Penis and scrotum
Squamous cell carcinoma and variants
Warty carcinoma

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 5 April 2018, last major update January 2010

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PubMed Search: Warty carcinoma penis full text[sb]

Cite this page: Cubilla, A., Chaux, A. Warty carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumwartycarcinoma.html. Accessed August 17th, 2018.
Definition / general
Terminology
  • Also called condylomatous carcinoma
Epidemiology
Sites
  • Affected sites include glans, foreskin and coronal sulcus
  • Usually affects multiple anatomical compartments
  • Tends to multicentricity
Clinical features
  • Slow growing
  • Lymph node metastasis in 17 - 18% of cases; associated with deep invasion
  • Intermediate behavior between low grade verrucous or papillary carcinomas and usual squamous cell carcinomas of penis
  • May recur due to inadequate excision or multicentric disease not identified at time of surgery
  • Low mortality rate (0 - 9%, Am J Surg Pathol 2001;25:673, Am J Surg Pathol 2000;24:505)
Prognostic factors
  • Poor: invasion of corpora cavernosa; high grade areas; presence of vascular / perineural invasion
Treatment
  • Partial or total penectomy; circumcision
  • Groin dissection according to risk group stratification
Gross description
  • Typical lesion is exophytic mass arising from glans; also coronal sulcus or foreskin
  • Verruciform, white-tan, cauliflower-like and up to 5 cm
  • May have cobblestone surface
  • Endophytic cut surface
  • May penetrate deep into corpus spongiosum or corpora cavernosa with broad or irregular contours
Gross images

Images hosted on PathOut server:

Exophytic,
cauliflower-like
white to tan tissue
replaces the glans

Exophytic neoplasm
covering the entire
glans and extending
to the foreskin

Microscopic (histologic) description
  • Low grade verruciform tumor with acanthosis, hyperkeratosis and parakeratosis
  • Identical to warty carcinomas of vulva, uterine cervix or anus
  • Arborescent papillary pattern with long, rounded or spiky papillae with prominent fibrovascular cores
  • Conspicuous koilocytosis (increased nuclear size with hyperchromasia, wrinkling and bi or multinucleation, perinuclear halos and individual cell necrosis) throughout entire tumor (not just surface)
  • May have intraepithelial abscesses
  • Early: sharply delineated interface between tumor and stroma with no invasion (noninvasive warty carcinoma)
  • Later: jagged boundary between tumor and stroma (invasive warty carcinoma)
Microscopic (histologic) images

Images hosted on PathOut server:

AFIP images:

Undulating, complex
and hyperkeratotic
papillae with
infiltration at the base

High power view of papillae
with hyperkeratosis,
parakeratosis and
koilocytotic atypia


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

Conspicuous koilocytosis,
nuclear pleomorphism
and atypical parakeratosis



Images hosted on other servers:

Figure 1D

Positive stains
Molecular / cytogenetics description
Differential diagnosis
  • Carcinoma cuniculatum: deep tumoral invaginations forming irregular, narrow and elongated neoplastic sinus tracts connecting surface to deep anatomic structures
  • Giant condyloma: benign, HPV changes only in superficial layers, no pleomorphism and no invasion
  • Papillary carcinoma: no HPV changes, irregular fibrovascular cores with complex papillae and invasive jagged border; more likely to have inguinal metastases
  • Verrucous carcinoma: no HPV changes; inconspicuous fibrovascular cores; broad based invasive front; no regional or distant metastases
  • Warty basaloid carcinoma: warty carcinoma mixed with basaloid squamous cell carcinoma; basaloid cells present in bottom layers of papillae or in deeply infiltrative nests; more aggressive than pure warty carcinoma