Warty (condylomatous) squamous cell carcinoma of the penis - A report of 11 cases and proposed classification of 'verruciform' penile tumors

Within the spectrum of penile squamous cell carcinomas, those that we descr iptively refer to collectively as the "verruciform" lesions are particularl y difficult to subclassify, In a review of 50 such tumors, we found 11 dist inctive neoplasms with condylomatous features conforming to the appearance of so-called "warty (condylomatous) carcinoma." The average patient age was 55 years and the average duration of disease was 19 months. The primary tu mor involved multiple anatomic sites (glans, coronal sulcus, and foreskin) in seven cases and a single site (glans or foreskin) in four cases. Grossly , white to gray cauliflower-like tumors typically measuring approximately 5 cm were noted. Histologically the tumors were mainly papillomatous with ac anthosis and hyperkeratosis. The papillae had prominent fibrovascular cores . The most conspicuous microscopic findings were striking nuclear atypia of koilocytotic type and clear cytoplasm. The interface between tumor and str oma was irregular in the majority of cases; deep invasion df corpus caverno sum was noted in five cases. The differential diagnosis included verrucous carcinoma, low-grade papillary squamous cell carcinoma, not otherwise speci fied, and giant condyloma acuminatum. Among other differences, the first tw o lesions show no koilocytotic changes and the last lacks malignant feature s and irregular stromal invasion. Metastatic spread occurred in two patient s; both are alive with evidence of recurrent disease 12 and 72 months after initial diagnosis. A third patient was alive with recurrent disease 12 mon ths after diagnosis. Five patients were free of disease 8, 12, 24, 52, and 108 months after diagnosis. Three patients were lost to follow up. Warty (c ondylomatous) carcinomas of the penis are morphologically distinctive verru ciform neoplasms with features of human papillomavirus-related lesions and should be distinguished from other verruciform tumors so that differences i n behavior, if any, between these tumors will become established.