Cervical verrucous carcinoma involving endometrium. Case report.

A case report of verrucous carcinoma of the cervix is presented. Verrucous carcinoma is a rare variant of squamous cell carcinoma with distinct clinical and histopathologic features, with a favorable prognosis. A 32-year-old woman had an abdominal hysterectomy with bilateral ovary transposition. Intravaginal brachytherapy using cesium 137 in a total dose of 60 Gy 0.5 cm from the vaginal layer was performed. Five year disease-free follow-up was observed. Macro- and microscopic examination of the tissue after hysterectomy was performed. The full thickness of the tumor is necessary for histopathological assessment. The cytology or superficial and simple biopsy may be misdiagnosed. The differentiating diagnosis among condyloma acuminata, verrucous carcinoma and invasive squamous cell carcinoma was analysed.     

Verrucous carcinoma of the endometrium: case history, pathologic findings, brief review of literature and discussion

BACKGROUND: Verrucous carcinoma is a rare condition. A defined disease of the oral cavity, larynx, esophagus, skin, vulva, vagina and cervix. But a verrucous carcinoma arising from the endometrium without evidence of cervical malignancy or endometrial adenocarcinoma is extremely rare. CASE: A 67-year-old G2P2 menopausal patient that was referred for consultation 1 year after presenting with vaginal bleeding to her gynecologist who subsequently underwent several endometrial biopsies where the pathological findings were repetitively similar: papillary squamous proliferation, cytologically bland with low mitotic activity but extensive proliferation. A hysterectomy with bilateral salpingo-oophorectomy was performed. The final histologic examination revealed a squamous cell carcinoma of endometrium, verrucous and well differentiated, and there was no cervical invasion identified. CONCLUSION: This is a rare form of endometrial cancer with apparent favorable prognosis that must be considered when squamous cells are identified on endometrial samplings.     

Verrucous carcinoma of the cervix--diagnostic and therapeutic difficulties with regards to HPV status. Case report

Verrucous carcinoma of the cervix is of special interest because of its rare occurrence and frequently existing difficulties in the differential diagnosis, which in verrucous disease eventually leads to a final, more favorable diagnosis. We present a case report of cervical verrucous carcinoma as a rare variant of squamous cell carcinoma in a 65-year-old woman who underwent total hysterectomy based on initial histological diagnosis of cervical dysplasia. Special attention is focused on clinical assessment of the lesion with the depicted restriction of exfoliated cytology as well as misdiagnoses of inappropriately taken, even colposcopically directed biopsy, not covering a full thickness of biopsied tissue. The macro- and micromorphologic similarities of cervical verrucous carcinoma with condylomata acuminata on one hand and invasive squamous cell carcinoma on the other, inclined us to search for a common factor causing human papillomavirus infection.     

Verrucous carcinoma of the female genital tract

Verrucous carcinoma is a variant of epidermoid carcinoma with distinctive clinical and pathologic features. It is a warty, fungating tumor that gradually increases in size and pushes into rather than invades contiguous structures. The diagnosis is often difficult. Originally, verrucous lesions in the mouth and pharnyx were described. Subsequently, similar lesions in the female genital tract have been encountered. To date, 22 verrucous carcinomas involving the cervix, vagina, or vulva have been reported in the literature. A survey of the members of The Society of Gynecologic Oncologists has added another 10 to the total number of cases. The clinical features, histologic findings, and therapy are discussed.     

Verrucous carcinoma of the vulva in Turner syndrome

BACKGROUND: Verrucous carcinoma of the vulva in a patient with Turner syndrome is extremely rare. CASE REPORT: A 7.5 x 4 cm exophytic tumor of the vulva with a palpable ipsilateral groin lymph node developed in a 41-year-old single nulligravid Japanese woman with short stature and a history of primary amenorrhea. Analysis of karyotype demonstrated mosaic Turner syndrome. She underwent total deep vulvectomy with en-block inguinal femoral lymphadenectomy. Histopathological finding of the extirpated specimen demonstrated verrucous carcinoma with clear margins and the absence of metastasis to the lymph nodes. There was no sign of HPV genome detected in the carcinoma tissue. CONCLUSION: This seems to be the first case of vulvar verrucous carcinoma in a patient with Turner syndrome.     

HPV-associated verrucous carcinoma of the perianal region--complete remission after surgical excision and postoperative monochemotherapy with methotrexat

Verrucous carcinoma of the perianal area continues still to be rare finding, which in histopathological aspect is a highly differentiated form of squamous cell carcinoma. Many literature data show that it is quite possible that HPV viruses play probably a key role in the etiology of verrucous carcinoma. We present a case of 48 year-old female patient with verrucous carcinoma localized in the perianal area, treated initially under the diagnosis of perianal skin tags, while surgical removal of the lesion was found rare form of HPV associated verrucous carcinoma. A preventive mono-chemotherapy with methotrexate by scheme was started for an initial period of 3 months. Six months later, the provided monitoring has not shown clinical or apparative data on tumor recurrence. The article discusses key points of the diagnostic algorithm in patients with HPV associated lesions with anogenital localization and provides valuable recommendations for correct clinical behavior in these risk groups.     

Carcinoma verrugoso de vagina. Presentación de un caso

Verrucous carcinoma of the vagina is a rare neoplasm. This entity is a slow-growing, locally invasive but generally nonmetastasizing neoplasm, with a characteristic gross and microscopic appearance.We report a case of verrucous carcinoma of the vagina in a postmenopausal woman diagnosed 4 years after transvaginal hysterectomy for grade 4 uterine prolapse. We also discuss the differential diagnosis and treatment.Verrucous carcinoma of the vagina is a rare neoplasm. The differential diagnosis includes typical squamous cell carcinoma, warty carcinoma, and condyloma acuminatum. Surgery remains the most effective treatment.     

Human papillomavirus--associated vulvar verrucous carcinoma in a 20-year-old with an intact hymen. A case report.

A 20-year-old woman with vulvar verrucous carcinoma, the youngest such patient reported to date, had human papillomavirus DNA 6/11 identified with an in situ hybridization technique. In addition to her youth, the patient was unusual in that she had an intact hymen. Although she denied having engaged in sexual activity, venereal transmission of the virus may have occurred without vaginal penetration.     

Verrucous carcinoma of the cervix: a report of two cases and literature review

Verrucous carcinoma of the cervix, like verrucous carcinoma of the vulva, is commonly misinterpreted as condyloma accuminata, resulting in a protracted delay of appropriate treatment. Since the correct diagnosis depends upon histological criterion which frequently belies the malignant nature of this lesion, conveyance to the pathologist of the history, physical findings, and clinical behavior of the lesion may facilitate early recognition. Aggressive surgical procedures including exenteration should be considered as primary treatment for large lesions and recurrent lesions when local excision fails. Radiotherapy is not usually an effective treatment for verrucous carcinoma and may induce malignant transformation. To date, 27 cases of verrucous carcinoma of the cervix have been reported. Two additional cases managed in recent years by the authors and a review of the world's literature about this uncommon lesion form the basis of this report.     

Combined ultrasound and magnetic resonance imaging findings on cervical verrucous carcinoma with endometrial invasion: a case report

BACKGROUND: Cervical verrucous carcinoma is a rare form of cervical cancer. Very few reports present the correlation between diagnostic images and clinicopathologic findings. CASE: A 50-year-old woman was treated with laser ablation for cervical condyloma 6 years prior to her presentation with progressive vaginal bleeding and a foul-smelling discharge at our clinics in August 2004. Biopsy of the cervical mass was compatible with pathologic features of condyloma acuminata. Ultrasonography with color Doppler revealed a 5.9x4.1-cm, hyperechogenic mass with a honeycomb appearance in the lower uterine corpus and hypervascularization of the tumor with resistance indexes ranging from 0.41 to 0.47. Magnetic resonance imaging (MRI) showed that the tumor had a homogeneous intensity on T1-weighted images and heterogeneous intensity on T2-weighted images. After administration of contrast medium, the tumor exhibited a lower signal intensity than did the surrounding cervical stroma. A human papillomavirus test was positive for types 11 and 53. Combined with the clinicopathologic findings, verrucous carcinoma of the cervix, stage Ib2, was suspected and the patient underwent radical hysterectomy and bilateral pelvic lymph node dissection. The final pathology report proved the impression of malignancy. The patient had an uneventful postoperative course, and no disease recurred during 1 year of follow-up. CONCLUSION: The diagnosis of cervical verrucous carcinoma requires a good clinical and pathologic correlation. Nevertheless, detailed imaging studies, such as ultrasound and MRI, as in our case, may provide valuable presurgical information for treatment.     

Verrucous carcinoma of the cervix

Summary Verrucous carcinoma of the cervix is a very rare variant of squamous cell carcinoma at this site. We report such a case in an 80-year-old woman because it presented difficulties with diagnosis and was successfully treated by vaginal hysterectomy.     

Simultaneously occurring condylomata acuminata, carcinoma in situ and verrucous carcinoma of the vulva and carcinoma in situ of the cervix in a young woman. A case report

A case of simultaneously occurring condylomata acuminata, carcinoma in situ and verrucous carcinoma of the vulva and carcinoma in situ of the cervix was seen in a 26-year-old woman. In situ DNA hybridization on sections of the condyloma acuminata and verrucous carcinoma yielded DNA sequences for human papillomavirus 6.     

Advanced squamous cell carcinoma of the vulva after treatment for verrucous carcinoma. A case report.

Verrucous carcinoma of the vulva, a rare variant of squamous cell carcinoma, is a locally destructive, nonmetastasizing tumor. While controversy surrounds the choice of treatment for this lesion, which frequently recurs, it is generally accepted that a recurrence is almost always local, with histologic characteristics and biologic behavior the same as those of the primary tumor. A case of squamous cell carcinoma of the vulva with involvement of the regional lymph nodes after treatment of verrucous carcinoma is reported to increase awareness of the potential biologic behavior of this uncommon tumor.     

Verrucous carcinoma of the female genital tract

Verrucous carcinoma is a variant of epidermoid carcinoma with distinctive clinical and pathologic features. It is a warty, fungating or cauliflower-like tumor that gradually increases in size and usually invades into contiguous structures with a pushing margin rather than by infiltration. To date, 41 verrucous carcinomas involving the cervix, vagina, or vulva have been reported. Three recently observed cases of this rare and distinct entity are presented. The slow-growing insidious nature of verrucous carcinoma along with the great tendency of local recurrence, marked freedom from metastases and lymph node involvement, and poor response to radiation are the chief characteristics of the clinical course of this disease. Both gynecologists and pathologists should be alert to the fact that precise initial diagnosis may be difficult because of the close gross and microscopic similarity to benign squamous papillomas and condyloma acuminata.     

Papillary squamous cell carcinoma of the uterine cervix: report of three cases and a review of its classification.

Papillary squamous cell carcinoma (SCC) of the uterine cervix has been defined as a malignant squamous cell lesion characterized by a papillary architecture with fibrovascular cores and moderate to severe dysplasia devoid of frank keratinization and koilocytic change. Papillary SCC should be histopathologically delineated from other rare variants of SCC with papillary features including verrucous and condylomatous carcinoma and the recently recognized (squamo-)transitional cell carcinoma of the uterine cervix. We report three cases of papillary SCC (FIGO stages IB, IV, and IVB) in postmenopausal women. Each tumor tested was positive for human papillomavirus (HPV) 16 and negative for HPV 6, 11 and 18 by general primer mediated polymerase chain reaction and subsequent enzyme-linked immunosorbent assay (PCR-ELISA). These findings 1) support the hypothesis that papillary SCCs (unlike verrucous carcinoma) are similar with regard to risk factors to (squamo-)transitional and condylomatous carcinoma; 2) suggest that HPV may play an etiologic role in at least some of these tumors; and 3) suggest that papillary SCC is the only subtype among squamous/(squamo-)transitional carcinomas that is associated with high-risk HPV infection in the absence of HPV-related histopathologic alterations.     

Specific serologic response to genital human papillomavirus types in patients with vulvar precancerous and cancerous lesions

OBJECTIVE: Antibodies to human papillomavirus are indicative for previous human papillomavirus exposure. Human papillomavirus antibody reactivities to vulvar precancerous lesions were reported poorly, and the role of human papillomavirus in some of these lesions is still unclear. STUDY DESIGN: In a direct enzyme-linked immunosorbent assay, serum samples from 126 healthy control subjects, 97 women with lichen sclerosus with or without squamous hyperplasia, 78 women with vulvar intraepithelial neoplasia, and 16 women with verrucous carcinoma were examined for immunoglobulin G and A antibodies to L1 virus-like particles of genital human papillomavirus types 6, 11, 16, 18, and 31, cutaneous human papillomavirus type 8, bovine papilloma virus, and cottontail rabbit papilloma virus. RESULTS: In lichen sclerosus/squamous hyperplasia with atypia immunoglobulin G and A, antibody positivity rates to high-risk human papillomavirus virus-like particle types 16, 18, and 31 were significantly higher than in the control group and the lichen sclerosus/squamous hyperplasia group without atypia. In patients with vulvar intraepithelial neoplasia I, increased immunoglobulin G antibody prevalences with both high-risk and low-risk human papillomavirus-virus-like particles were detected; whereas in patients with vulvar intraepithelial neoplasia II/III, this was observed only with the human papillomavirus types 16, 18, and 31. When only reactivities with 2 genital human papillomavirus types were compared, percentages of positives to only 1 of these 2 types ranged between 43% and 82%, with regard to all respective positives. CONCLUSION: Our data support the role of high-risk human papillomavirus types, mainly human papillomavirus-16, in the pathogenesis of different vulvar lesions with atypia. Serologically, there are no indications that lichen sclerosus/squamous hyperplasia without atypia is associated with human papillomavirus, but high-risk human papillomavirus in lichen sclerosus/squamous hyperplasia with atypia could play a role in carcinogenesis. High antibody specificity was clearly demonstrated among 5 genital, 1 cutaneous human, and 2 animal papillomavirus types.     

Metachronous carcinoma of the vulva and fallopian tube

BACKGROUND: Metachronous carcinoma of the vulva and fallopian tube is an unusual co-occurrence of gynecological malignancies. A report of such a case that developed and recurred over a 7-year period is presented. CASE: A 53-year-old G3P3 female presented with a verrucous carcinoma of the vulva and a serous papillary adenocarcinoma of the left fallopian tube metachronously. To investigate a possible association between the co-occurrence of the rare neoplasms and factors associated with multiple gynecological malignancies, we analyzed the status of human papillomavirus infection and DNA mismatch repair deficiency as indicated by microsatellite instability. All samples analyzed were negative for these factors. CONCLUSION: The present results support the possibility that metachronous carcinomas of the vulva and fallopian tube involve unknown etiological factors or arise independently.     

Two cases of coincident carcinomas of the head and neck and the uterine cervix

BACKGROUND: Human papillomavirus (HPV) is an independent risk factor for select head and neck carcinomas and most uterine cervix carcinomas. We report two patients with synchronous diagnoses of cervical cancer and HPV-related head and neck cancer. CASE: One patient was a 53-year-old woman with regionally metastatic tonsillar carcinoma treated surgically and with adjuvant radiation. Abnormal vaginal bleeding developed. Gynecologic examination showed advanced cervical carcinoma. The other patient was a 78-year-old woman surgically treated for carcinoma of the left anterior nose. Five months later, symptoms of recurrent nasal carcinoma and concurrent vaginal bleeding developed. Gynecologic examination showed advanced cervical carcinoma. CONCLUSIONS: These cases of coincident tumors demonstrate possible systemic susceptibility to the carcinogenic effects of HPV. The common association of HPV with both uterine cervix cancers and select head and neck cancers should prompt early evaluation of gynecologic or upper aerodigestive tract symptoms for patients with known HPV-related cancers.     

Ineffectiveness of bleomycin in verrucous carcinoma of the vulva.

A case of verrucous carcinoma of the vulva is reported and the literature concerning verrucous carcinoma of the vulva is reviewed. The difficulties about the therapy are discussed.     

Verrucous carcinoma of the uterine cervix

Three cases of verrucous carcinoma arising at the uterine cervix were presented with regard to their clinical courses, histological and ultrastructural findings, referring specially to the problems of diagnosis and treatment, and the relationship between viral infection and the disease. In order to obtain a correct diagnosis of verrucous carcinoma, not only repeated punch biopsies, but also wide resection of the tumor by incision biopsy are indispensable, aiming at an accordance between clinical and pathological diagnosis. In treating verrucous carcinoma, which is a slowly progressive nonmetastasizing tumor with strong local invasion, surgery should be the primary choice. Radiotherapy including postoperative irradiation is contraindicated for the reason that not only is verrucous carcinoma radioresistant, but also because anaplastic change following radiation often occurs. Even though in our survey using electronmicroscopy, no virus-like particles were observed, there still remains a strong possibility of the participation of some infections in verrucous carcinoma. This is because all of the primary lesions in our cases, like the other reports in the literature, were located at the posterior lip of the portio .