Vulva
Malignant neoplasms
Warty (condylomatous) carcinoma

Author: Priya Nagarajan, M.D., Ph.D. (see Authors page)
Editor: Sara Peters, M.D., Ph.D.

Revised: 10 October 2017, last major update January 2015

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Warty (condylomatous) carcinoma

Cite this page: Nagarajan, P. Warty (condylomatous) carcinoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/vulvawartycarcinoma.html. Accessed November 19th, 2017.
Definition / general
  • Human papillomavirus (HPV) associated carcinoma occurring in younger population (mean age: 55 years) compared to usual type squamous cell carcinoma (55 - 85 years)
  • In the future, with increasing understanding of vulvar neoplasia, vulvar carcinomas may be classified as human papillomavirus (HPV) associated or non-HPV associated, replacing the current nomenclature (Histopathology 2013;62:161)
Terminology
  • Synonym: condylomatous carcinoma
  • Often considered along with basaloid carcinoma of vulva due to common etiology
Epidemiology
  • More common in younger age group; may be more common in African American women
  • Patients may have synchronous or metachronous human papillomavirus (HPV) associated lesions, such as condyloma acuminatum or other genital tract squamous tumors
Sites
  • Most common site is labia majora
Etiopathogenesis
Clinical features
  • Enlarging warty mass
Diagnosis
  • Histologic examination of the entire lesion is essential to rule out invasion at the base
Prognostic factors
  • Prognosis in general is good and is between verrucous carcinoma and usual type squamous cell carcinoma
  • Early diagnosis and regular follow up for residual, recurrent or metachronous lesions is important
  • Presence of perineural invasion can predict local recurrence
  • Metastasis is common in patients with lymphovascular space invasion
Case reports
Treatment
  • Surgical resection is the most common mode of management
  • Partial or total vulvectomy or conservative wide excision with or without sentinel lymph node biopsy and inguinofemoral lymph node dissection
Clinical images

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Verrucous and pedunculated mass

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Giant condyloma

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After surgery

Gross description
  • Papillomatous tumor with warty surface, often pedunculated
Microscopic (histologic) description
  • In general, the superficial (exophytic) portion of the tumor resembles a condyloma while the deep (endophytic) portion is characterized by invasive and usually well differentiated squamous cell carcinoma
  • Exophytic portion has the following features:
    • Multiple true papillae with delicate fibrovascular cores, lined by keratinized stratified squamous epithelium
    • Mitotic figures are frequent and may be found in the suprabasal layers; atypical mitotic figures may be present
    • Cytologic atypia is seen in basal and suprabasal cells (more prominent), characterized by nuclear pleomorphism and hyperchromasia
    • Perinuclear cytoplasmic clearing with irregular nuclear contours (koilocytic changes) is prominent
  • At the deeper aspects of the tumor, there are irregular nests of squamous epithelium with dyskeratotic cells and keratin pearls
  • Adjacent vulvar intraepithelial neoplasia - grade III is frequently seen
Microscopic (histologic) images

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Hyperkeratosis, parakeratosis and acanthosis

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Giant condyloma



Images contributed by Dr. Priya Nagarajan:
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Low power, true papillae

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Exo-endophytic growth pattern


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Intermediate power, true papillae

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Deep aspects, typical SCC

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Multiple atypical mitoses, plasma cells in stroma

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HPV cytopathic effects and multiple mitoses

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HPV cytopathic effects


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Adjacent VIN III

Positive stains
Molecular / cytogenetics description
Differential diagnosis