AFIP images
Various images
Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Nests and differentiation
AFIP images
Infiltrating tumor
has squamous
and glandular
features
Glandular portion is CEA+
Cervix: poorly formed glands and squamous components (arrows)
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Cervix: malignant glandular (arrow) and squamous components (star)
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Male urethra
Male urethra
Prostatic urethra
Male urethra development
Contributed by Debra L. Zynger, M.D.
Prostatic urethra
Penile urethra
Contributed by Debra L. Zynger, M.D.
Prostate, cross section with prostatic urethra
Prostatic urethra
Prostatic
verumontanum
and prostatic
urethra
Bulbourethral (Cowper) glands
Penile urethra
Penile intraepithelial (juxtaepithelial) glands
Penile glands of Littré
Fossa navicularis
AFIP images
Transverse section
Meatus
Glans
Cut section
Shaft cross section
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Compartments
Local anatomy
Arteries
Veins
Urethra
Corpora cavernosa
Transverse sections
AFIP images
Mucosal and wrinkled portion of foreskin
Cross section
Contributed by Diego F. Sanchez, M.D. and Antonio L. Cubilla, M.D.
Penile shaft surgical margin
Surgical margin connective tissue
Erectile corpora
Albuginea and corpus cavernosum
Corpora cavernosa
Corpus spongiosum
Glans
Foreskin in anatomical position
Foreskin epithelium
Foreskin dartos
Penile urethra
Littre glands
AFIP images
Cross section of the scrotal wall
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Embryologic development
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Constricted human
scrotum (without
hair) with the raphe
clearly exposed
AFIP images
Muscle bundles of the
dartos are beneath
the keratinized
squamous epithelium
Thick bundles of
conspicuous smooth
muscle in the deep
reticular dermis
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Marked ulceration with tissue destruction
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Dermis with
lymphoplasmacytic
infiltrate and dilated
blood vessels
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Ulcer almost circumscribing penis and causing penis / scrotal edema
AFIP images
Skin: not necessarily penis
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Skin - not necessarily penis
AFIP images
2 small papules with irregular margins
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Penile lesions
Typical appearance in female
Contributed by Liwei Jia, M.D., Ph.D.
Intact basement membrane
Mitotic figures
Proliferation
AFIP images
Acanthosis and spotty distribution of atypical cells
Microscopic findings of bowenoid papulosis / HSIL
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Acute erythema and edema
AFIP images
Slightly raised flat disc with central ulceration
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Ulcers
Regional adenopathy
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Gram stain
Gentian violet stain
AFIP images
Multiple exophytic lesions
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Multiple exophytic and warty lesions on the shaft and glans of the penis
Contributed by Debra L. Zynger, M.D.
Giant condyloma acuminatum
Contributed by Asra Feroze, M.B.B.S. and Ritu Bhalla, M.D.
Exophytic growth
Cauliflower-like lesion
Fibrovascular cores
Hyperkeratosis and parakeratosis
Characteristic koilocytes
p16
Condyloma histopathology
Genital warts under microscope
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Classification
Epispadias: male baby
Proximal shaft
Penoscrotal
43 year old man with median raphe cyst
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Median raphe cysts:
Pseudostratified columnar epithelium
Single larger mucinous cell
Cyst lining cells are CK7+
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Scrotal MR and ultrasound
Scrotal ultrasound
AFIP images
Scrotal lesion
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Erythematous penile patches
Contributed by Debra L. Zynger, M.D.
White lesion
Contributed by Debra L. Zynger, M.D.
Intraepithelial growth
Nests and single cells
Basal location
Nuclear features
Microinvasion
Deep invasion
Comedonecrosis
Muscle invasion
H&E for comparison with IHC
CK7
GATA3
CK5/6
p63
S100
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Fournier gangrene severity index
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Necrosis spreading along fascial planes
Paraphimosis
Lesions on penis and scrotum
AFIP images
Extensive sloughing
Corbus disease: necrosis of glans
Corbus disease: cut surface
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Bacteria, neutrophils and necrotic tissue
AFIP images
Figure 10-76
Scrotum and inner thigh skin
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Ulcerated lesion with hypertrophic borders
Various images
Beefy red penile ulcer
Multiple ulcers on the penile shaft, pubis and scrotum
Raw granulation tissue
Diffuse ulceration
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Donovan bodies
Squamous cells and keratin pearls
Contributed by Shaheed W. Hakim, M.D. and AFIP
Mapped partial penectomy specimen
Foreskin
SCC involves corpora cavernosa
Partial penectomy specimen
Contributed by Shaheed W. Hakim, M.D. and AFIP
Grade 1
Grade 2, more disorganized growth
Grade 3
Lamina propria invasion
Urethral mucosal involvement
AFIP images
Periurethral corpus spongiosum involvement
Possible sites of involvement
Tumor involvement in yellow
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Penis anatomy
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Herpesvirus structure
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Multiple vesicles and ulcerations on surface
Herpetic vesicles of penis
Herpes vegetans
Contributed by Daniel Anderson, M.D., M.B.A. and Garrison Pease, M.D.
HSV infected cells
HSV infected cells
HSV1 / HSV2 IHC
Ulcer interface, virally infected cells
Ulcer interface, viral changes
HSV1 / HSV2 IHC
HSV1 / HSV2 IHC
HSV ulcer, mixed inflammation
Necrotic virally infected cells
Viral multinucleation, margination, molding
Hypertrophic epidermis, dense inflammation
Dense inflammation and ulcer
Ulcer interface, dense inflammation
Mixed inflammation and ulceration
Cell in ulcer, viral change
Ulcer interface, viral changes
Details viral changes
Multinucleation, margination, molding
Virally infected cells at interface
Multinucleation, margination, molding
Ulcer and viral changes
Viral changes at interface
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HSV infected squamous cells
Herpes under the microscope
by Dr. Jared Gardner
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Lichen sclerosus and melanosis
Lichen sclerosus and phimosis
Depigmentation, glans atrophy and ecchymoses
Severe sclerosis, scarring and ulceration
Contributed by Diego F. Sanchez, M.D. and Antonio L. Cubilla, M.D.
Atrophy and sclerosis
Hyperplasia and sclerosis
Linear sclerosis
Vacuolization and perivascular sclerosis
Edema and hyalinization
Classic lichen sclerosus
Lichenoid lichen sclerosus
Lymphocytic depleted lichen sclerosus
PeIN and lichen sclerosus
Pseudohyperplastic carcinoma, lichen sclerosus
Lichen sclerosus et atrophicus
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Sinus tract
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Lymph nodes
AFIP images
Melanosis
AFIP images
Melanosis
Contributed by Harry Ioachim, M.D.
Multiple lesions on shaft of 30 year old drug abuser
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Lesions on shaft of penis
Skin lesions (site unspecified)
AFIP images
Henderson-Patterson bodies
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Henderson-Patterson bodies
Molluscum bodies
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Pap stain
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Viral particles
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Median raphe cysts
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Pseudostratified columnar epithelium
Single larger mucinous cell within epithelium
CK7
CK13
CEA
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Anatomy of corpus spongiosum in glans penis
Histology of intima
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Nodule on the left side of glans penis
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Excised nodule
Contributed by Maria Tretiakova, M.D., Ph.D.
Plexiform architecture
Intravascular proliferation
Intravascular intimal proliferation
Fibromyxoid stroma
Bland myofibroblastic cells
SMA staining
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Raccoon
Dog
Walrus
Figure F: obvious distal ligament within the glans penis
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Figure C: distal ligament
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Nonretractable foreskin
Fournier gangrene
AFIP images
Regular rows of
small papules
form a ring
around the corona
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1 - 2 cm papules
AFIP images
Benign epithelial hyperplasia with vascular fibrous stroma
AFIP images
Erythroplasia of Queyrat: moist red lesion involving glans
Bowen disease
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Erythematous lesion in the glans
Erythroplasia of Queyrat
PeIN with lichen sclerosus
PeIN in multiple compartments
Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Squamous cell atypia
Small basaloid cells
Basaloid nonkeratinized cells
Small blue cells and koilocytes
Basaloid type
Warty type
Atypical lichen sclerosus
Differentiated type
Ki67 positivity
Strong en bloc cytoplasmic and nuclear p16 immunostaining
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p16 and HPV ISH
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Penile deformation
Dorsal plaque
AFIP images
Penile curvature
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Penile curvature
AFIP images
Tunica albuginea
AFIP images
Thickening of tunica albuginea
Fibrosis
Penile fibromatosis
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Leprosy presenting as phimosis
Tight preputial orifice
Erection with phimosis
Phimotic foreskin
Treatment
AFIP images
Glans mucosa
AFIP images
Marked deformity of penis
Contributed by Debra L. Zynger, M.D. and AFIP images
Scrotoplasty
Replacement of entire scrotal wall by solid yellow-white tissue with interspersed cysts
AFIP images
Characteristic vacuoles,
sclerotic stroma and
occasional foreign body
giant cells
Numerous, variably sized vacuolated spaces
Oil Red O stain
Contributed by Nasir Ud Din, M.B.B.S.
Incidentally found scrotal calcinosis
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Scrotal calcinosis with vitiligo
Pre and postoperative scrotum
Scrotal skin showing calcifications
Multiple white scrotal nodules
Contributed by Debra Zynger, M.D.
White nodule
Contributed by Nasir Ud Din, M.B.B.S., Debra Zynger, M.D. and @katcollmd on Twitter
Skin tissue showing calcium deposits
Multiple calcium deposits
Calcium deposits with granulomatous reaction
Dermal calcium deposits with epidermis
Scrotal calcinosis
Scrotal calcinosis
Contributed by Sleiman Khal, M.D. (Case #468)
FNA smear of scrotal calcinosis
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FNA smear of scrotal calcinosis
Scrotal calcinosis: pathology mini tutorial
AFIP images
Schematic representation of effect of anatomic depth of invasion on risk of lymph node metastasis in carcinoma
Possible sites of
resection margin
involvement at time
of frozen section
Verruciform lesions
Frozen section evaluation of surgical margins
Contributed by Stewart F. Cramer, M.D. and AFIP images
Large bosselated mass
Tumor at junction of scrotum and penis
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Arising on genital lichen sclerosus
Papillary SCC
Ulcerated SCC on glans
Verrucous carcinoma
AFIP images
Glans:
Exophytic cauliflower-like mass
Glans extensively
involved by a
multinodular mass
with focal ulceration
Foreskin:
Circumcision
specimen shows a
flat, granular and
beige neoplasm
Massive involvement
has caused multiple
foci of ulceration
Coronal sulcus:
Nodular white
tumor extensively
involves the sulcus
Cut section
shows 2
discrete nodules
of tumor
Verruciform lesions:
Verrucous
carcinoma
Cobblestone:
Cobblestone appearance representing condyloma
Multiple compartments:
Massive involvement
of glans, coronal
sulcus and foreskin
Massive involvement
has resulted in
autoamputation
4 separate
foci of
carcinoma
are present
Superficial spreading (SCC):
Tumor involves
the glans with
extension to
coronal sulcus
Tumor is white,
involves the mucosa
of the foreskin
and coronal sulcus
Assessment of depth of invasion:
Penile carcinoma has
been transversely
sectioned
Assessment of
depth of invasion
of tumor in
resected specimen
Vertical growth (SCC):
Solid yellow-tan
neoplasm in
the dorsal half
of the glans
Mixed low and high grade (SCC):
Neoplasm shows
superficial, white,
serrated papillary
Margin involvement:
Frozen section evaluation of surgical margins
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Red-tan ulcerated tumor
Fungating mass
Contributed by Antonio L. Cubilla, M.D., Alcides Chaux, M.D. and AFIP images
Scrotum: well, moderately and poorly differentiated tumors
Mucosa is involved by carcinoma
Invasion of the lamina propria
Mixed (hybrid) usual: verrucous carcinoma
Usual type: well differentiated (left, grade 1); moderately differentiated (middle, grade 2); poorly differentiated (right, grade 3)
Pseudoglandular growth
Low grade keratinizing (A, B); moderate to high grade nonkeratinizing (C); high grade nonkeratinizing tumor (D); and carcinoma with prominent glycogenated clear cells (E)
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Pseudoglandular growth:
Conjunctiva: acantholysis of neoplastic squamous cells
Head and neck: pseudolumina are present but no true glands
Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Flat: hyperkeratosis and acanthosis but also normal maturation without atypia
Papillary: hyperkeratosis, papillomatosis and acanthosis
Pseudoepitheliomatous
AFIP images
Acanthosis, absence
of nuclear atypias
and hyperkeratosis
Contributed by Debra Zynger, M.D.
pTis
pT1a
pT2
pT3
pT3 partial penectomy
pT3 penectomy
pT4 penectomy, orchiectomy and scrotal excision
Contributed by Debra Zynger, M.D.
CIS / PeIN (pTis)
Subepithelial invasion (pT1a)
Perineural invasion (pT1b)
Invasion of corpora spongiosum (pT2)
Inguinal lymph node metastasis (pN1)
AFIP images
Sharply delineated lesion
Two well circumscribed, minimally elevated lesions
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Primary chancre
Atrophic scar with condylomata lata
Secondary rash / lesions:
Palm, limbs and hands
Back
Face, teeth
"Kissing" lesions
Various images
AFIP images
Lesion characterized by acanthosis
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Perivascular dermal infiltrate
Chorioretinitis of congenital syphilis
Darkfield microscopy
Patchy infiltrate
Epithelioid cells surrounded by lymphomono-nuclear cells
Various images
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Spirochete in culture
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Intraurethral paraffin
AFIP images
Granular, elevated
tan white mass
of distal shaft and
coronal sulcus
Contributed by Liwei Jia, M.D., Ph.D. and @JMGardnerMD on Twitter
Verrucous epithelial hyperplasia
Band-like plasma cells
Neutrophilic infiltrates
Foamy histiocytes
Verruciform xanthoma
Amin: 2022
Cheng: 2019
Colecchia : 2016
Epstein: 2020
IARC: 2022
Wobker: 2021
Yang: 2020
Zhou: 2022
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