Penis & scrotum
Squamous cell carcinoma and variants
HPV associated squamous cell carcinoma
Warty carcinoma
Authors: Alcides Chaux, M.D., Antonio L. Cubilla, M.D.
Last author update: 1 January 2010
Last staff update: 17 April 2023
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Warty carcinoma penis full text[sb]
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Clinical features | Prognostic factors | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Molecular / cytogenetics description | Differential diagnosisCite this page: Chaux A, Cubilla AL. Warty carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumwartycarcinoma.html. Accessed May 30th, 2023.
Definition / general
- HPV related low grade verruciform tumor, identical to vulvar, cervical or anal counterparts (J Urol 2009;182:528)
Terminology
- Also called condylomatous carcinoma
Epidemiology
- 7 - 10% of penile carcinomas (Anal Quant Cytol Histol 2007;29:185), 34 - 36% of verruciform carcinomas
- Mean age 48 - 55 years
Sites
- Affected sites include glans, foreskin and coronal sulcus
- Usually affects multiple anatomical compartments
- Tends to multicentricity
Clinical features
- Slow growing
- Lymph node metastasis in 17 - 18% of cases; associated with deep invasion
- Intermediate behavior between low grade verrucous or papillary carcinomas and usual squamous cell carcinomas of penis
- May recur due to inadequate excision or multicentric disease not identified at time of surgery
- Low mortality rate (0 - 9%, Am J Surg Pathol 2001;25:673, Am J Surg Pathol 2000;24:505)
Prognostic factors
- Poor: invasion of corpora cavernosa; high grade areas; presence of vascular / perineural invasion
Treatment
- Partial or total penectomy; circumcision
- Groin dissection according to risk group stratification
Gross description
- Typical lesion is exophytic mass arising from glans; also coronal sulcus or foreskin
- Verruciform, white-tan, cauliflower-like and up to 5 cm
- May have cobblestone surface
- Endophytic cut surface
- May penetrate deep into corpus spongiosum or corpora cavernosa with broad or irregular contours
Gross images
AFIP images
Exophytic,
cauliflower-like
white to tan tissue
replaces the glans
Exophytic neoplasm
covering the entire
glans and extending
to the foreskin
Microscopic (histologic) description
- Low grade verruciform tumor with acanthosis, hyperkeratosis and parakeratosis
- Identical to warty carcinomas of vulva, uterine cervix or anus
- Arborescent papillary pattern with long, rounded or spiky papillae with prominent fibrovascular cores
- Conspicuous koilocytosis (increased nuclear size with hyperchromasia, wrinkling and bi or multinucleation, perinuclear halos and individual cell necrosis) throughout entire tumor (not just surface)
- May have intraepithelial abscesses
- Early: sharply delineated interface between tumor and stroma with no invasion (noninvasive warty carcinoma)
- Later: jagged boundary between tumor and stroma (invasive warty carcinoma)
Microscopic (histologic) images
Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Conspicuous
koilocytosis, nuclear
pleomorphism and
atypical parakeratosis
AFIP images
Undulating,
complex and
hyperkeratotic
papillae
High power view
of papillae
Images hosted on other servers:
Figure 1D: warty carcinoma
Positive stains
Molecular / cytogenetics description
- 22 - 100% are associated with HPV, usually HPV 16 (Am J Pathol 2001;159:1211)
Differential diagnosis
- Carcinoma cuniculatum:
- Deep tumoral invaginations forming irregular, narrow and elongated neoplastic sinus tracts connecting surface to deep anatomic structures
- Giant condyloma:
- Benign, HPV changes only in superficial layers, no pleomorphism and no invasion
- Papillary carcinoma:
- No HPV changes, irregular fibrovascular cores with complex papillae and invasive jagged border
- More likely to have inguinal metastases
- Verrucous carcinoma:
- No HPV changes
- Inconspicuous fibrovascular cores
- Broad based invasive front
- No regional or distant metastases
- Warty basaloid carcinoma:
- Warty carcinoma mixed with basaloid squamous cell carcinoma
- Basaloid cells present in bottom layers of papillae or in deeply infiltrative nests
- More aggressive than pure warty carcinoma
