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Penis and scrotum

Squamous cell carcinoma and variants

Sarcomatoid carcinoma

 

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

Revised: 25 May 2010, last major update May 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Aggressive variant of penile squamous cell carcinomas composed mostly of anaplastic spindle cells (Am J Surg Pathol 2005;29:1152)

● ICD-O: 8074/3

 

Terminology

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● Also called spindle cell carcinoma

● Rare tumors with distinct sarcoma and carcinoma components are called carcinosarcoma

 

Epidemiology

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● Median age 59 years (range 28-81 years)

 

Sites

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● Preferred site is glans but extension to coronal sulcus and foreskin is not unusual

 

Etiology

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● May occur after radiation therapy; low HPV detection rate

 

Clinical behavior

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● Represents 1-3% of all penile carcinomas (J Urol 2004;172:932)

● High mortality rate (40-75%)

● Inguinal nodal metastases in 75-89% and local recurrence in 67% of all cases

 

Case reports

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● 50 year old man (Indian J Urol 2008;24:267)

 

Gross description (Macroscopy)

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● Large gray-white or red polypoid or fungating mass with frequent ulceration and hemorrhage

● Mean tumor size 3-5 cm (up to 7 cm)

● Cut surface shows deep invasion of corpus spongiosum or corpora cavernosa

● Superficial or deep tumor satellite nodules

 

Gross images

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A polypoid solid mass (A) replaces the glans and surrounds the urethra. In (B) the tumor (red) spares the urethra (u) and meatus (m) but there is extensive involvement of the glans (g) and corpus cavernosum (cc). Nodules of tumor are deep in the shaft of the penis (red), with positive resection margins (rm). The foreskin (f) is edematous.

 

Micro description (Histopathology)

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● Predominantly anaplastic spindle cells resembling fibrosarcoma or leiomyosarcoma

● Occasional giant or multinucleated malignant fibrohistocytoma-like cells

● Foci of usual squamous cell carcinoma present in most cases

● Prominent necrosis and mitotic activity

● Areas of myxoid, chondroid, osteosarcomatous or angiosarcomatous-like changes may be observed

● Penile intraepithelial neoplasia in adjacent mucosa is not uncommon

 

Micro images

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                                                                Figure 1

Aggregate of rounded carcinoma cells                        Biphasic tumor

(top right) and highly atypical spindled

carcinoma cells

 

 

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

                                                               

Composed of anaplastic  tumor cells with                  Resembles angiosarcoma

marked nuclear atypia and pleomorphic

giant cells (lower left). Note the high mitotic

rate and atypical mitotic figures

 

 

Figure 2               

Sarcomatoid areas

are vimentin+

 

Positive stains

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● Cytokeratin, p63, cytokeratin 34bE12

 

Negative stains

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● Muscle-specific actin, desmin, S100

 

Differential Diagnosis

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● Primary penile sarcoma: usually in penile shaft, no squamous differentiation, no penile intraepithelial neoplasia, negative for p63 and keratin 34bE12

● Melanoma: melanin, intraepidermal melanocytic proliferation, nevoid component, positive for S100, MelanA and HMB45, negative for keratin

 

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

 

 

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