Penis and scrotum - Clear cell carcinoma

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Penis and scrotum

Clear cell carcinoma

Editor: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)

Revised: 4 May 2010, last major update April 2010

Definition

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● Recently described aggressive variant of penile carcinoma

Epidemiology

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● Middle aged men

Sites

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● Foreskin inner mucosa

Etiology

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● Most likely of sweat gland origin

● HPV-16 DNA found in all reported cases

Clinical features

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● All reported patients presented with inguinal nodal metastases with clear cells and sclerotic basement membrane material

Case reports

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● Series of 5 cases is only report to date (Am J Surg Pathol 2004;28:1513)

Treatment

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● Excision with wide surgical margin

Gross description (Macroscopy)

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● Large, exophytic and partially ulcerated

● Size 2.5-5.5 cm

Micro description (Histopathology)

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● Solid proliferation of large neoplastic clear cells

● Marked nuclear atypia

● Extensive geographical necrosis

● Angiolymphatic invasion is common

● Warty PeIN may be found at surface

Positive stains

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● MUC-1, EMA, CEA (most cells), pan-cytokeratin

● PAS+ and d-PAS+ intracytoplasmic material

Differential Diagnosis

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● Clear cell urothelial carcinoma: previous/concurrent history of urothelial carcinoma elsewhere (Int J Urol 2003;10:348), preferential central location, concurrent areas of urothelial carcinoma in situ, positive for urothelial markers (uroplakin-III, thrombomodulin)

● Metastatic renal cell carcinoma: concurrent/previous history of renal carcinoma, deep-seated, shaft location, positive for CD10, RCC, PAX2, PAX8 and CA9 (Actas Urol Esp 2005;29:593)

● Sebaceous carcinoma: foreskin outer skin, smaller nuclei, absence of HPV, PAS negative (Arch Pathol Lab Med 2007;131:1655)

● Warty carcinoma: less aggressive behavior, prominent papillae with condylomatous feature, conspicuous koilocytosis, necrosis not common, negative for MUC-1

● Well-differentiated squamous cell carcinoma with glycogenated (“clear”) cells: “clear” glycogenated cells are usually focal and not prominent, retained squamous maturation, pyknotic nuclei, superficially located, negative for MUC-1

End of Penis and scrotum > Penis > Clear cell carcinoma

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