Vulva, vagina & female urethra
Squamous carcinoma and precursor lesions
Warty carcinoma

Topic Completed: 1 January 2015

Minor changes: 25 August 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Warty (condylomatous) carcinoma

Priya Nagarajan, M.D., Ph.D.
Sara B. Peters, M.D., Ph.D.
Page views in 2019: 2,002
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Cite this page: Nagarajan P, Peters SB. Warty carcinoma. website. Accessed October 20th, 2020.
Definition / general
  • Human papillomavirus (HPV) associated carcinoma occurring in younger population (mean age: 55 years) compared to usual type squamous cell carcinoma (55 - 85 years)
  • In the future, with increasing understanding of vulvar neoplasia, vulvar carcinomas may be classified as human papillomavirus (HPV) associated or non-HPV associated, replacing the current nomenclature (Histopathology 2013;62:161)
  • Synonym: condylomatous carcinoma
  • Often considered along with basaloid carcinoma of vulva due to common etiology
  • More common in younger age group; may be more common in African American women
  • Patients may have synchronous or metachronous human papillomavirus (HPV) associated lesions, such as condyloma acuminatum or other genital tract squamous tumors
  • Most common site is labia majora
Clinical features
  • Enlarging warty mass
  • Histologic examination of the entire lesion is essential to rule out invasion at the base
Prognostic factors
  • Prognosis in general is good and is between verrucous carcinoma and usual type squamous cell carcinoma
  • Early diagnosis and regular follow up for residual, recurrent or metachronous lesions is important
  • Presence of perineural invasion can predict local recurrence
  • Metastasis is common in patients with lymphovascular space invasion
Case reports
  • Surgical resection is the most common mode of management
  • Partial or total vulvectomy or conservative wide excision with or without sentinel lymph node biopsy and inguinofemoral lymph node dissection
Clinical images

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Verrucous and pedunculated mass

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Giant condyloma

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After surgery

Gross description
  • Papillomatous tumor with warty surface, often pedunculated
Microscopic (histologic) description
  • In general, the superficial (exophytic) portion of the tumor resembles a condyloma while the deep (endophytic) portion is characterized by invasive and usually well differentiated squamous cell carcinoma
  • Exophytic portion has the following features:
    • Multiple true papillae with delicate fibrovascular cores, lined by keratinized stratified squamous epithelium
    • Mitotic figures are frequent and may be found in the suprabasal layers; atypical mitotic figures may be present
    • Cytologic atypia is seen in basal and suprabasal cells (more prominent), characterized by nuclear pleomorphism and hyperchromasia
    • Perinuclear cytoplasmic clearing with irregular nuclear contours (koilocytic changes) is prominent
  • At the deeper aspects of the tumor, there are irregular nests of squamous epithelium with dyskeratotic cells and keratin pearls
  • Adjacent vulvar intraepithelial neoplasia - grade III is frequently seen
Microscopic (histologic) images

Contributed by Priya Nagarajan, M.D., Ph.D.

Low power, true papillae

Exo-endophytic growth pattern

Intermediate power, true papillae

Deep aspects, typical SCC

Multiple atypical mitoses, plasma cells in stroma

HPV cytopathic effects and multiple mitoses

HPV cytopathic effects

Adjacent VIN III

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Hyperkeratosis, parakeratosis and acanthosis

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Giant condyloma

Positive stains
Molecular / cytogenetics description
Differential diagnosis
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