carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumpenisverr.html. Accessed November 25th, 2020.
Definition / general
  • Verruciform, slow growing, extremely well differentiated variant of squamous cell carcinoma with low malignant potential
  • ICD-O: 8051 / 3
Terminology
  • Also called Buschke-Löwenstein tumor
Epidemiology
Sites
  • Glans is the preferred site but there is occasionally extension to other compartments
  • Tends to be multicentric in foreskin
Etiology
Clinical features
  • Many cases classified as verrucous carcinoma could be reclassified as other verruciform neoplasms
  • Slow growing but may recur locally
  • No inguinal nodal metastases and no death due to disease in pure verrucous carcinoma
Treatment
Gross description
  • Broad based white to gray exophytic neoplasm with a verruciform pattern of growth
  • Invasion is usually limited to lamina propria or superficial corpus spongiosum
Gross images

AFIP images

Large, destructive,
cauliflower-like
mass has extensively
replaced the penis

Papillary lesion involving the glans

Microscopic (histologic) description
  • Very well differentiated with prominent intercellular bridges, minimal atypia and rare mitotic figures
  • Penetrates through lamina propria with broad base and pushing borders
  • Hyperkeratotic and acanthotic papillae with keratin cysts
  • Orthokeratosis more prominent than parakeratosis
  • Tumor cells are polygonal squamous cells with glassy cytoplasm, central vesicular nuclei and intercellular edema; may have superficial vacuolated clear cells but no koilocytosis
  • Dense inflammatory infiltrate may obscure tumor stroma boundary
  • Intraepithelial abscess and crust formation is common
  • Frequently associated with squamous hyperplasia and differentiated penile intraepithelial neoplasia
  • Central fibrovascular cores are uncommon
Microscopic (histologic) images

Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.

Mixed (hybrid) usual - verrucous carcinoma

Exophytic growth

Acanthosis



AFIP images

Pronounced exophytic tumor

Sharp interface
between
neoplasm and
lamina propria

Tumor cells have bland cytologic features

Negative stains
Differential diagnosis
  • Giant condyloma: conspicuous koilocytosis, prominent fibrovascular cores
  • Hybrid verrucous carcinoma: foci of usual squamous cell carcinoma intermingled with a typical verrucous carcinoma
  • Papillary carcinoma: invasive and jagged border, more atypia, irregular but usually evident fibrovascular cores
  • Squamous hyperplasia: no atypia, no stromal reaction and no extension beyond lamina propria (in some cases distinction is not possible)
  • Warty carcinoma: koilocytotic change present, jagged tumor front, neoplastic cells with more pleomorphism, prominent fibrovascular cores and usually deeper invasion
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