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WHO Classification of Tumours
Verrucous carcinoma, NOS
Anus and anal canal


Definition

A well differentiated squamous cell carcinoma characterized by a papillary growth pattern, acanthosis, mild cytologic atypia, and pushing tumor margins. The most commonly affected anatomic sites are the oral cavity, nasal cavity, larynx, esophagus, anus, vagina, vulva, and the plantar region of the foot.

Verrucous carcinoma of the anal canal
In the anogenital area, this tumour is also called giant (malignant) condyloma or Buschke-Löwenstein tumour

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Grussendorf-Conen EI (1997)
Anogenital premalignant and malignant tumors (including Buschke-Löwenstein tumors).
Clin Dermatol 15: 377-88



. It has a cauliflower-like appearance, is larger than the usual condyloma (with a diameter of up to 12 cm), and fails to respond to conservative treatment. In contrast to an ordinary condyloma, it is characterized by a combination of exophytic and endophytic growth.

Histologically, it shows acanthosis and papillomatosis with orderly arrangement of the epithelial layers and an intact but often irregular base with blunt downward projections and keratin-filled cysts. The endophytic growth may represent invasive activity, but convincing evidence of invasive growth is rare. Cytologically, the epithelial cells appear benign. Large nuclei with prominent nucleoli may be present, but cytonuclear atypia is usually minimal and mitoses are restricted to the basal layers

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Longacre TA, Kong CS, Welton ML (2008)
Diagnostic problems in anal pathology.
Adv Anat Pathol 15: 263-78



.

Some verrucous carcinomas contain HPV, the most common types being HPV6 and HPV11. They are regarded as an intermediate state between the ordinary condyloma and SCC, and the clinical course is typically that of local destructive invasion without metastases

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Bertram P, Treutner KH, Rübben A, Hauptmann S, Schumpelick V (1995)
Invasive squamous-cell carcinoma in giant anorectal condyloma (Buschke-Löwenstein tumor).
Langenbecks Arch Chir 380: 115-8




Click to access Pubmed
Longacre TA, Kong CS, Welton ML (2008)
Diagnostic problems in anal pathology.
Adv Anat Pathol 15: 263-78



. The presence of severe cytological changes, unequivocal invasion or metastases should lead to the diagnosis of SCC and to the appropriate therapy.

Topographic definition of the anal canal, anal margin and perianal region