Penis and scrotum
Squamous cell carcinoma and variants
Squamous cell carcinoma, NOS

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 4 April 2018, last major update May 2010

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Squamous cell carcinoma, NOS penis[TI] free full text[sb]

Cite this page: Cubilla, A., Chaux, A. Squamous cell carcinoma, NOS. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumSCC.html. Accessed October 16th, 2018.
Definition / general
Terminology
  • Also called usual, typical, conventional, classical or epidermoid squamous cell carcinoma
Epidemiology
  • Mean age 58 years
Sites
  • Glans is the preferred site but extension to coronal sulcus and inner foreskin is common
Etiology
Clinical features
  • Inguinal nodal metastases in 28 - 39% and recurrences in 28% of all cases
  • Intermediate mortality rate (20 - 38%)
Case reports
Gross description
  • Predominant growth patterns are vertical and superficial spreading
  • Gross aspect is nondistinctive and variable
  • Mean tumor size varies from 2 cm in low incidence areas to 4 - 5 cm in high incidence areas
  • Cut surface shows tan-white solid irregular tumor with superficial or deep penetration
Gross images

Images hosted on PathOut server:

Exophytic cauliflower-like mass has effaced the glans, which is extensively involved by a multi- nodular mass with focal ulceration

Circumcision specimen shows
flat, granular, beige neoplasm
involving mucosa of the
foreskin but not the skin

Nodular white tumor extensively involves sulcus

Massive involvement
of the glans, coronal
sulcus and foreskin


Autoamputation of penis

Massive involvement
caused multiple foci of
ulceration of foreskin in
an uncircumcised man

Extensive squamous cell carcinoma in situ

Focal infiltration of the corpus spongiosum

Solid yellow-tan neoplasm


Superficial, white,
serrated papillary
and tan, solid, deeply
invasive components

Four separate foci present

Cobblestone appearance representing condyloma (top)



Images hosted on other servers:

Red-tan ulcerated tumor

Fungating mass

Microscopic (histologic) description
  • Usually keratinized with moderate differentiation
  • Up to 50% of cases are heterogeneous (more than one histological grade)
  • Most cases have differentiated penile intraepithelial neoplasia and squamous hyperplasia
  • Tumors composed exclusively of extremely well differentiated or poorly differentiated areas are uncommon
  • In some cases clear glycogenated cells may predominate (but must differentiate from koilocytes)
  • Stroma has variable lymphoplasmacytic infiltrate
  • Foreign body type giant cells often seen in highly keratinized tumors
Microscopic (histologic) images

Images hosted on PathOut server:

Low grade keratinizing (A, B); moderate to high grade nonkeratinizing (C); high grade nonkeratinizing tumor (D); and carcinoma with prominent glycogenated clear cells (E)

Mucosa involved by
carcinoma at the top,
uninvolved epidermis
at the bottom


Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.

Usual type: well differentiated (left, grade 1); moderately differentiated (middle, grade 2); poorly differentiated (right, grade 3)

Mixed (hybrid) usual - verrucous carcinoma



Images hosted on other servers:

Grade 2

Finger-like projections into dermis

Differential diagnosis
  • Basaloid carcinoma: basophilic cytoplasm, indistinctive cellular borders and mostly HPV+
  • Clear cell carcinoma: exclusively composed of high grade large polygonal cells with clear PAS+ cytoplasm, extensive areas of geographical necrosis and HPV+
  • Pseudoepitheliomatous hyperplasia: elongated rete ridges, no nuclear atypia, regular epithelial nests with evident peripheral palisading and no stromal reaction
  • Urothelial carcinoma: ventral surface of penis, absence of squamous metaplasia, microglandular hyperplasia, lichen sclerosus or penile intraepithelial neoplasia, presence of urothelial carcinoma in situ or history of urothelial CIS or bladder tumor