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.