Penile Verrucous Carcinoma

Abstract

A 71-year-old man with a penile verrucous carcinoma presenting as a large cutaneous horn is described. Both verrucous carcinoma and penile cutaneous horn are relatively uncommon entities and have not been previously reported to occur concomitantly. A brief review of the relevant medical literature and methods of therapy is included.

Penile cancer

“…41 A marked inflammatory lymphohistiocytic infiltrate is usually present. 41,65 Tumor cells are not found in blood vessels or lymphatic vessels; this phenomenon presumably correlates with the lack of metastases in patients with this tumor. 41,66,177 A more regular architecture, with lack of irregular stromal penetration and presence of broad bulbous expansion at its base, would differentiate verrucous carcinoma from warty SCC.…”

“…64 Verrucous carcinoma accounts for 5% to 24% of all penile malignancies and represents 5% to 16% of all SCCs. 41,65,66 It has been reported in young adults as well as in the elderly, 41 but two-thirds of cases occur before the age of 50 years. It may be relatively frequent in uncircumcised homosexual men.…”

“…In rare cases, it may resemble a penile horn. 65 Verrucous carcinoma typically reaches a huge size. Due to its trend for continuous growth, 174,257 it has a marked tendency to infiltrate deeply the corpus cavernosum and the urethra and to cause local destruction of underlying tissues, with urethral fistulation and perforation of the prepuce.…”

“…258 Evolution toward SCC, with later metastases, has sometimes been observed and related to x-ray exposure 259 or infection by high-risk HPV types (16 and 18). 41,65,66,68,177,259 However, focally invasive SCC may also occur in nonirradiated HPV-negative tumors and cannot be excluded on the basis of absence of oncogenic HPV detection. 178 Therefore, histopathologic assessment deserves the utmost importance for correct evaluation and proper management of any genital warty lesions.…”

“…Intracytoplasmic glycogen is scant. 41,65 Tumor projections appear as blunt-shaped masses that extend downward, pushing into the dermis and deeper structures to form sinuses and keratin-filled cysts. Centripetal keratinization is often present, but there are no horn pearls.…”