Penis and scrotum
Squamous cell carcinoma and variants
Pseudohyperplastic carcinoma


Topic Completed: 1 January 2010

Revised: 13 February 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Pseudohyperplastic carcinoma penis
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Cite this page: Chaux A, Cubilla AL. Pseudohyperplastic carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumpseudohypercarcinoma.html. Accessed March 22nd, 2019.
Definition / general
  • 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
  • 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

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
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