Warty-basaloid carcinoma: clinicopathological features of a distinctive penile neoplasm. Report of 45 cases

Mod Pathol. 2010 Jun;23(6):896-904. doi: 10.1038/modpathol.2010.69. Epub 2010 Mar 19.

Abstract

Most penile cancers are squamous cell carcinomas, but there are several subtypes with different clinicopathologic, viral, and outcome features. We are presenting 45 cases of a distinctive morphological variant of penile squamous cell carcinoma composed of mixed features of warty and basaloid carcinomas. This tumor was earlier recognized in a recent viral study and showed a high association with human papillomavirus infection. However, clinicopathologic features are not well known. In this multi-institutional study, patients' mean age was 62 years. Most tumors (64%) invaded multiple anatomical compartments, including glans, coronal sulcus, and, especially, inner foreskin mucosa. Tumor size ranged from 2 to 12 cm (mean 5.5 cm). Three morphological patterns were recognized: (1) the most common, observed in two-thirds of the cases was that of a typical condylomatous tumor on surface and basaloid features in deep infiltrative nests; (2) in 15% of the cases, there were non-papillomatous invasive carcinoma nests with mixed basaloid and warty features; and (3) unusually, predominantly papillomatous. Invasion of penile erectile tissues was frequent, either corpus spongiosum or cavernosum (47% each). Tumors limited to lamina propria were rare. Most tumors were of high grade (89%). Vascular and perineural invasion were found in about one-half and one-quarter of cases, respectively. Associated penile intraepithelial neoplasia was identified in 19 cases and mostly showed basaloid, warty-basaloid, or warty features. Inguinal nodal metastases were found in 11/21 patients with groin dissections. Invasion of corpora cavernosa, high histological grade, and presence of vascular/perineural invasion were more prevalent in metastatic cases. In 21 patients followed, the cancer-specific mortality rate was 33% with a mean survival time of 2.8 years. Warty-basaloid carcinomas are morphologically distinctive human papillomavirus-related penile neoplasms that, such as basaloid carcinomas, are biologically more aggressive than typical warty carcinoma from which they should be distinguished.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Brazil
  • Carcinoma in Situ / mortality
  • Carcinoma in Situ / pathology*
  • Carcinoma in Situ / virology
  • Carcinoma, Basal Cell / mortality
  • Carcinoma, Basal Cell / pathology*
  • Carcinoma, Basal Cell / virology
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / virology
  • Cell Differentiation
  • Condylomata Acuminata / mortality
  • Condylomata Acuminata / pathology*
  • Condylomata Acuminata / virology
  • Humans
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Papillomaviridae / pathogenicity
  • Paraguay
  • Penile Neoplasms / mortality
  • Penile Neoplasms / pathology*
  • Penile Neoplasms / virology
  • Precancerous Conditions / mortality
  • Precancerous Conditions / pathology*
  • Precancerous Conditions / virology
  • Prognosis
  • Retrospective Studies
  • Texas
  • Time Factors