Anus & perianal area

Carcinoma

Verrucous carcinoma



Topic Completed: 31 March 2021

Minor changes: 21 April 2021

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PubMed Search: Verrucous carcinoma anus

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Verrucous carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/anusverrucous.html. Accessed November 27th, 2021.
Definition / general
  • Uncommon lower grade variant of squamous cell carcinoma
  • Considered intermediate between condyloma acuminatum and squamous cell carcinoma
Essential features
Terminology
  • Giant condyloma acuminatum / Buschke-Löwenstein tumor: sometimes postulated to represent the same entity or spectrum of disease (Histopathology 1985;9:1155)
  • Large condyloma acuminatum term has been proposed for tumors 2 - 10 cm, with giant referring to those > 10 cm (Mod Pathol 2008;21:112A)
Epidemiology
  • More common in men
Pathophysiology
Clinical features
  • Large anal tumor (often > 10 cm) that may be accompanied by abscess or fistula
  • Often will recur but does not metastasize; mortality is approximately 20% (Dis Colon Rectum 1994;37:950)
Case reports
Treatment
Gross description
  • Polypoid; resembles a condyloma but is larger
Microscopic (histologic) description
  • Very well differentiated squamous malignancy with minimal atypia and pushing borders
  • Locally destructive, without obvious invasive features, lymphovascular invasion, etc.
  • Can exhibit surface maturation and extensive keratinization
  • May transform into conventional squamous cell carcinoma; rate of such transformation may be dependent on tumor size
  • Similar to verrucous carcinoma at other sites
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
Verrucous carcinoma Verrucous carcinoma Verrucous carcinoma

Verrucous carcinoma

Sample pathology report
  • Anus, resection:
    • Verrucous carcinoma (see synoptic report and comment)
    • Comment: Verrucous carcinoma is effectively considered a subtype of well differentiated squamous cell carcinoma, with a good prognosis overall.
Differential diagnosis
Board review style question #1

Which of the following is true about verrucous carcinoma of the anus?

  1. HPV is always involved in its carcinogenesis
  2. It has a propensity to metastasize early
  3. It may transform to traditional squamous cell carcinoma
  4. Most cases are small (< 2 cm)
Board review style answer #1
C. It may transform to traditional squamous cell carcinoma

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Reference: Verrucous carcinoma
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