Verrucous carcinoma

Cervix

Squamous cell carcinoma

Verrucous carcinoma

Authors: Ashwyna Sunassee, M.D., Ryan W. Askeland, M.D.

Topic Completed: 1 August 2015

Minor changes: 20 February 2020

Copyright: 2003-2020, PathologyOutlines.com, Inc.

PubMed Search: Verrucous carcinoma [title] cervix

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Table of Contents

Cite this page: Sunassee A. Verrucous carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixcytologyverrucousca.html. Accessed August 12th, 2020.

Definition / general

Rare; diagnosis of exclusion (Ann Diagn Pathol 2009;13:344)

Slow growing, locally aggressive

More common in vulva

Diagnosis is difficult with superficial biopsies

Invades locally (may extend into endometrial cavity), and up to 50% recur, but metastases are unlikely

HPV may be a possible etiology (Ann Diagn Pathol 2009;13:344, Anticancer Res 2007;27:4491)

Clinical features

Vaginal bleeding

Exophytic tumorous mass

Radiology description

Ultrasonography with color

Doppler:

Hyperechogenic mass with honeycomb appearance and hypervascularization of the tumor

MRI:

Homogenous intensity on T1 weighted images
Heterogenous intensity on T2 weighted images

After administration of contrast medium, tumor exhibits lower signal intensity than surrounding cervical stroma (J Reprod Med 2007;52:441)

Case reports

32 year old woman with cervical verrucous carcinoma involving endometrium (Eur J Gynaecol Oncol 1999;20:35)

38 year old woman with pelvic abscess with fistula to the abdominal wall due to verrucous carcinoma (Gynecol Oncol 1999;74:115)

65 year old woman with angiogenesis in metastatic verrucous carcinoma of the uterine cervix (Oncol Rep 2000;7:1079)

86 year old woman with verrucous carcinoma of the cervix with uterine prolapse (Ann Diagn Pathol 2009;13:344)

85 year old woman with serous adenocarcinoma of the fallopian tube, associated with verrucous carcinoma of the uterine cervix (World J Surg Oncol 2009;7:20)

Multicentric verrucous carcinoma of the female genital tract (Gynecol Oncol 2003;90:478)

Treatment

Usually surgical excision

Radiation may induce anaplastic transformation with subsequent regional and distal metastasis

Further surgical excision (even exenteration) is required for recurrent tumors (Zhonghua Yi Xue Za Zhi (Taipei) 2000;63:765)

Gross description

Large, exophytic, warty lesion resembling condyloma

Cut surface shows sharply circumscribed deep margin

Microscopic (histologic) description

Thickened, acanthotic papillary squamous epithelium with mild dysplasia and diffuse parakeratosis

Fibrovascular cores limited to superficial part of tumor (in contrast to benign condyloma, where fibrovascular cores extend from a deep layer to the surface)

Well differentiated bulbous rete ridge pattern at the base of the lesion (helps to distinguish from a well differentiated squamous carcinoma, that forms keratin superficially but may be relatively anaplastic and infiltrating in deeper layers)

Blunt pattern of invasion, with minimal nuclear atypia at epithelial-stromal interface

May be exophytic and endophytic

May have intense inflammatory infiltrate

No / rare mitotic figures (Anticancer Res 2007;27:4491, Ann Diagn Pathol 2009;13:344)

Microscopic (histologic) images