Penis and scrotum - Squamous cell carcinoma

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Penis and scrotum

Neoplastic lesions of scrotum

Squamous cell carcinoma of scrotum

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

Revised: 24 May 2010, last major update May 2010

Definition

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● Most common type of primary scrotal cancer

Epidemiology

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● Mean age 62 years

● Dramatic decrease in incidence in US in past 50 years

Etiology

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Risk factors

● Occupational exposure: chimney sweeps, paraffin workers, tar workers, cotton mill workers, machine operators in engineering, screw-making workers, automatic lathe operators, petroleum wax pressmen and truck drivers

● Poor hygiene

● PUVA treatment, radiotherapy

● HPV infection in about 50% of cases

Clinical features

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● Solitary, slow-growing lesion, frequently ulcerated

● Left side and anterolateral aspect of scrotum in occupational cases

● Nodal metastases present in 50% of enlarged inguinal nodes

Staging

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TNM staging is same as nonmelanotic skin tumors, click here

Lowe's staging:

A1: Localized to scrotum

A2: Locally extensive involving adjacent structures, including testis, spermatic cord,

penis, pubic bone or perineum

B: Metastases to inguinal lymph nodes

C: Metastases to pelvic lymph nodes

D: Metastases to distant organs

References: J Urol 1983;130:423

Case reports

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● 58 year old man with scrotal warts and ulcers (The Internet Journal of Urology 2007;4(2))

● 63 year old with tumor arising from a surgical scar (Ann R Coll Surg Engl 2007;89:W17)

Treatment

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● Wide local excision with bilateral lymphadenectomy

Clinical images

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Tumor at junction of scrotum and penis Large bosselated mass. AFIP image

Smaller lesion present on right scrotum courtesy of Dr. S. F. Cramer,

Patient was a corkstone maker Rochester, New York

Scrotal ulcer and warts

Gross description (Macroscopy)

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● Red plaque or white-gray granular lesion

● Rarely has exophytic growth

Micro description (Histopathology)

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● Most cases are well to moderately differentiated squamous cell carcinoma of the usual type

● Verrucous, sarcomatoid, warty, basaloid and papillary variants may be seen

● Scrotal intraepithelial neoplasia frequently found

Micro images

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Well, moderately and poorly differentiated tumors Perineural invasion

AFIP images courtesy of Dr. A. Cubilla, Paraguay

End of Penis and scrotum > Neoplastic lesions of scrotum > Squamous cell carcinoma

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