General
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• Rare; diagnosis of exclusion
• 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
• One paper claims that HPV+ cases are better classified as SIL, giant condyloma or invasive squamous cell carcinoma (Can J Surg 1993;36:147)

Case reports
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• Patient with tumors in cervix and vagina (Gynecol Oncol 2003;90:478)
• Patient with with pelvic abscess and abdominal wall fistula (Gynecol Oncol 1999;74:115)
• 32 year old woman with endometrial involvement, hysterectomy and brachytherapy (Eur J Gynaecol Oncol 1999;20:35)
• 65 year old woman with multiple small recurrent tumors 13 years later in retroperitoneal space (Oncol Rep 2000;7:1079)

Treatment
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• Usually hysterectomy
• Radiation may induce anaplastic transformation

Gross description
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• Large, warty lesion resembling condyloma
• Cut surface shows sharply circumscribed deep margin

Micro description
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• Well differentiated squamous cell carcinoma with a polypoid growth pattern (but no fibrovascular cores) expanding the underlying stroma instead of involving crypts
• 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
• No koilocytosis

Micro images
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Various images

Squamous cells with central keratinization but no fibrovascular cores

Bland epithelium with at most mild atypia

Pushing margin

 

Penis

Cytology description
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• See Cervix - cytology

Differential diagnosis
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• Condyloma acuminatum: more delicate architecture, distinct fibrovascular cores
• Squamous cell carcinoma with papillary growth pattern: usually has finger-like invasive tongues, marked nuclear atypia
• Warty / condylomatous carcinoma: prominent cytoplasmic halos around tumor cells

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