Verrucous carcinoma masquerading as a giant fibroepithelial polyp

The authors report a case of a verrucous carcinoma (VC) of the buttocks clinically simulating a giant (6.5 cm in length and 5.4 cm in greatest diameter) fibroepithelial polyp (FEP) capped by a large cutaneous horn. The growth had been present for 15 years and had never been biopsied despite numerous physical exams. VC typically presents distinctly as a large cauliflower-like growth with histological features of acanthosis, parakeratosis, minimal cytological atypia, and deep pushing epithelial borders. It is considered a low-grade, well-differentiated variant of squamous cell cancer and is commonly associated with human papillomavirus (HPV). Anogenital VC has been associated more with "low-risk" (type 6 and 11) than "high-risk" (16 and 18) HPV types. Presentation of VC as a FEP is unusual and demonstrates the necessity of maintaining a high level of clinical suspicion of anogenital growths, particularly those involving atypical features such as ulceration or the presence of a cutaneous horn.