Penile verrucous carcinoma with anaplastic transformation following radiotherapy. A case report with human papillomavirus typing and flow cytometric DNA studies.
We report a case of penile verrucous carcinoma with anaplastic transformation after radiotherapy. A 49-year-old man with penile verrucous carcinoma initially underwent excision and chemotherapy followed by radiotherapy when the carcinoma recurred locally. Twenty-four months after the completion of radiotherapy, the verrucous cancer transformed to an anaplastic spindle-cell carcinoma, which resulted in his death 10 months after diagnosis. Autopsy confirmed a huge hemorrhagic recurrent lesion and lung metastases. In situ hybridization with biotinylated DNA probes did not detect any type of human papillomavirus (HPV) (types 6/11, 16/18, and 31/33/51) in either the primary or the anaplastic tumor. Immunohistochemical HPV capsid antigens were also negative in both lesions. A flow cytometric analysis, using paraffin-embedded materials, showed a diploid DNA content in the excised verrucous carcinoma and an aneuploid content in the anaplastic tumor. This patient most likely had radiation-induced transformation of an anaplastic carcinoma. Wide excision and, if necessary, amputation, are preferred to radiotherapy.
Fukunaga
M
M
Department of Pathology, Jikei University School of Medicine, Tokyo, Japan.
Yokoi
K
K
Miyazawa
Y
Y
Harada
T
T
Ushigome
S
S
D002277:Carcinoma / Q000473:pathology* / Q000821:virology; D018289:Carcinoma, Verrucous / Q000473:pathology* / Q000532:radiotherapy / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005434:Flow Cytometry; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics; D010412:Penile Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000821:virology
D004279:DNA, Viral