Penis and scrotum - Carcinoma Cuniculatum

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Penis and scrotum

Squamous cell carcinoma and variants

Carcinoma Cuniculatum

Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)

Revised: 16 May 2010, last major update April 2010

Definition

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● Rare, low-grade variant of verruciform penile carcinoma with deeply penetrating and burrowing pattern of growth

● More common in plantar surface of foot, first described in 1954 (Br J Surg 1954;42:245)

Terminology

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● Cuniculatum: from “cuniculus”, rabbit’s burrow (hole)

Epidemiology

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● Elderly men

● Mean age 77 years (range 73-83 years)

Sites

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● Glans and coronal sulcus frequently involved

● Multiple anatomical compartments usually affected

Etiology

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● No evidence of HPV infection

Clinical features

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● Slow growing

● Tumors may begin as small warts and slowly progress to larger tumors

● No reported cases with regional nodal metastasis or cancer-related death

Case reports

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● Series of seven cases (Am J Surg Pathol 2007;31:71)

Gross description (Macroscopy)

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● Verruciform pattern of growth

● Average size 6.3 cm (range 5-9 cm)

● Tumor invade deep erectile tissues with a burrowing pattern of growth on cut section

● Stroma-tumor interface sharply delimited

● Presence of cyst-like and sinus structures

● Fistulae to preputial or shaft skin are common

Micro description (Histopathology)

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● Low-grade keratinizing neoplastic nests resembling verrucous carcinoma

● Hyperkeratosis, papillomatosis and marked acanthosis

● Bulbous front of invasion

● Cyst-like and sinus lumina filled with hyperkeratotic material

● No/rare vascular and perineural invasion; no fibrovascular cores; no koilocytes

Micro images

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Contributed by Dr. Alcides Chaux and Dr. Antonio Cubilla:

Low-power view of a carcinoma cuniculatum showing well-differentiated neoplastic nests forming cyst-like sinuses and tracts; note the intense stromal reaction

High-power view of a cyst-like structure in a carcinoma cuniculatum showing well-differentiated neoplastia with progressive squamous maturation and extensive acantholysis

Foot:

Burrowing invasion of the dermis by bulbous broad columns of well differentiated squamous epithelium

Virtual slides

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83 year old man

Differential Diagnosis

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● Verrucous carcinoma: similar in the exophytic component, usually limited to lamina propria or superficial corpus spongiosum, absence of a burrowing pattern of growth

● Mixed (hybrid) usual-verrucous carcinoma: verrucous carcinoma with foci of usual squamous cell carcinoma typically located at tumor front, absence of a burrowing pattern of growth

● Warty carcinoma: condylomatous papillae with prominent fibrovascular cores, conspicuous koilocytosis, jagged tumor front

End of Penis and scrotum > Squamous cell carcinoma and variants > Carcinoma Cuniculatum

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