BRIEF REPORT Mixed papillary-sarcomatoid carcinoma of the penis: report of an aggressive subtype Graziele Bovolim 1 & Walter Henriques da Costa 2 & Gustavo Cardoso Guimaraes 2 & Fernando Augusto Soares 1 & Isabela Werneck da Cunha 1 Received: 4 April 2017 /Revised: 30 May 2017 /Accepted: 28 June 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 . Male cancer . Epithelial-mesenchymal transition . Penile malignancies Introduction 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 [1], 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 [1]. Usual squamous cell carcinoma corresponds to 70% of all tu- mors. It is very important to recognize histological variants since they have prognostic importance [2]. 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 [1]. One of the special variant recently described is papillary squamous cell carcinoma [3]. It is an unusual low-grade tumor with verrucous pattern of growth, focally infiltrative, and very low rate of nodal metastasis and recurrence [3]. From the other side, sarcomatoid variant represents one of the most aggres- sive subtype with an infiltrative pattern of growth [4]. 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 [4]. 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. Case report 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 iwcunha@accamargo.org.br 1 Department of Pathology, A. C. Camargo Cancer Center, São Paulo, Brazil 2 Department of Urology, A. C. Camargo Cancer Center, Rua Professor Antônio Prudente 211, São Paulo 01509-900, Brazil Virchows Arch DOI 10.1007/s00428-017-2191-2