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.     

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 .     

Squamous carcinoma of the uterine cervix with CIN 3-like growth pattern: An under-diagnosed lesion

Abstract. Al-Nafussi AI, Monaghan H. Squamous carcinoma of the uterine cervix with CIN 3-like growth pattern: An under-diagnosed lesion.
Invasive squamous carcinomas of the cervix have traditionally been classified into keratinizing, non-keratinizing, verrucous, warty (condylomatous), papillary transitional (squamo-transitional), and lymphoepithelioma-like carcinomas. The majority of these tumors are easily recognized. We present for the first time the pathological appearances of six cases of invasive squamous carcinoma with growth pattern simulating tangentially cut CIN 3 involving endocervical glandular crypts/clefts. In all cases initial diagnosis on biopsy and/or loop excision was thought to be CIN 3, perhaps with suspicion of early invasion. On further excision and/or on clinical grounds the tumors were frankly invasive. We propose the use of the term squamous carcinoma with "CIN 3-like growth pattern" for such lesions. This is in order to avoid misinterpretation as CIN 3 with subsequent inappropriate management of patients with this type of tumor.     

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.     

Verrucous squamous cell carcinoma of the female genital tract. Report of three cases and survey of the literature

Three new cases of gynecological verrucous squamous cell carcinomas are reported; one in the uterine cervix, and two in the vulva. The English literature covering the 49 cases reported previously is surveyed with special reference to the diagnostic and therapeutic aspects of these tumors, as well as with their clinical behavior and possible relationship to viral (HPV) lesions (Condylomas) of the genital tract.It was concluded that so far the exact relationship between the different verrucous squamous cell lesions in the genital tract remains obscure, all such lesions should be regarded as potentially malignant, and treated accordingly by radical surgery.     

Undenuded invasive cervical carcinomas erroneously treated by cauterization

Two cases of occult invasive carcinoma of the cervix have been reported with emphasis on diagnostic failure and subsequent inappropriate treatments. A prompt replacement with malignant cells simulating dysplasia or carcinoma in situ was observed at the sites of cauterization preoperatively. However, histology of postoperative specimen showed apparent invasiveness in both cases and lymphatic metastases in one of them. These findings have led us to a concept that the present cases may represent a variety of occult carcinomas, which is in between the common and verrucous types of squamous cell carcinomas.     

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.     

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.     

Lymphoma-like lesion of the uterine cervix.

Lymphoma-like lesion of the uterine cervix is a benign reactive lymphoid hyperplasia associated with chronic cervicitis that may pose a problem in differential diagnosis from malignant lymphoma. It is a rare entity and only about 20 cases have been reported in the world literature. Two cases of cervical lymphoma-like lesion are described. In both patients, the diagnosis was based on microscopic examination of biopsies taken from the uterine cervix. One patient subsequently had a cervical conization that confirmed the diagnosis of lymphoma-like lesion. Both patients are well, alive and with no evidence of malignant lymphoma. It is concluded that the diagnosis of lymphoma-like lesion is based on the well-established characteristic microscopic features of this lesion. Immunohistochemical staining is usually not helpful in distinguishing this lesion from malignant lymphoma. No specific treatment is necessary for this condition.     

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.     

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.     

Adenoid cystic and adenoid basal carcinomas of the cervix

Adenoid basal and adenoid cystic carcinomas of the cervix are uncommon and differ from each other in their histology, treatment, and prognosis. Whereas adenoid basal carcinoma is a slow-growing, locally invasive lesion amenable to simply hysterectomy, adenoid cystic carcinoma is an aggressive tumor associated with regional lymph node involvement and late pulmonary metastases. This study, based on the evaluation of nine cases of adenoid cystic and five cases of adenoid basal carcinoma of the cervix, reviews the literature and formulates a program for the management of these rare lesions.     

A case of microglandular adenocarcinoma of the endometrium

BACKGROUND: Microglandular adenocarcinoma is a rare type of endometrium carcinoma and had some potential diagnostic problems with difficulties in discriminating from some malign and benign lesions of cervix. CASE REPORT: A 70-year-old woman misdiagnosed as cervical adenocarcinoma was referred to our clinic, and the lesion was ultimately evaluated as microglandular adenocarcinoma in repeat of endometrial curettage specimen. Postoperatively, histopathologic examination of specimen revealed grade 1 microglandular adenocarcinoma. To our best knowledge, this is the twelfth case of uterine carcinoma simulating microglandular hyperplasia in the literature. CONCLUSION: Because microglandular adenocarcinoma can be confused with benign lesions like microglandular hyperplasia and malignant lesions of cervix, we aim to discuss the clinical, demographic and immunohistochemical characteristics of the patients with microglandular adenocarcinoma useful in differential diagnosis.     

A case report: verrucous carcinoma of the endometrium--the difficulty of diagnosis, and a review of the literature

A verrucous carcinoma is a subtype of well-differentiated squamous-cell carcinomas, arising in the vagina, vulva, and uterine cervix. But a verrucous carcinoma very rarely arises in the uterine endometrium. The present paper presents a case of a verrucous carcinoma of the endometrium that is described in association with the tumor marker SCC; this paper also includes a review of the relevant literature.     

Pathogenesis of microglandular hyperplasia of the cervix uteri.

Microglandular hyperplasia of the cervix has commonly been associated with pregnancy and oral contraceptive use. In a review of 22 cases seen over the last 10 years, 6 of the cases were not associated with hormonal changes. The idiopathic presentation of this lesion is reviewed. Microglandular hyperplasia of the cervix mimicking clear cell carcinoma of the cervix occurred in a 26-year-old woman with a history of in utero stilbestrol exposure who was taking an oral contraceptive. The differentiation of these two unusual lesions of the cervix is discussed.     

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.     

Primary signet ring cell carcinoma of the uterine cervix: A clinicopathologic study of two cases with review of the literature

Haswani P, Arseneau J, Ferenczy A. Primary signet ring cell carcinoma of the uterine cervix: A clinicopathologic study of two cases with review of the literature. Int J Gynecol Cancer 1998; 8 : 374–379.
Signet ring cell carcinoma of the endocervix is most commonly considered to be metastatic in origin. We describe two cases of apparently primary cervical signet ring cell adenocarcinoma occurring in patients aged 33 and 38 years, respectively. Both patients had been treated previously for cervical "condylomas". The lesions, occupying the posterior lip of the cervix, were formed predominantly of malignant neoplastic signet ring cells. One case was positive for HPV type 18 and coexisted with adenocarcinoma in situ and a high grade squamous intraepithelial lesion (HSIL). One patient died 18 months after the diagnosis of carcinoma with massive intra-abdominal metastasis; autopsy was not performed. The second patient is alive and well nine months postsurgery and undergoing pelvic radiotherapy for FIGO stage IB1 adenocarcinoma with one of the pelvic nodes containing a metastasis. Although in neither of the two cases was absolute proof obtained of the absence of a gastrointestinal tract tumor, the clinical presentation of the tumors, the history of previous HPV infection of the cervix, the coexistent in situ adenocarcinoma and HSIL and the detection of HPV type 18 in one case lent support for a primary cervical origin of this rare form of adenocarcinoma.     

Papillary squamous cell carcinoma of the uterine cervix: a clinicopathologic study of nine cases

Papillary squamous cell carcinoma (PSCC) of the uterine cervix is an infrequently described subtype of cervical malignancy. Nine cases of PSCC encountered at the University of Virginia Medical Center are reviewed. The clinical course of these patients, including a propensity for late metastases and recurrences, appears distinctive. The papillae of PSCC are lined by dysplastic cells, unlike verrucous carcinoma. PSCC may exist in an in situ state, and demonstration of invasion, when present, requires deep biopsies or cervical conization. Therapy for PSCC appears to be the same as for ordinary squamous cell carcinoma of equivalent clinical stage.     

Hematoma de mama que simula un cáncer y cáncer de mama que debuta con hematoma

Some benign breast lesions, such as hematoma, may present mammographically as a speculated or ill-defined mass mimicking a carcinoma. Equally, an unknown malignant lesion can bleed and appear clinically as a breast hematoma. We report the cases of two patients: the first patient had a mammographic lesion suggestive of carcinoma that was later revealed to be a breast hematoma. The second patient, who was receiving anticoagulant therapy, had a breast hematoma that required surgical drainage. Surgery revealed an apparently malignant underlying lesion. The malignancy was confirmed by histological analysis.