Case Studies VERRUCOUS CARCINOMA A CASE REPORT TOM C. G.&RwN,
MD, Pr+D,
OF THE LEG POSITIVE
WILLIAM
FOR HUMAN
1,. THEI.MO, MD, JACOR VKXOR, PHD,
Human papillomavirus (HPV) types 6 and/or 11 have been associated with benign lesions, while types 16. 18, 31, and 33 are prevalent in malignant lesirms. This care report describes thefindings in a verrucous carcinoma of the leg, which was examined for HPV types I 1, 16. and 18 by in situ DNA hybridization. The lesion gave positive results for HPV subtypes I I and 18. a combination that, to our knowledge, has not been previously reported in this neoplasm. Hrxill P.~THOI. 22: 1170- I1 73. Copyright 0 1991 by W.B. Saunders Company
In 1925, Buschke and I,iiwenstein’ described a “carcinoma-like” lesion of the penis growing on the base of a condyloma acuminatum, with local invasion of deeper cell layers but without metastases. Due to its nonmetastasizing growth pattern, these investigators did not want to refer to this lesion as a carcinoma, and it later became known as “giant condyloma” or “Buschke-Liiwenstein tumor.” Buschke and Liiwenstein suspected that the lesion was caused by a virus that they were unable to identify at that time. This assumption was strengthened when the human papillomavirus (HPV) was identified as the etiologic agent of the condyloma acuminatum.” carcinoma” was first defined by The term “verrucous Ackerman’ in 1948 as a type of squamous cell carcinoma of the oral cavity most commonly involving the buccal mucosa and lower gingiva of tobacco-chewing older men. Since then, its identity has been well established and it subsequently has been reported in nearly all parts of the body, including the larynx, bronchi, esophabms, vulva, vagina, uterine cervix, endometrium, perineum, penis, anus, rectum, and leg.“-” In the last 10 years, HPV has been further subdivided into more than 50 types. Of these. HPV types 6 and 11 generally have been associated with benign lesions of the cervix and anogenital region, while HPV types 16, 18, and 33, among others, have been considered to be affiliated with higher grades of dysplasia, carcinoma in situ, and invasive carcinoma. To our knowledge, these HPV subtypes have not been described in peripheral carcinomas. CASE
REPORT
The patient, a 64-year-old man from Santo Domingo. was admitted to Kings County Hospital Center with a chief complaint of pain and swelling of the right leg for 2 years. Physical examination revealed a large ulcer involving the lower and middle third of the pretibial region as well as palpable adenopathy in the right femoral triangle. Adjacent to the ulcer Frownthe Department of Pathology, Kings County Hospital Center and State University of New York (SUNY) Health Science Center at Brooklyn, Brooklyn. NY; and Lifecodes Corporation, Valhalla, NY. Address correspondence and reprint requests to Ton1 C. Garven, MD, PhD, Departnlent of Patholog, Kings
MD, Pr+D,
OF THE LEG POSITIVE
WILLIAM
FOR HUMAN
1,. THEI.MO, MD, JACOR VKXOR, PHD,
Human papillomavirus (HPV) types 6 and/or 11 have been associated with benign lesions, while types 16. 18, 31, and 33 are prevalent in malignant lesirms. This care report describes thefindings in a verrucous carcinoma of the leg, which was examined for HPV types I 1, 16. and 18 by in situ DNA hybridization. The lesion gave positive results for HPV subtypes I I and 18. a combination that, to our knowledge, has not been previously reported in this neoplasm. Hrxill P.~THOI. 22: 1170- I1 73. Copyright 0 1991 by W.B. Saunders Company
In 1925, Buschke and I,iiwenstein’ described a “carcinoma-like” lesion of the penis growing on the base of a condyloma acuminatum, with local invasion of deeper cell layers but without metastases. Due to its nonmetastasizing growth pattern, these investigators did not want to refer to this lesion as a carcinoma, and it later became known as “giant condyloma” or “Buschke-Liiwenstein tumor.” Buschke and Liiwenstein suspected that the lesion was caused by a virus that they were unable to identify at that time. This assumption was strengthened when the human papillomavirus (HPV) was identified as the etiologic agent of the condyloma acuminatum.” carcinoma” was first defined by The term “verrucous Ackerman’ in 1948 as a type of squamous cell carcinoma of the oral cavity most commonly involving the buccal mucosa and lower gingiva of tobacco-chewing older men. Since then, its identity has been well established and it subsequently has been reported in nearly all parts of the body, including the larynx, bronchi, esophabms, vulva, vagina, uterine cervix, endometrium, perineum, penis, anus, rectum, and leg.“-” In the last 10 years, HPV has been further subdivided into more than 50 types. Of these. HPV types 6 and 11 generally have been associated with benign lesions of the cervix and anogenital region, while HPV types 16, 18, and 33, among others, have been considered to be affiliated with higher grades of dysplasia, carcinoma in situ, and invasive carcinoma. To our knowledge, these HPV subtypes have not been described in peripheral carcinomas. CASE
REPORT
The patient, a 64-year-old man from Santo Domingo. was admitted to Kings County Hospital Center with a chief complaint of pain and swelling of the right leg for 2 years. Physical examination revealed a large ulcer involving the lower and middle third of the pretibial region as well as palpable adenopathy in the right femoral triangle. Adjacent to the ulcer Frownthe Department of Pathology, Kings County Hospital Center and State University of New York (SUNY) Health Science Center at Brooklyn, Brooklyn. NY; and Lifecodes Corporation, Valhalla, NY. Address correspondence and reprint requests to Ton1 C. Garven, MD, PhD, Departnlent of Patholog, Kings
