Penis and scrotum - Papillary carcinoma

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Penis and scrotum

Squamous cell carcinoma and variants

Papillary carcinoma

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

Revised: 26 May 2010, last major update May 2010 - in progress

Definition

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● Slow growing, low-grade verruciform variant of squamous cell carcinoma representing 5-15% of all penile carcinomas (Anal Quant Cytol Histol 2007;29:185) and 27-53% of all verruciform tumors

● Diagnosis is made after exclusion of other verruciform tumors

● ICD-O: 8050/3

Epidemiology

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● Mean age 57 years (range 26-84 years)

Sites

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● Usually involves glans, possibly with foreskin and coronal sulcus

Etiology

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● Low HPV detection rate (Am J Surg Pathol 2010;34:104)

Clinical behavior

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● Inguinal nodal metastases in 0-25% and local recurrence in 12% of all cases

● Low mortality rate (0-6%, Am J Surg Pathol 2010;34:223)

Gross description (Macroscopy)

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● Usually in glans but extension to coronal sulcus and inner foreskin is common

● Large gray-white exophytic destructive lesion

● Mean tumor size 5.5 cm (range 1-9 cm)

● Cut surface shows pearly white papillomatous tissue, poor demarcation between tumor and stroma

Gross images

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Tumor of foreskin Longitudinal section after removal of foreskin

Note a pearly white superficial neoplasm involving

the ventral portion of the glans

Micro description (Histopathology)

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● Well differentiated papillary squamous neoplasm

● Prominent hyperkeratosis and acanthosis

● Complex papillae with irregular fibrovascular cores

● Irregular/infiltrative tumor base

● Frequent association with squamous hyperplasia (74%), differentiated penile intraepithelial neoplasia (46%) and lichen sclerosus (34%)

● May have keratin cysts and intraepithelial abscesses

● High grade foci are unusual

● No koilocytotic changes

Micro images

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Surface papillarity Well-differentiated papillae Invasion at the base

and focal invasion but no koilocytosis

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

Low-power view of a papillary carcinoma showing complex papillae (some with round and others with spiky tips) with irregular fibrovascular cores, mild to moderate acanthosis, and hyperkeratosis; note the jagged tumor base (lower left field)

Detail of a papilla in a papillary carcinoma; note the irregular fibrovascular core, mild to moderate acanthosis, slight parakeratosis and evident stromal reaction; cells with round nuclei and clear perinuclear spaces should not be confused with koilocytes

Negative stains

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● p16INK4a

Differential Diagnosis

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● Verrucous carcinoma: inconspicuous fibrovascular cores, broad/bulbous boundary of tumor and stroma

● Warty carcinoma: prominent fibrovascular cores, pleomorphic cells with koilocytotic changes

● Squamous cell carcinoma, NOS: no prominent papillary features, most cases are moderately differentiated

● Squamous hyperplasia: no atypia, no stromal reaction, no extension beyond lamina propria

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

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