Penis and scrotum
Squamous cell carcinoma and variants
Reviewers: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 27 May 2010, last major update May 2010
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● Verruciform, slow growing, extremely well-differentiated variant of squamous cell carcinoma with low malignant potential
● ICD-O: 8051/3
● Also called Buschke-Löwenstein tumor
● Represents 3-8% of all penile carcinomas (Anal Quant Cytol Histol 2007;29:185) and 12-38% of all verruciform tumors
● Median age 57 years
● Glans is the preferred site but there is occasionally extension to other compartments
● Tends to be multicentric in foreskin
● 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
● Partial or total penectomy
● Possibly intra-arterial chemotherapy (Urology 2003;61:1216)
Gross description (Macroscopy)
● Broad-based white-to-gray exophytic neoplasm with a verruciform pattern of growth
● Invasion is usually limited to lamina propria or superficial corpus spongiosum
A large, destructive, cauliflower-like mass
has extensively replaced the penis.
Cut section shows a papillary lesion involving the glans with extension to coronal sulcus and foreskin. In the diagram (right) the tumor is represented in yellow and landmarks are indicated as follows: f-foreskin, cos-coronal sulcus, ca-carcinoma, gl-glans, cs-corpus spongiosum, cc-corpus cavernosum. Note the bulbous, pushing contour of the tumor base.
Micro description (Histopathology)
● 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, 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
Nests of well differentiated Pushing border
keratinized tumor cells
Fig A: Whole mount shows pronounced exophytic tumor. The lesion is well differentiated with hyperkeratosis, papillomatosis and acanthosis.
Fib B: The interface between the neoplasm and the lamina propria is sharp, and the bases of the squamous tongues are broad and blunt.
Fig C: The tumor cells have bland cytologic features.
Contributed by Dr. Alcides Chaux and Dr. Antonio Cubilla:
Mixed (hybrid) usual-verrucous carcinoma: Exophytic growth with marked acanthotic,
a verrucous carcinoma (upper right field) hyperkeratotic papillae. Fibrovascular
intermingled with a high-grade solid cores are inconspicuous, tumor base is
usual type squamous cell carcinoma broad and well-defined, and stromal
(lower left field) reaction is evident.
Acanthosis with marked hyperkeratosis and inconspicuous fibrovascular cores. Neoplastic cells are well-differentiated with minimal basal/parabasal atypia. Tumor front is broad-based and there is moderate chronic inflammation in underlying stroma.
● Low/negative p16INK4a and Ki-67 (Mod Pathol 2009;22:1160)
● 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, 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, usually deeper invasion
End of Penis and scrotum > Squamous cell carcinoma and variants > Verrucous carcinoma
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