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.     

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.     

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.     

Verrucous carcinoma of the vulva.

A case of invasive verrucous carcinoma of the vulva is reported. The English literature is reviewed and the mode of therapy 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.     

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.     

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 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.     

Verrucous carcinoma of the vulva

Three cases of verrucous carcinoma of the vulva are reported. This variant of epidermoid carcinoma can easily be misdiagnosed if correlation is not made between the clinical and histopathologic appearance. These tumors tend to invade locally and rarely metastasize. Anaplastic transformation has been reported after radiation therapy, making surgical excision the treatment of choice.     

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.     

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 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 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.     

Verrucous carcinoma of the vulva

We reported a case of verrucous carcinoma of the vulva, (VCV) presented at an 71 year old caucasian woman, who was admitted to University of Chile Clinical Hospital, December 11, 1987. She had complained of vulvar itching, pain and a tumor at left labium mayor during the last ten years. The tumor was removed, and then a simple vulvectomy with bilateral superficial lymphadenectomy through separate groin incisions was performed. All the 27 inguinal nodes were free of metastasis, and the vulvar skin presented a mixed dystrophy with light atypia (VIN I). She is alive and well one year after surgical treatment.     

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.     

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 .     

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.     

Some epidemiologic aspects of carcinoma of the vulva in Israel

A nationwide study of squamous cell carcinoma of the vulva in Israeli Jewish women has been conducted for a comparison of the incidence, the age pattern and the ethnic distribution of squamous cell carcinoma of the vulva to those of squamous cell carcinoma of the cervix. The mean annual incidence rates by age in squamous cell carcinoma of the vulva rise continuously to age 70+ while in squamous cell carcinoma of the cervix a plateau is reached at age 40 to age 69. In contrast to the relatively low incidence of squamous cell carcinoma of the cervix in Israeli Jewish women, the age-specific incidence rates of squamous cell carcinoma of the vulva are similar to those of white women in the United States. On the other hand, there is a trend to a higher incidence of both squamous cell carcinoma of the cervix and squamous cell carcinoma of the vulva in the North African ethnic group of Israeli Jewish women.     

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.