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Penis and scrotum
Squamous cell carcinoma and variants
Squamous cell carcinoma - general

Reviewer: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Reviewers page)
Revised: 25 May 2013, last major update April 2010
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

See also specific variants described separately

General
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Diagrams
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Schematic representation of effect of anatomic level of invasion on risk of lymph node metastasis in carcinoma of the glans:
Each dot represents an individual case in a series of 51 cases, green representing cases without lymph node metastasis and the red, cases with lymph node metastasis
Note the propensity for the latter cases to spread into the deep corpus spongiosum or corpus cavernosum
The converse is true for the cases represented by the green dots (lp-lamina propria, scs-superficial corpus spongiosum, dcs-deep corpus spongiosum, cc-corpus cavernosum)


Schematic representation of effect of anatomic depth of invasion on risk of lymph node metastasis in carcinoma arising from the mucosa of the foreskin:
Each dot represents an individual case in a series of 20 cases, green dots representing cases without lymph node metastasis and the red dots, cases with lymph node metastasis
Note the tendency for most of the former to invade no deeper than the superficial dartos and the spread to deep dartos or beyond of all cases with lymph node metastasis (m-mucosa, lp-lamina propria, sd-superficial dartos, dd-deep dartos, dm-dermis, e-epidermis)


Possible sites of resection margin involvement at time of frozen section
Left: possible sites of involvement; purple dots indicate the usual sites of positive margins (u-urethra, lp-lamina propria, cs-corpus spongiosum, bf-Buck’s fascia)
Right: urethral mucosal involvement


Verruciform lesions:

A: Verrucous carcinoma - regular papillae with broad bulbous bases and prominent hyperkeratosis (red); keratinized cysts are present (seen on cross section at base)
B: Papillary carcinoma, not otherwise specified - papillae that are more irregular than in A, many with fibrovascular cores; infiltration present at base and koilocytosis is absent
C: Giant condyloma - arborescent hyperkeratotic papillae with broad bases and koilocytosis (indicated by the white dots) at the surface
D: Warty (condylomatous) carcinoma - papillae are more irregular than in C, koilocytosis is diffuse and interface between tumor and stroma is irregular


Frozen section evaluation of surgical margins:

A: Periurethral corpus spongiosum involvement by carcinoma (ca-yellow, u-urethra, cc-corpos cavernosa, fas-Buck’s fascia)
B: Squamous cell carcinoma involves the corpora cavernosa with the left more involved than the right; urethra (bottom) uninvolved
C: B showing tumor involvement in yellow (ca-carcinoma, a-tunica albuginea, cc-corpus cavernosum, cs-corpus spongiosum, u-urethra)

Epidemiology
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Risk factors
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HPV related squamous cell carcinoma
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Sites
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Clinical features and outcome
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Poor prognostic factors
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Treatment
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Clinical images
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Arising on genital lichen sclerosus

Papillary SCC

Ulcerated SCC on glans


Verrucous carcinoma

Gross description
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Gross images
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Glans:

An exophytic cauliflower-like mass

Glans extensively involved by a multi-
nodular mass with focal ulceration


Foreskin:

A circumcision specimen shows a flat, granular and beige
neoplasm involving the mucosa of the foreskin but not the skin

Massive involvement has caused
multiple foci of ulceration


Coronal sulcus:

Nodular white tumor extensively involves the sulcus

Cut section shows two discrete nodules of tumor;
glans to left and the foreskin to right;
nodule to the left is in sulcus, the one on the right involves foreskin


Multiple compartments:

Massive involvement of glans, coronal sulcus and foreskin with complete
effacement of the corpus spongiosum, sparing the urethra
Penis had been destroyed by the cancer, necessitating an emasculating procedure

Massive involvement has resulted in autoamputation
Patient had penile lesion for 11 years but declined treatment

Four separate foci of carcinoma are present (red in diagram on right):
the larger neoplasm is located in the ventral glans (g) and is exophytic; three
smaller flat lesions involve the glans, coronal sulcus (cos) and mucosa of the foreskin (f)


Superficial spreading squamous cell carcinoma:

Tumor involves the glans with extension to coronal sulcus; there is an abnormal white
to erythematous abnormality of the glans mucosa, which is extensive squamous cell
carcinoma in situ with a minor foci of invasion of epithelial compartments: mucosa of
foreskin (f), glans (g) and coronal sulcus (cos); urethra (u), meatus (m), and skin of shaft (s) not involved


The tumor is white, involves the mucosa of the foreskin and coronal sulcus and
completely covers the glans; there is focal superficial infiltration of the corpus spongiosum;
diagram shows (red) widespread involvement


Vertical growth squamous cell carcinoma:

A solid yellow-tan neoplasm in the dorsal half of the glans (top)
Diagram shows that the neoplasm (in red) replaces the corpus spongiosum
of the dorsal glans and is present at the interface with the tunica albuginea (a)
Foreskin (f), meatus (m), urethra (u), and corpus cavernosum (cc) are not compromised


Verruciform lesions:

Verrucous carcinoma: A large, destructive, cauliflower-like mass has extensively replaced the penis


Mixed low- and high-grade squamous cell carcinoma:

Neoplasm shows superficial, white, serrated papillary and tan, solid, deeply invasive components
In the diagram, glans surface is completely covered dorsally by a thickened solid tissue (dark blue),
which corresponds to the squamous hyperplasia (sh); a papillary exophytic appearance just below
the meatus (in mixed blue-red-black colors) corresponds to a low-grade papillary carcinoma (pca)
and a serrated benign papillary hyperplasia (ph) (lower part); most of the corpus spongiosum,
including its periurethral and meatal (m) components, is replaced by a high-grade carcinoma (red)
Surgical margins are positive ventral to the urethra (u)


Assessment of depth of invasion:

Penile carcinoma has been transversely sectioned showing
differing depths of invasion of crucial anatomic compartments
Note involvement of corpora cavernosa (central two slices), urethra
and periurethral corpus spongiosum (top), and Buck’s fascia (top and bottom)


Assessment of depth of invasion of tumor in resected specimen:
A close-up of the bottom portion of the top specimen is seen


Margin involvement:

Frozen section evaluation of surgical margins
A: Periurethral corpus spongiosum involvement by carcinoma (ca-yellow, u-urethra, cc-corpos cavernosa, fas-Buck’s fascia)
B: Squamous cell carcinoma involves the corpora cavernosa, with the left more involved than the right; urethra (bottom) uninvolved
C: B showing tumor involvement in yellow (ca-carcinoma, a-tunica albuginea, cc-corpus cavernosum, cs-corpus spongiosum, u-urethra)

Micro description
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Micro images
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Depth of invasion

Various histologic subtypes

Mucosa is involved by carcinoma at the
top but epidermis (bottom) is spared


Grade 1

Grade 2

Grade 3


Tumor embolus

Invasion of the lamina propria with
sparing of the corpus spongiosum (left)


EGFR+

Positive stains
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Molecular description
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End of Penis and scrotum > Squamous cell carcinoma and variants > Squamous cell carcinoma - general


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