A Huge Mesenteric Lymphangioma Presenting as a Small Bowel Volvulus in a Paediatric Patient: A Case Report.

Lymphangioma is a benign tumor characterized by proliferation of thin-walled lymphatic spaces. Lymphangioma of the small-bowel mesentery is rare, with an incidence of 1 : 250,000, representing less than 1% of all lymphangiomas. The predilection of the tumor is in the head and neck (70%), axillary (20%), and internal organs (10%). They are usually asymptomatic but can cause acute abdominal symptoms due to complications such as volvulus, bleeding, or lymphangioma rupture that require emergent surgery. Here, we report a case of mesenteric lymphangioma (ML) of a small bowel in a paediatric patient who presented with pain abdomen on and off which increased in severity and later had features of subacute intestinal obstruction. He underwent explorative laparotomy, and the mass was excised completely along with the part of small intestine. Pathological analysis of the surgical specimen confirmed the diagnosis of ML of the small intestine. The postoperative recovery was uneventful, and the patient was discharged after ten days of hospital stay. Though benign in nature, ML may cause acute abdominal symptoms that require emergent surgery. Therefore, it has to be kept in differential diagnosis of the acute abdominal condition.

Fine-needle aspiration cytology diagnosis of aspergilloma - A case report.

Fine-needle aspiration cytology, a simple and inexpensive technique can aid in early diagnosis of aspergilloma. Here, we present a case of 55-years-old female with a past history of pulmonary tuberculosis and a right-lung cavitary lesion, diagnosed as aspergilloma.

Incidental finding of a large polypoidal gallbladder mass diagnosed as papillary adenocarcinoma - A case report.

INTRODUCTION AND IMPORTANCE: Lesions which project from the gallbladder wall into its lumen are known as gallbladder polyps. Nearly 5% of all adults have gallbladder polyps, the majority are pseudo-polyps with no neoplastic potential. Although gallbladder polyps are commonly found in cholecystectomy specimen, only a very few gallbladder polyps present as carcinoma in a polypoid lesion. CASE PRESENTATION: A 48 years old male patient came for a routine health checkup and ultrasonography (USG) of abdomen showed incidental finding of a polypoid lesion measuring 43 × 28 mm in the gallbladder. Computed tomography scan revealed a soft tissue mass of similar size almost filling the lumen of the gallbladder and showed notable enhancement in post-contrast images. The mass was concluded to be suggestive of gallbladder carcinoma. Extended radical cholecystectomy was performed and histopathological examination of the polypoid lesion showed papillary adenocarcinoma with tumor staging of T2b. CLINICAL DISCUSSION: The prevalence of polypoid lesions of the gallbladder are reported to be 2-12% of all cholecystectomy specimens. Gallbladder polyps are one of the common USG findings in general population. It is difficult to differentiate between the benign and malignant polypoid lesions of the gallbladder solely depending on imaging studies. A size larger than 10 mm is the best indicator of malignancy. The most common malignant gallbladder polyp is adenocarcinoma. CONCLUSION: In majority of the cases, gallbladder polyp is an incidental finding. Even though most of the gallbladder polyps are benign in nature, cholecystectomy is the treatment of choice if the suspicion for malignancy is high.

Thirty-five cases of gallbladder carcinoma out of 4914 cholecystectomy specimens from a Nepalese tertiary care hospital - A retrospective cohort study.

INTRODUCTION: The density of gallbladder carcinoma differs in different parts of the world. It is an aggressive tumor with poor prognosis presenting in advanced stages due to paucity of signs and symptoms. This research was conducted to analyze the frequency of incidental and clinically suspected gallbladder carcinoma with clinicopathological correlation. METHODS: This is a retrospective cohort study conducted in the Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal from January 2005 to December 2020. RESULTS: The study included 35 cases of gallbladder carcinoma compiled over a period of 16 years. There were 11 males and 24 females with a male to female ratio of 1: 2.1. Age ranged from 29 to 75 years with a mean age of 56.51 ± 11.38 years. Incidental carcinoma was observed in 26 (74.28%) cases while clinically suspected carcinoma was identified in 9 (25.71%) cases. Gallstone was associated in 14 (40%) cases of incidental carcinoma. Tumor staging of both incidental and clinically suspected carcinomas showed 13 (37.14%) cases in T1 stage, 15 (42.85%) cases in T2 stage and 7(20%) cases in T3 stage. CONCLUSION: Our analysis established prevalance of gallbladder carcinoma from 5th to 7th decades with female predominance and higher association of gallstones in incidental carcinoma. The principal histology in incidental carcinoma was well differentiated carcinoma while poorly differentiated carcinoma was encountered only in clinically suspected carcinoma.

Adenosarcoma of Uterus- Rare Biphasic Malignant Tumor: A Case Report.

Uterine adenosarcoma is a rare variant of mixed Mullerian tumors comprised of neoplastic glands with the benign appearance and sarcomatous stroma. The epithelium most often consists of endometrium- like cells, while the sarcomatous component usually shows low-grade homologous uterine sarcoma. These tumors present as a pelvic mass or an enlarged uterus with abnormal vaginal bleeding. Here, we present a case of 61 years old postmenopausal female patient with chief complaints of excessive vaginal bleeding and urine retention.

Renal cell carcinoma with widespread metastasis in 19 years old young male - A rare case report.

INTRODUCTION AND IMPORTANCE: Renal cell carcinoma is the most common malignant tumor of the kidney which occurs more frequently in men and older people than in women and young adults. Renal cell carcinoma is the second most common renal malignancy diagnosed among pediatric and adolescent patients comprising of 2% to 6% of renal cancers. CASE PRESENTATION: A 19 years old young adult male came with a history of epigastric and back pain, hematuria and weight loss. Per abdominal examination showed a palpable mass in the epigastric and left hypochondriac region. Radiological imaging showed diffuse infiltration of renal interstitium with multiple hypodense lesions in left kidney, renal vein infiltration, and lytic destruction of vertebral bodies and left superior pubic ramus. Fine needle aspiration cytology and trucut biopsy was taken which confirmed renal cell carcinoma, clear cell type with bone metastasis. CLINICAL DISCUSSION: Although most renal cell carcinoma is sporadic and relatively uncommon in young adults, the incidence of renal cell carcinoma in this age group has steadily increased. Young adults are less likely to receive diagnosis of renal cell carcinoma incidentally. A few reported pediatric series have shown that renal cell carcinoma is highly aggressive, tends to be invasive, and metastasizes to the lungs and bones. CONCLUSION: Young adult with clear cell renal cell carcinoma showing wide spread metastasis is rare. Since, young age is an independent prognostic factor for cancer-specific survival, early diagnosis of the tumor will be beneficial for patients.

Extra-gastrointestinal stromal tumor presenting as a huge peritoneal mass and mimicking as mesothelioma - A case report.

INTRODUCTION AND IMPORTANCE: Extra-gastrointestinal stromal tumors are group of soft tissue neoplasm, which originates outside the gastrointestinal tract comprising of less than 5% of the total gastrointestinal stromal tumors. CASE PRESENTATION: A 67 years old male came with a history of vague abdominal pain, discomfort and loss of appetite. Per abdominal examination showed a palpable firm mass which was filling both the flanks. Radiological imaging revealed a large abdomino-pelvic mass with central necrotic areas. Exploratory laparotomy was done and the mass was excised intact from the sigmoid mesocolon. Histopathological diagnosis was given as extra-gastrointestinal stromal tumors. CLINICAL DISCUSSION: Extra-gastrointestinal stromal tumor was first described by Miettinen et al. in 1999. The tumor can arise from the pleura, omentum, mesentery, retroperitoneum and prostate. The clinical presentation of the tumor depends on its location and the size of tumor. Patients with these tumors present with abdominal pain, followed by abdominal mass and distention. These tumors show pathological, immunohistochemical and molecular biological characters similar as that of gastrointestinal stromal tumor. CONCLUSION: Extra-gastrointestinal stromal tumor is a rare tumor and can reach to a considerable large size before presenting with clinical symptoms especially if the tumor arises from the mesocolon. IHC study plays an important role to reach to the final diagnosis as the tumor can mimic mesothelioma in routine staining.

Non-neoplastic Lesions of Gallbladder Among Cholecystectomy Specimens of a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Gallbladder diseases are prevalent worldwide and present with a diverse histopathological spectrum. Mucosal irritation and chronic inflammation is considered as an important etiological factor for the mechanical or functional dysfunction of emptying of the gallbladder. This study aims to find the prevalence of non-neoplastic lesions of gallbladder among cholecystectomy specimens of a tertiary care center. METHODS: A descriptive cross-sectional study was conducted in the Department of Pathology, of a tertiary care center from January 2005 to December 2020. Ethical approval was taken from the Institutional Review Committee. All the patients who had undergone cholecystectomy procedures which showed non-neoplastic lesions were enrolled in the study. Convenient sampling was done. Statistical Package for Social Sciences version 21 and Microsoft Excel were used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 4914 cholecystectomy specimens, 4852 (98.73%) (95% Confidence Interval= 98.42- 99.04) were non-neoplastic lesions. There were 1252 (25.8%) males and 3600 (74.2%) females with a male to female ratio of 1:2.87. Age ranged from 2 to 89 years with a mean age of 45±14.48 years. Gallbladder lesions were observed maximum in age group 41-50 years with 1200 (24.7%) cases. Among the non-neoplastic lesions, cholecystitis without any specific finding was the most common finding with 3028 (62.4%) cases followed by cholelithiasis with 1478 (30.5%) cases. CONCLUSIONS: The prevalence of non-neoplastic lesions of gallbladder is similar to other studies done in similar setings. Female predominance was noted in non-neoplastic lesions.

Benign Skin Neoplasms among the Histopathological Specimens of Skin Neoplasm in a Teaching Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Skin tumors are relatively uncommon malignancies worldwide, but its incidence has been progressively increased over the last few decades. Skin tumor belongs to a diverse group of neoplasms arising from the epidermis, adnexal structures and dermis rendering the classification difficult. The study aims to find out the prevalence of benign skin neoplasm among the histopathological specimens of skin neoplasm of a teaching hospital. METHODS: A descriptive cross-sectional study among the hospital records of histopathological samples of skin neoplasm in the Department of Pathology of a tertiary care center from January 2017 to December 2020. Ethical approval was taken from the Institutional Review Committee (Ref: MEMG/IRC/427/GA). Convenient sampling was done. Data were entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 21 software. Point estimate at 95% Confidence Interval was calculated with frequency and descriptive statistics. RESULTS: Out of total skin neoplasm samples, 121 (57.34%) (50.67-64.01 at 95% Confidence Interval) benign skin neoplasms were present. Among them, the majority were keratinocytic tumor 81 (66.9%) followed by skin appendageal 23 (19.0%) and melanocytic tumors 17 (14.0%). Acrochordan 18 (14.9%) and pilomatricoma 12 (9.9%) were the predominant keratinocytic and appendageal neoplasms respectively. Most of the cases occurred in head and neck region 64 (52.9%). CONCLUSIONS: The study concluded that the prevalence of benign skin neoplasm was slightly lower compared to the other studies. Most of the benign skin neoplasms were keratinocytic tumors followed by appendageal and melanocytic tumors. Acrochordan was the commonest benign keratinocytic tumor.

A Misdiagnosed Case of Hypertrophic Gastropathy.

Hypertrophic gastropathy is a rare idiopathic hyperproliferative disorder which may present as Menetrier's disease (MD) characterized by foveolar hyperplasia in the gastric fundus and body. It is often accompanied by a severe loss of plasma proteins (including albumin) from the altered gastric mucosa. The disease occurs in two forms, a childhood form due to cytomegalovirus infection and an adult form attributed to overexpression of transforming growth factor-alpha (TGF-α). The most common symptoms include epigastric pain with fullness and vomiting and generalized peripheral edema with hypoalbuminemia. We present a case of 75-year-old female presenting with epigastric pain and vomiting. Upper gastrointestinal endoscopy and computed tomography scan revealed an irregular mucosal fold at the body and antrum and thickening of the stomach wall, respectively. Though the endoscopic gastric mucosal biopsy was nonspecific, the patient underwent partial gastrectomy due to clinicoradiological suspicion of carcinoma. On histopathology, the case was reported as hypertrophic gastropathy, consistent with MD. Though there is a strong clinical and radiological suspicion of malignancy in the hypertrophied gastric mucosa, MD should be one of the important differential diagnoses.

Recurrence of ruptured intracranial epidermoid cyst - A rare case report and presentation.

INTRODUCTION: Intracranial epidermoid cysts are congenital tumors that develop from ectodermal remnants during neuroembryogenesis between the third and fifth weeks of gestation. These tumors are benign and usually present with local mass effect. Here, we present a rare case of ruptured intracranial epidermoid cyst with recurrence. PRESENTATION OF CASE: A 55 years old male patient was brought to emergency with a history of headache and loss of consciousness for 1 h. Radiological imaging showed the features suggestive of ruptured intracranial epidermoid cyst which was operated. Two years later the patient re-presented with headache for 4-5 days where repeat MRI revealed recurrence of the tumor. DISCUSSION: Epidermoid cysts are very slow growing tumor at a linear rate due progressive accumulation of normally dividing epidermal cells. These tumors often reach a large size before the onset of symptoms. At times, the tumor capsule may show infiltration to the brain parenchyma and tight adherence to neurovascular structures which leads to the incomplete removal of the tumor capsule leading to recurrence of tumor. CONCLUSION: Rupture of intracranial epidermoid cyst is a rare phenomenon and recurrence of this tumor in patients is even infrequent.

Sensitivity of Sinus Radiography Compared to Computed Tomogram: A Descriptive Cross-sectional Study from Western Region of Nepal.

INTRODUCTION: Radiography of the paranasal sinuses is commonly used diagnostic modality. However, the trustworthiness of plain radiographic findings of paranasal sinuses is debatable. The intention of this study was to weigh the diagnostic soundness of plain radiograph of the paranasal sinuses to that of computed tomogram scan. METHODS: This is a descriptive cross sectional study carried out in 110 participants in Department of Radiology of Gandaki Medical College from November 2017 to April 2018. Ethical approval is obtained from Institution review board (Ref. No.39/074/075). Sample size was calculated taking confidence level of 95%, expected prevalence of 14% and precision of 6.5% in population of 492098 in Province 4 of Nepal. Random sampling method was used. Data was enter in Statistical Package for the Social Sciences version 17 software and analysed. RESULTS: A total of 110 participants are included in this study of which 62 (56.4%) are females and 48 (43.6%) are males with an overall mean age of 34.5 years. The commonly involved sinus was maxillary 56 (50.9%) followed by ethmoid 33 (30%) sinus. The overall sensitivity and specificity of detecting sinusitis by sinus radiography is higher for maxillary sinus (89.7% and 87%) followed by ethmoid (69.7% and 96.1%) and frontal (61.5% and 96.9%) sinuses. CONCLUSIONS: Sinus radiography is more sensitive for detecting pathologies in maxillary sinuses, while it is moderate for frontal, ethmoid sinuses and least for sphenoid sinuses. Diagnostic accuracy of computed tomogram scan is more, hence should be recommended to characterize the complex pathology and anatomy of the osteomeatal complex.

Histopathologic Profile of Salivary Gland Tumors among Specimens from a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Salivary gland tumors are rare, comprising about 3% of all head and neck neoplasms. About 80% of the tumors are in parotids, 10% in submandibular glands and the remainders are distributed in sublingual and minor salivary glands. This study was conducted to evaluate the relative frequencies, types, site of distribution and the histopathological features of salivary gland tumors. METHODS: A descriptive cross-sectional study was conducted in the Department of Pathology, Manipal College of Medical Sciences, Pokhara from January 2011 to December 2019. Ethical approval was taken from the institutional review committee of Manipal College of Medical Sciences (Ref: 314). Convenient sampling was done among specimen. Data were entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 21. RESULTS: Among the 130 specimens, the patients' age ranged from 6 to 78 years with a mean age of 37.26 years for benign tumors and 48.45 years for malignant tumors. There was female predominance with a male to female ratio of 1:1.36. There were 98 cases of benign tumors, commonest being pleomorphic adenoma with 82 (83.67%) cases which was noticed more frequently in fourth decade of life. Among the 32 malignant tumors, mucoepidermoid carcinoma was the commonest tumor 20 (62.5%), followed by adenoid cystic carcinoma 7 (23.33%). CONCLUSIONS: Benign salivary gland tumors were more common than malignant tumors and the most common site of location was the parotid for both the benign and malignant tumors. Female outnumbered the male population in benign tumors whereas males were slightly more than females in malignant tumors. This study corroborated well with other previously published studies.

Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study.

INTRODUCTION: Thyroid gland lesions are the most common endocrine disorders encountered globally. Diseases of the thyroid gland present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. The objective of the study is to find the frequency of different thyroid lesions. METHODS: A descriptive cross-sectional study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2005 to Jan 2020. Ethical approval was taken from the Institutional Review Committee (Ref: 330). Patients who had undergone thyroidectomy procedures for both non-neoplastic and neoplastic thyroid lesions were enrolled. Convenient sampling was done. IBM Statistical Package for Social Sciences version 21 and Microsoft Excel were used. RESULTS: Out of 345 thyroidectomy specimens, 246 (71.3%) cases of non-neoplastic lesions, and 99 (28.69%) cases of neoplastic lesions were present. There were 54 males and 291 females with a male to female ratio of 1:5.4. The age ranged from 9 to 76 years with a mean age of 43.67 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 205 (83.33%) cases followed by Grave's disease and lymphocytic thyroiditis with 14 (5.69%) cases each. In neoplastic lesions, papillary carcinoma was the commonest lesion with 56 (56.56%) cases followed by follicular carcinoma with 14 (14.14%) cases and follicular adenoma with 13 (13.13%) cases. There were also 9 (9.09%) cases of anaplastic carcinoma in neoplastic lesions. CONCLUSIONS: Colloid goiter and papillary carcinoma was the most commonly encountered non-neoplastic and neoplastic lesion with a female predominance. Rare tumors like anaplastic carcinoma, papillary carcinoma, and follicular carcinoma with anaplastic transformation were also encountered.

Hydatidosis of infratemporal fossa with proptosis - an unusual presentation: a case report and review of the literature.

BACKGROUND: Hydatid disease is one of the common zoonotic diseases caused by the larval stage of Echinococcus granulosus. It is endemic in sheep-raising and cattle-raising areas worldwide and humans are an accidental intermediate host following the ingestion of the larvae. Head and neck involvement of echinococcosis is a rare entity and involvement of the infratemporal region is extremely rare even in endemic areas. Only a few cases of hydatid cysts located in the infratemporal fossa have been reported in the literature. Moreover, extension of the hydatid cyst into the intraorbital region and infiltrating into the surrounding orbital bone is even rarer. CASE PRESENTATION: We present a case of a 65-year-old Gurung Nepalese woman with painless proptosis of her left eyeball of 2 months' duration with recent progressive diminution of vision for 15 days. Radiological findings showed a cystic mass in the left infratemporal fossa extending into the left orbit and involving the surrounding orbital bone. Surgical removal was carried out. On histopathological evaluation, it was reported as hydatid cyst infiltrating into the bone. She was prescribed albendazole and discharged after surgery. However, she was lost to follow up and returned after 15 months with recurrence and proptosis of the same eye. Repeat excision of the lesion was carried out and postoperatively she was administered tablet albendazole. She was found to be disease free after 6 months of follow up. CONCLUSIONS: Clinical and radiological findings are important but may not be sufficient in the preoperative diagnosis of hydatid disease especially if rare sites are involved. Proptosis may be seen in several conditions and orbital or infratemporal hydatidosis, although rare, should be considered a differential diagnosis.

Clinicohematological Study of Pancytopenia in a Tertiary Care Hospital of Western Region of Nepal.

INTRODUCTION: Pancytopenia is a relatively common hematological entity and is a manifestation of many illnesses which can be life threatening at times. The severity of pancytopenia and the underlying pathology determine the management and prognosis. This study was conducted to evaluate hematological and bone marrow findings in patients presenting with pancytopenia. METHODS: A prospective observational study was conducted in Department of Pathology, Manipal College of Medical Sciences, Pokhara from January 2011 to December 2016. Clinical and hematological parameters including bone marrow aspiration and biopsy were evaluated in all patients who presented with pancytopenia. RESULTS: Among 138 cases studied, patients' age ranged from 2 to 82 years with a mean age of 43.95 years, and there was male predominance. Most of the patients presented with generalized weakness, pallor, dypnoea and fever. Hypoplastic marrow was seen in 38 (27.5%) cases, followed by 26 (18.8%) cases of megaloblastic anemia and 19 (13.76%) cases of acute leukemia. Other findings included one case each of hemophagocyosis, leishmaniasis, plasmodium vivex malaria and metastatic carcinoma. CONCLUSIONS: This study highlights that pancytopenia is a common hematological problem and that the study of detailed primary hematological investigations along with bone marrow study in patients with pancytopenia will help to identify the cause for further planning and management.

Squamous cell carcinoma arising in familial gingival fibromatosis-a rare case report.

Familial gingival fibromatosis is a rare hereditary condition due to chromosomal abnormality which can occur as an isolated disease or as part of a syndrome and has an incidence of 1:350 000. This condition leads to esthetic, functional, psychological and masticatory disturbance of the oral cavity. Here, we present a case of 21-year-old female with severe enlargement of gums in maxilla and mandible. Deciduous teeth were erupted at normal age but the permanent teeth in the oral cavity were not erupted. Her grandmother, father and younger sister were also affected with the same condition. Incisional biopsy from the chronic ulcerated gingiva showed squamous cell carcinoma. Patient was referred to other cancer institution, where metastases to lung, bone and lymph node was detected on CT scan. The diagnosis was made based on clinical examination, family history and histopathological examination.

Ganglioneuroblastoma in a newborn with multiple metastases: a case report.

BACKGROUND: Ganglioneuroblastoma is a tumor of peripheral neuroblastic tissue which occurs predominantly in the pediatric age group; it is a rare occurrence in the newborn period with only one case reported at birth to date. CASE PRESENTATION: We report the case of a newborn male baby of Brahmin ethnicity from Nepal who presented with respiratory distress and blueberry muffin skin lesions after birth. A computed tomography scan showed a mass lesion in the posterior mediastinum, which was diagnosed as ganglioneuroblastoma on fine-needle aspiration cytology. He also had metastases to multiple sites including heart, lungs, skin and brain. CONCLUSIONS: Ganglioneuroblastoma is a rare tumor in newborns. Any newborn presenting with respiratory distress associated with blueberry muffin skin lesions should be evaluated for neuroblastic tumor.

Diffuse vascular malformation of large intestine clinically and radiologically misdiagnosed as ulcerative colitis.

Hemangiomas and vascular malformations of the gastrointestinal tract are rare clinical entities that usually present as overt or occult bleeding. They can be distributed throughout the gastrointestinal system, or present as a singular cavernous hemangioma. Overall, 80% of such malformations are of cavernous subtype and are misdiagnosed as hemorrhoids and ulcerative colitis. Mucosal edema, nodularity and vascular congestion can lead to the incorrect diagnosis of inflammatory bowel disease. We present a case of 26-year-old male who presented with pain abdomen, bleeding per rectum and was treated as a case of ulcerative colitis for past 12 years on the basis of clinical and radiological features. As the patient did not respond, subtotal colectomy was done which on histopathologically reported as cavernous vascular malformation-diffuse infiltrating (expansive type).

Warty Carcinoma Penis: An Uncommon Variant.

Penile carcinoma frequency varies widely in different parts of the world and comprises 1-10% of all the malignancies in males. Majority of the cases of penile carcinoma are squamous cell carcinoma of penis comprising 60% to 70% of all cases. Warty carcinoma of penis is an unusual neoplasm and a variant of penile squamous cell carcinoma comprising 5%-10% of all the variants. The other histological variants include basaloid, verrucous, papillary, sarcomatous, mixed, and adenosquamous carcinoma. The various histological entities with an exophytic papillary lesions including warty carcinoma are together referred to as the "verruciform" group of neoplasms. The warty carcinoma has to be differentiated from these lesions and is typically distinguished by histological features of hyperkeratosis, arborescent papillomatosis, acanthosis, and prominent koilocytosis with nuclear pleomorphism. We present a case of 65-year-old male with growth measuring 6 × 4 cm in the penis who underwent total penectomy and was diagnosed as warty carcinoma penis.