Penis and scrotum
Squamous cell carcinoma and variants
Pseudohyperplastic carcinoma

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

Revised: 5 April 2018, last major update January 2010

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Pseudohyperplastic carcinoma penis

Cite this page: Cubilla, A., Chaux, A. Pseudohyperplastic carcinoma. website. Accessed December 15th, 2018.
Definition / general
  • Nonverruciform, highly differentiated invasive tumor resembling pseudoepitheliomatous hyperplasia
  • Affects elderly patients (mean age 69 years)
  • About a dozen cases have been reported
  • Preferentially involves inner mucosa of foreskin
  • Tends to be multicentric
Clinical features
  • Good prognosis
  • Usually no recurrence after excision
  • Negative inguinal nodes
  • Circumcision or partial penectomy
  • Groin dissection is not needed in absence of clinically evident metastatic disease
Gross description
  • Often multicentric
  • Typically flat or slightly elevated, white and granular, 2 cm
Microscopic (histologic) description
  • Nonverruciform, highly differentiated and 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
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.

Well differentiated
squamous cells
with minimal atypia

Molecular / cytogenetics description
  • HPV- in analyzed cases
Differential diagnosis
  • Pseudoepitheliomatous hyperplasia: regular nests, conspicuous peripheral palisading, scant stromal reaction, no extension beyond lamina propria and 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