Penis and scrotum - Pseudohyperplastic squamous cell carcinoma

Home Chapter Home Jobs Conferences Fellowships Books

Penis and scrotum

Squamous cell carcinoma and variants

Pseudohyperplastic carcinoma

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

Revised: 6 May 2010, last major update: January 2010

Definition

=========================================================================

● Nonverruciform, highly differentiated invasive tumor resembling pseudoepitheliomatous hyperplasia

Epidemiology

=========================================================================

● Affects elderly patients (mean age 69 years)

● About a dozen cases have been reported

Sites

=========================================================================

● Preferentially involves inner mucosa of foreskin

● Tends to be multicentric

Clinical features

=========================================================================

● Good prognosis

● Usually no recurrence after excision

● Negative inguinal nodes

Treatment

=========================================================================

● Circumcision or partial penectomy

● Groin dissection is not needed in absence of clinically evident metastatic disease

Gross description (Macroscopy)

=========================================================================

● Often multicentric

● Typically flat or slightly elevated, white and granular, 2 cm

Micro description (Histopathology)

=========================================================================

● Nonverruciform, highly differentiated, downward proliferation of keratinizing nests of squamous cells with minimal atypia

● Squamous pearls in almost all cases

● Most nests are orderly and surrounded by reactive fibrous stroma with variable inflammatory cells

● Tumor cells have eosinophilic cytoplasm with distinct intercellular bridges

● Definite invasion with irregular stromal interface is present, but may need additional sections to identify

● Frequent extension beyond lamina propria

● Adjacent squamous epithelium exhibits squamous hyperplasia and differentiated penile intraepithelial lesion

● Well-developed lichen sclerosus is almost always present (Am J Surg Pathol 2004;28:895)

● Peripheral palisading is not evident

Micro images

=========================================================================

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

There is a downward proliferation of irregular epithelial nests composed of extremely well-differentiated squamous cells with minimal atypia. The surface is flat and there is prominent hyperkeratosis. Note the underlying chronic inflammatory response.

Molecular / cytogenetics description

=========================================================================

● HPV negative in analyzed cases

Differential Diagnosis

=========================================================================

● Pseudoepitheliomatous hyperplasia: regular nests; conspicuous peripheral palisading; scant stromal reaction; no extension beyond lamina propria; no cytological atypia

● Squamous cell carcinoma, usual type: glans penis is preferential location; has irregular nests with moderately differentiated neoplastic cells; the presence of broad areas of highly differentiated tumor is uncommon

● Verrucous carcinoma: exophytic pattern of growth; broad pushing tumor base

End of Penis and scrotum > Squamous cell carcinoma > Pseudohyperplastic variant

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).