Penis & scrotum
Squamous cell carcinoma and variants
HPV independent squamous cell carcinoma
Verrucous carcinoma
Authors: Alcides Chaux, M.D., Antonio L. Cubilla, M.D.
Last author update: 1 May 2010
Last staff update: 28 October 2020
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Verrucous carcinoma[TIAB] penis
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Clinical features | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Negative stains | Differential diagnosisCite this page: Chaux A, Cubilla AL. Verrucous carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumpenisverr.html. Accessed June 2nd, 2023.
Definition / general
- Verruciform, slow growing, extremely well differentiated variant of squamous cell carcinoma with low malignant potential
- ICD-O: 8051 / 3
Terminology
- Also called Buschke-Löwenstein tumor
Epidemiology
- Represents 3 - 8% of all penile carcinomas (Anal Quant Cytol Histol 2007;29:185) and 12 - 38% of all verruciform tumors
- Median age 57 years
Sites
- Glans is the preferred site but there is occasionally extension to other compartments
- Tends to be multicentric in foreskin
Etiology
- Consistently HPV- (Mod Pathol 1992;5:48) or only rarely HPV+ when applying strict diagnostic criteria (Am J Surg Pathol 2010;34:104)
Clinical features
- Many cases classified as verrucous carcinoma could be reclassified as other verruciform neoplasms
- Slow growing but may recur locally
- No inguinal nodal metastases and no death due to disease in pure verrucous carcinoma
Treatment
- Partial or total penectomy
- Possibly intra-arterial chemotherapy (Urology 2003;61:1216)
Gross description
- Broad based white to gray exophytic neoplasm with a verruciform pattern of growth
- Invasion is usually limited to lamina propria or superficial corpus spongiosum
Gross images
AFIP images
Large, destructive,
cauliflower-like
mass has extensively
replaced the penis
Papillary lesion involving the glans
Microscopic (histologic) description
- Very well differentiated with prominent intercellular bridges, minimal atypia and rare mitotic figures
- Penetrates through lamina propria with broad base and pushing borders
- Hyperkeratotic and acanthotic papillae with keratin cysts
- Orthokeratosis more prominent than parakeratosis
- Tumor cells are polygonal squamous cells with glassy cytoplasm, central vesicular nuclei and intercellular edema; may have superficial vacuolated clear cells but no koilocytosis
- Dense inflammatory infiltrate may obscure tumor stroma boundary
- Intraepithelial abscess and crust formation is common
- Frequently associated with squamous hyperplasia and differentiated penile intraepithelial neoplasia
- Central fibrovascular cores are uncommon
Microscopic (histologic) images
Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Mixed (hybrid) usual - verrucous carcinoma
Exophytic growth
Acanthosis
AFIP images
Pronounced exophytic tumor
Sharp interface
between
neoplasm and
lamina propria
Tumor cells have bland cytologic features
Negative stains
- Low / negative p16 INK4a and Ki67 (Mod Pathol 2009;22:1160)
Differential diagnosis
- Giant condyloma: conspicuous koilocytosis, prominent fibrovascular cores
- Hybrid verrucous carcinoma: foci of usual squamous cell carcinoma intermingled with a typical verrucous carcinoma
- Papillary carcinoma: invasive and jagged border, more atypia, irregular but usually evident fibrovascular cores
- Squamous hyperplasia: no atypia, no stromal reaction and no extension beyond lamina propria (in some cases distinction is not possible)
- Warty carcinoma: koilocytotic change present, jagged tumor front, neoplastic cells with more pleomorphism, prominent fibrovascular cores and usually deeper invasion
