OSU Department of Pathology

Anatomical Pathology Interesting Case Conference

Microscopic Description:

Polygonal squamous cells with glassy cytoplasm, central vesicular nuclei and intercellular edema.

It shows a well-differentiated exophytic mass with marked hyperkeratosis pushing into the underlying stroma.

Minimal nuclear atypia and no mitotic figures were seen.

IHC- HPV negative*, CK 10 was positive.

Discussion:

Verrucous carcinoma of the penis (also known as a Buschke-Lowenstein tumor) is a rare, low-grade variant of squamous cell carcinoma. It typically presents as a slow-growing, cauliflower-like warty mass on the glans or foreskin, which is highly localized in men aged between 50-70.

Strong association with phimosis, poor penile hygiene, Uncircumcised men, HPV, condyloma acuminatum and lichen sclerosis.

Initially asymptomatic, as the tumor expands it may cause pain, bleeding, foul smell(due to necrosis and inflammation), keratin-filled sinus tracts. Metastasis to inguinal (groin) lymph nodes is rare.

Grossly, it is seen as broad-based white to gray exophytic neoplasm with a verruciform pattern of growth with invasion limited to lamina propria or superficial corpus spongiosum.

On Microscopy, Exophytic proliferative lesion made up of irregular hyperplastic squamous cells penetrating through lamina propria with broad base is seen. Also, marked epidermal hyperplasia, acanthosis, papillomatosis, focal telangiectasia and with dense inflammatory infiltrate in stroma with intraepithelial abscess and crust formation is seen. Central fibrovascular cores, nuclear atypia and mitotic figures are uncommon.

The primary and most effective treatment for well-differentiated tumor is local excision or a partial/total penectomy depending on the tumor's size and invasion.

Local recurrence is uncommon (usually less than 5%) if the tumor is completely excised; incomplete resection leads to a much higher recurrence rate.

References:

Li F, Xu Y, Wang H, Chen BO, Wang Z, Zhao Y, Zhu S, Chen G. Diagnosis and treatment of penile verrucous carcinoma. Oncol Lett. 2015 Apr;9(4):1687-1690. doi: 10.3892/ol.2015.2909.

Jo DI, Han SH, Kim SH, Kim HY, Chung H, Kim HS. Optimal treatment for penile verrucous carcinoma: a systematic literature review. BMC Urol. 2021 Jan 29;21(1):13. doi: 10.1186/s12894-020-00777-1.

Jo, D. I., Choi, S. K., Kim, S. H., Kim, C. K., Chung, H., & Kim, H. S. (2017). Local Excision for the Treatment of Penile Verrucous Carcinoma. Urology Case Reports, 13, 16–18.

Kanik, A. B., Lee, J., Wax, F., & Jag Bhawan. (1997). Penile verrucous carcinoma in a 37-year-old circumcised man. Journal of the American Academy of Dermatology, 37(2), 329–331.

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