Penis and scrotum - Adenosquamous carcinoma

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Penis and scrotum

Squamous cell carcinoma and variants

Adenosquamous carcinoma

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

Revised: 5 May 2010, last major update April 2010

Definition

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● Mixed tumor composed of neoplastic squamous nests intermingled with areas of glandular differentiation

● ICD-0: 8560/3

Epidemiology

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● 1-2% of all penile carcinomas (Anal Quant Cytol Histol 2007;29:185)

● Mean age of 55 years (range 30-74 years)

Sites

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● Most common site is glans but extension to coronal sulcus and inner foreskin is common

Etiology

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● May originate in misplaced glandular cells in perimeatal region, in metaplastic goblet cells of foreskin mucosa or as aberrant differentiation of squamous epithelium

Clinical behavior

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● Local recurrence in up to 25% and inguinal nodal metastases in 43-50% of cases

● Low mortality rate (0-14%)

Case reports

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● 3 patients (ages 37, 72 and 74 years) with superficial tumors (Am J Surg Pathol 1996;20:156)

Gross description (Macroscopy)

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● Firm, gray-white, granular tumor

Gross images

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A: Deep invasion of lamina propria and corpus spongiosum

B: Diagram shows mostly squamous neoplasm (red) with focal glandular differentiation (green)

Micro description (Histopathology)

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● Squamous cell and glandular patterns, with squamous cell pattern usually predominating

● Both components are usually discrete but mixtures can be found

● Glands produce intraluminal and intracellular mucin

● Frequent presence of penile intraepithelial neoplasia in adjacent mucosa

Micro images

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Infiltrating tumor has squamous Glandular portion is CEA+

and glandular features

Contributed by Dr. Alcides Chaux and Dr. Antonio Cubilla:

Deeply infiltrative, solid high-grade squamous nests (left upper field)

intermingled with areas showing glandular differentiation (right lower field)

Cervix:

Various images

Poorly formed glands and squamous components (arrows)

Pancreas:

Mucicarmine CK 5/6

Positive stains

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● CEA in glandular portion

● p63 in squamous component

● 34bE12 in both components

Differential Diagnosis

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● Adenosquamous (mucoepidermoid) carcinoma of urethra: ventral in penis, restricted to periurethral tissue and corpus cavernosa

● Littre gland adenocarcinoma: ventral in penis, restricted to periurethral tissue and corpus cavernosa

● Metastatic disease: usually involves shaft, tumor emboli present (Int J Surg Pathol 2010 Jan 14 [Epub ahead of print])

● Mucoepidermoid carcinoma: mixed tumor with mucin, but no glandular or ductal structures

● Pseudoglandular (acantholytic, adenoid) carcinoma: prominent acantholysis simulates glandular spaces but lining is composed of squamous epithelium; spaces contain necrotic debris and keratin, not mucin

End of Penis and scrotum > Squamous cell carcinoma and variants > Adenosquamous carcinoma

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