Uterine cervical and vaginal verrucous squamous cell carcinoma.

A case of verrucous squamous cell carcinoma involving the cervix and vagina simultaneously is described. The tumor was aggressive locally, recurring after radical hysterectomy and total vaginectomy. It recurred again after local radiation of minimal disease. Treatment of verrucous squamous cell carcinoma is discussed.     

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 uterine cervix: report of a case with follow-up of 6 1/2 years

A case of verrucous carcinoma of the uterine cervix was reported with a long-term follow-up and close observation. The patient was a 73-year-old, Japanese female, who had a suspicious Papanicolaou smear on routine examination. The cervix was replaced by a papillary mass, which was diagnosed as benign papilloma. The patient was followed every 6 months with cytology, colposcopy, and punch biopsy. No cytologic or microscopic diagnosis of invasive squamous cell carcinoma was made during the entire follow-up period. Total abdominal hysterectomy and partial vaginectomy were performed after 6 1/2 years' follow-up, and the tumor was finally diagnosed as verrucous carcinoma. The patient is alive and well 4 years after the operation.     

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 vulva. A clinicopathologic and immunohistochemical study of five cases

The clinicopathologic features of five cases of verrucous carcinoma of the vulva and their staining pattern with antikeratin monoclonal antibodies AE1 and AE3 were compared with those of conventional squamous cell carcinoma. Two patients had local recurrences but none died of the tumor. AE1 and AE3 antibodies stained the entire epithelial thickness in both verrucous and squamous cell carcinoma, but in the former the positivity was uniform and homogeneous everywhere, while in squamous cell carcinoma the positivity was extremely disorganized and patchy. The pattern of expression of monoclonal antibodies AE1 and AE3 confirms that verrucous carcinoma is an extremely well-differentiated squamous neoplasm in contrast to squamous cell carcinoma, which is heterogeneous from a viewpoint of differentiation.     

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.     

Malignant potential of gigantic condylomatous lesions of the vulva.

A diagnostic and therapeutic approach in the identification of malignant lesions and the types of HPV in 11 patients with gigantic condylomatous vulvar protuberances is presented. Different histological types of squamous cell vulvar carcinoma have been found in 8 (72.7%) cases: condylomatous (4), verrucous (3) and basaloid type of the carcinoma (1). HPV type 16, confirmed in 5 cases, was most often present (4 condylomatous and 1 basaloid carcinoma types). Other types of HPV such as HPV-6 was detected in 3 cases of verrucous, type 11 in 2 cases of verrucous and condylomatous carcinoma and type 18 in 1 case of condylomatous carcinoma. Radical vulvectomy followed by bilateral inguinofemoral lymphadenectomy was performed in 4 patients with condylomatous carcinoma, hemivulvectomy in basaloid carcinoma whereas wide local excision was performed in the verrucous type of carcinoma. No patient died except 1 with condylomatous carcinoma in whom 6 positive lymph nodes were detected after the primary operation. The patient died 4 years later following 3 excisions of local recurrences.     

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.     

Synchronous invasive squamous cell carcinoma and clear cell adenocarcinoma of the uterine cervix: a different human papillomavirus status

BACKGROUND: A multiple primary invasive carcinoma of the cervix is a rare condition and is seldom composed of squamous cell carcinoma and clear cell adenocarcinoma. CASE: A 47-year-old woman presented with contact bleeding. The anterior lip of the cervix revealed a 2.0-cm protruded mass. Preoperative pathological and imaging studies demonstrated the squamous cell carcinoma of the exocervix alone. Radical hysterectomy was performed on the diagnosis of stage 1B cervical cancer. Histological examination of the specimen manifested a coexisting invasive clear cell adenocarcinoma in the endocervix. Human papillomavirus (HPV) 18 was detected in the squamous cell carcinoma; however, no HPV was detected in the clear cell adenocarcinoma. CONCLUSION: This finding suggests that there was an obvious difference in association of HPV with the two neoplasms.     

Pigmented squamous cell carcinoma of the uterine cervix.

A 57-year-old female presented with an abnormal Pap smear. Colposcopic examination of the cervix revealed white mucosa with erosion and several areas of black pigmentation. After a colposcopically directed biopsy and loop conization, radical hysterectomy and bilateral salpingo-oophorectomy with pelvic and paraaortic lymphadenectomy were performed. Pathological examination disclosed an invasive squamous cell carcinoma admixed with many dendritic melanocytes. Melanin granules were present within the melanocytes and tumor cells. Although similar tumors have been reported in other sites, this is the first report to our knowledge of a pigmented squamous cell carcinoma of the uterine cervix.     

Hepatic resection for metastatic squamous cell carcinoma from the uterine cervix.

A solitary hepatic tumor was diagnosed 3.5 years after a 67-year-old woman had undergone radical hysterectomy and postoperative irradiation for stage Ib squamous cell carcinoma of the cervix. Hepatic resection confirmed squamous cell carcinoma that had metastasized from the uterine cervix. One year and 10 months following hepatic resection, this patient is doing well with no evidence of any recurrence. This is a report of successful hepatic resection for metastatic carcinoma from the uterine cervix.     

A case of triple primary gynecological malignancy

A 71-year-old woman was admitted due to postmenopausal vaginal bleeding. During a routine physical examination, a tumor in the left breast was discovered. A fractionated curettage was performed. Endometrial adenocarcinoma and squamous cell carcinoma of the cervix was found on histological examination. A total hysterectomy was performed. Subsequently, a breast biopsy was performed which revealed an infiltrating duct carcinoma of the breast and a mastectomy was performed. Triple gynecological cancer is discussed.     

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.     

A case report of multicentric verrucous carcinoma of the female genital tract

BACKGROUND: Verrucous carcinoma is a variant of squamous cell carcinoma with distinct features including slow locally invasive growth and verrucous appearance. Verrucous carcinoma of the vagina is considered an extremely rare lesion because only 17 cases have been reported in the literature. CASE: We report a case of vaginal verrucous carcinoma with a second focus in the cervix. The patient was treated with surgery and adjuvant interferon therapy for local recurrence. Human papillomavirus was detected in both vaginal and cervical tumor tissue by immunohistochemistry. CONCLUSION: Diagnosis of verrucous carcinoma may be difficult, particularly if biopsy specimen involves only the surface epithelium. The role of human papillomavirus as an etiologic agent in verrucous carcinoma is still a matter of discussion. Effective management requires surgical resection. The efficiencies of radiotherapy and interferon therapy are discussed.     

Pelvic abscess with fistula to the abdominal wall due to verrucous carcinoma.

The case report of a 38-year-old woman with a pelvic abscess resulting from verrucous carcinoma of the uterine cervix is presented. This case is remarkable because the abscess formed a fistula through the anterior abdominal wall and because there was no visible lesion on the cervix. The patient underwent a total abdominal hysterectomy, left salpingectomy, fistulectomy, and removal of the abscess. Diagnosis was made on pathologic examination of the extirpated specimen. Genital tract verrucous carcinoma and genitocutaneous fistulae are reviewed.     

The therapy of verrucous carcinoma of the vulva. Observations on three cases

Vulvar verrucous carcinoma is a distinct variant of squamous cell carcinoma, with a very low biological aggressiveness. Surgery is considered to be the elective treatment, even if there is no agreement in literature about the extent of surgical resection. Radiotherapy cannot be used in the management of this neoplasia. Sometimes this therapeutic modality induces an anaplastic transformation of the tumor, which can turn into a more aggressive malignancy. In this paper the clinical histories of 3 patients with vulvar verrucous carcinoma are discussed, in particular as regards therapy.     

Coexistence of verrucous and squamous carcinoma of the vulva

AIM: To evaluate the coexistence of verrucous and squamous carcinoma of the vulva and to assess the clinical course, survival and rate of recurrent disease of these patients. METHODS: The records of 17 patients who were diagnosed with verrucous carcinoma of the vulva over a 12-year period were studied retrospectively. Presence of genuine verrucous carcinoma or coexistence of verrucous and squamous carcinoma of the vulva on vulvar biopsies, results of histopathological assessment of final vulva and inguino-femoral node specimens and histological evaluation of recurrent disease specimens were the main outcome measures. RESULTS: Five of the 17 patients (29.5%) initially underwent radical vulvectomy and inguino-femoral lymphadenectomy. Histology of the specimens verified the coexistence of verrucous and squamous carcinomas in four of the five cases. Twelve women (70.5%) underwent simple vulvectomy for genuine verrucous carcinoma; in the final histology, 10 of these women (58.8%) were confirmed as having genuine verrucous carcinomas while two (11.7%) were found to have both verrucous and squamous carcinomas and were further managed by lymphadenectomy. None of our patients died of the disease. Three women (17.5%) presented with local relapse of the tumour, and were managed by wide local excision of the tumour. CONCLUSIONS: In the present study, 35% of patients with verrucous carcinomas of the vulva had coexistent squamous carcinoma. Separation of the cases of genuine verrucous carcinoma from coexistent verrucous and squamous tumours is based on the establishment of correct diagnosis by a large and deep vulvar biopsy as well as the meticulous assessment of the specimen by the pathologist. This will result in the decrease of the rate of over- and under-treatment of these patients.     

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.     

Invasive adenocarcinoma of mixed endocervical and clear cell type, associated with invasive squamous cell carcinoma of the cervix uteri. A case report

A case of invasive adenocarcinoma (predominantly of endocervical type but also with clear cell elements blended in part of the growth) associated with squamous cell carcinoma of the uterine cervix is reported in a young woman aged 18 years. Malignant squamous and atypical glandular cells were detected in Papanicolaou (Pap) smears, which raised the question of a mixed tumor. A diagnosis of cervical cancer was justified by means of a punch biopsy and the patient was treated by modified radical hysterectomy. Histologic and immunohistochemical examination of the hysterectomy specimen revealed two distinct types of an invasive malignant tumor, i.e., of glandular and squamous cell origin, closely related but not integrated. Interestingly, the glandular component comprised both endocervical and clear cell elements. Careful consideration of squamous or glandular atypia in cytological smears may lead to a more precise diagnosis, especially in young women.     

Primary squamous cell carcinoma of the endometrium. A report of 3 cases.

Primary squamous cell carcinoma of the endometrium (PSCCE) is a rare disease of unknown etiology. Diagnosis is based on the identification of squamous cell carcinoma in the endometrium with no coexisting analogous cervical component or endometrial adenocarcinoma. There must also be no connection between the endometrial tumour and the squamous epithelium of the cervix. Although the majority of patients are classified as stage I disease, prognosis is rather dismal. We report two new cases of primary squamous cell carcinoma of the endometrium which fulfill all the above criteria and we discuss another interesting case of squamous cell carcinoma of questionable endometrial origin. Management by abdominal hysterectomy and adjuvant pelvic irradiation resulted in long-term survival of our patients.