Verrucous Carcinoma
Elsa F. Velazquez, MD
Antonio L. Cubilla, MD
Key Facts
Clinical Issues
Unicentric tumors are more frequent
Multicentric tumors may occur
Some cases may be associated with longstanding lichen sclerosus
Macroscopic Features
Exophytic papillary tumor
Broad and pushing base
Usually confined to lamina propria
Rarely affects superficial corpus spongiosum
Microscopic Pathology
Acanthotic papillae
Slender fibrovascular cores
Prominent (orange) keratin craters between papillae
Lack of koilocytosis
Extremely well differentiated
Epithelium of papillae and keratin predominate over fibrovascular core
Pushing, club-shaped base
Higher grade areas &/or infiltrative borders are not features of pure VC and raise possibility of hybrid (mixed) VC
Top Differential Diagnoses
Condyloma acuminatum/giant condyloma
Warty (condylomatous) carcinoma
Papillary carcinoma, NOS
Mixed VC/SCC of usual type
Carcinoma cuniculatum
 Cut section of a partial penectomy specimen shows a verruciform tumor with sharp bulbous base confined to the lamina propria. |
 Graphic of a verrucous carcinoma (yellow) highlights the papillary, spiky surface and well-demarcated base. Note the VC  , corpus spongiosum  , foreskin  , albuginea  , corpus cavernosum  , and urethra  . |
TERMINOLOGY
Abbreviations
Verrucous carcinoma (VC)
Synonyms
Well-differentiated squamous cell carcinoma
Definitions
Extremely well-differentiated verruciform squamous cell carcinoma with bulbous deep borders and lack of koilocytosis
ETIOLOGY/PATHOGENESIS
Unknown Pathogenesis
Likely HPV-unrelated
Some cases are associated with lichen sclerosus
Tumor suppressor gene TP53 and its functional protein product p53 are believed to be involved in HPV-unrelated pathway of carcinogenesis
CLINICAL ISSUES
Epidemiology
Incidence
Rare; approximately 4% of all penile carcinoma
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