American Urological Association - Verrucous Carcinoma

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Verrucous Carcinoma

Image A

Image B

  • Clinical: Rare, accounts ~4% of penile carcinoma.
  • Gross: Exophytic tumor with papillary or spiky surface affecting the glans and prepuce (image A).
  • Probably not HPV-related (negative for p16 overexpression).
  • Histology:
    • Well-differentiated squamous cell carcinoma with broad pushing borders rather than the finger-like infiltrative borders of a typical squamous cell carcinoma (image B).
    • Cytologic atypia is minimal and mitotic figures are rare.
  • DDX:
    • Condyloma acuminatum (giant condyloma of Buschke and Löwenstein) – has conspicuous koilocytes (HPV-related).
  • Behavior: Has excellent prognosis; locally invasive but almost never metastasize; may recur if inadequately excised.
  • Radiation should be avoided as it may cause the verrucous carcinoma to dedifferentiate into a highly aggressive spindle cell squamous carcinoma.

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