Mixed papillary-sarcomatoid carcinoma of the penis: report of an
Walter Henriques da Costa
Gustavo Cardoso Guimaraes
Fernando Augusto Soares
Isabela Werneck da Cunha
Received: 4 April 2017 /Revised: 30 May 2017 /Accepted: 28 June 2017 /Published online: 8 July 2017
Springer-Verlag GmbH Deutschland 2017
Abstract Several different histological subtypes of penile
carcinoma had been described in the last decades, many with
different biological behavior and prognosis. The association
of two histological subtypes (mixed tumors) can be observed
in one third of the cases. The most common association is of
warty and basaloid tumors, two HPV-related carcinomas.
Here, we described a mixed papillary-sarcomatoid carcinoma,
never reported before. Although it is a clinical aspect of a low-
grade verruciform tumor, its prognosis showed it to be very
aggressive due to the sarcomatoid component hidden above
the papillary component. The two components showed oppo-
site cadherin/vimentin expression pointed to epithelial-
mesenchymal transition between them.
Keywords Penile carcinoma; sarcomatoid differentiation
Penile carcinoma is a rare tumor worldwide and usually af-
fects patients in fifth to sixth decades. Its incidence is higher in
development countries and in Brazil represents around 2% of
all men cancers.
Per the 2016 WHO classification , penile carcinoma has
two different pathogenesis pathways, related and non-related to
HPV infection. Also, they can be divided based on their growth
pattern in exophytic and endophytic tumors. More recently, a
comprehensive histological classification was described .
Usual squamous cell carcinoma corresponds to 70% of all tu-
mors. It is very important to recognize histological variants
since they have prognostic importance . Approximately
one third of tumor can show a mixed pattern. The most com-
mon association is of warty and basaloid tumors, two HPV-
related carcinomas .
One of the special variant recently described is papillary
squamous cell carcinoma . It is an unusual low-grade tumor
with verrucous pattern of growth, focally infiltrative, and very
low rate of nodal metastasis and recurrence . From the other
side, sarcomatoid variant represents one of the most aggres-
sive subtype with an infiltrative pattern of growth . Inguinal
metastasis is seen in about 80% of sarcomatoid cases, and
mortality rate is around 50–60%. Most patient dies of the
disease within 1 year . Both subtypes affect patients in sixth
decade, and both are non-HPV-related.
Herein, we report a case of papillary squamous cell carci-
noma and sarcomatoid carcinoma, a mixed subtype. To the
best of our knowledge, this is the first time that this association
is reported on the literature.
A 78-year-old patient seeks for medical attention in a primary
care service due to a history of a rapid progressive verrucous
lesion in penile glans (6-month evolution). A superficial biopsy
was taken with a diagnosis of squamous papilloma. Since the
histological diagnosis was not concordant with clinical behav-
ior, the patient was referred to A. C. Camargo Cancer Center.
* Isabela Werneck da Cunha
Department of Pathology, A. C. Camargo Cancer Center, São
Department of Urology, A. C. Camargo Cancer Center, Rua
Professor Antônio Prudente 211, São Paulo 01509-900, Brazil
Virchows Arch (2017) 471:815–818