Case Number : Case 1451- 15 January Posted By: Guest

Warty (condylomatous) squamous cell carcinoma. What is scream-ish?

Agree with warty squamous cell carcinoma. I think we can see microinvasion on the first picture. A differential could be the pseudohyperplastic variant of squamous cell carcinoma that like the warty and verrucous subtype are extremely well differentiated neoplasms. However, this variant (the pseudohyperplastic) tends to be multifocal, more frequent on the very elderly and lacks the clear viral effect seen here...

Ed like you all to Munch it over!

Is this some kind of riddle?

I dont munch it

Giant condylomata of Buschke and Löwenstein. The viral features are quite striking. PKMB, suggested by Mona is a possibility, and has malignant potential.

Ahhhhhhhhhh okkkkkkk the nuclei in the last picture looks like the face in the painting. Hahahaha it took a while....

I agree with Mona.......look forward to the answer

I thought this would do for differentiated PeIN or differentiated squamous cell carcinoma in situ if you prefer.  Could not resist the little riddle!  In the next adjacent x2 field there was a larger exophytic well differentiated squamous cell carcinoma with pushing invasion.  I thought there may be some viral changes here but I have to admit to uncertainty but I do think the nuclear features in the parakeratosis are atypical and commensurate with a neoplastic rather than hyperplastic process.  Not sure the IHC will be overly useful in this case as we would probably just expect some supra-basal Ki67, perhaps slight up regulation of basal third wild pattern p53 and p16 only (I did it anyway for interest and it was as stated).  Bottom line is that these cases can be very difficult on biopsy and if not sure about PeIN to make sure you express uncertainty and keep patient under follow-up.