Penis and scrotum - Verruciform carcinoma

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Penis and scrotum

Squamous cell carcinoma and variants

Verruciform carcinoma

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

Revised: 27 May 2010, last major update May 2010

See also specific entities: cuniculatum, giant condyloma, papillary, verrucous, warty carcinoma,

Definition

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● Penile exophytic tumors with verruciform gross appearance and low/intermediate grade papillomatous features

● Either condylomatous (giant condyloma, warty carcinoma) or non-condylomatous (verrucous carcinoma, papillary NOS carcinoma, carcinoma cuniculatum)

Etiology

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● Variable incidence of HPV infection

Clinical behavior

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● Low incidence of regional metastasis and better outcome than usual carcinoma

● Biopsies may be unable to determine histologic type (Int J Surg Pathol 2004;12:139)

Gross description (Macroscopy)

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● Usually large tumors with a cauliflower-like aspect

● May present a predominant exophytic or a mixed exophytic-endophytic pattern of growth

Micro description (Histopathology)

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● Papillae with mild to marked acanthosis

● Hyperkeratosis and parakeratosis

● May have prominent, irregular or inconspicuous fibrovascular cores

● Variable HPV-related cytopathic changes (koilocytosis)

● Tumor front may be broad-based or jagged

● Stromal reaction is usually evident

Micro images

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A: Verrucous carcinoma: regular papillae with broad bulbous bases and prominent hyperkeratosis (red). Keratinized cysts are present (seen on cross section at base).

B: Papillary carcinoma, not otherwise specified: papillae are more irregular than in A, many with fibrovascular cores. Infiltration is present at the base and koilocytosis is absent.

C: Giant condyloma: arborescent hyperkeratotic papillae with broad bases and koilocytosis (indicated by the white dots) at the surface.

D: Warty (condylomatous) carcinoma: papillae are more irregular than in C, koilocytosis is diffuse, and the interface between tumor and stroma is irregular.

End of Penis and scrotum > Squamous cell carcinoma and variants > Verruciform carcinoma

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