Penis & scrotum
Squamous cell carcinoma and variants
Squamous cell carcinoma, NOS
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PubMed Search: Squamous cell carcinoma, NOS penis[TI] free full text[sb]
- NOS: not otherwise specified; i.e. usual histologic pattern
- Represents 48 - 65% of all penile squamous cell carcinomas (Anal Quant Cytol Histol 2007;29:185)
- ICD-O: 8070 / 3
- Also called usual, typical, conventional, classical or epidermoid squamous cell carcinoma
- Mean age 58 years
- Glans is the preferred site but extension to coronal sulcus and inner foreskin is common
- 25% of cases are HPV+ (Am J Surg Pathol 2010;34:104)
- Inguinal nodal metastases in 28 - 39% and recurrences in 28% of all cases
- Intermediate mortality rate (20 - 38%)
- 66 year old man with metastatic disease in pleural effusion (Arch Pathol Lab Med 1992;116:198)
- Predominant growth patterns are vertical and superficial spreading
- Gross aspect is nondistinctive and variable
- Mean tumor size varies from 2 cm in low incidence areas to 4 - 5 cm in high incidence areas
- Cut surface shows tan-white solid irregular tumor with superficial or deep penetration
AFIP images
Exophytic cauliflower-like mass has effaced the glans, which is extensively involved by a multi- nodular mass with focal ulceration
Circumcision
specimen shows
flat, granular,
beige neoplasm
Nodular white tumor extensively involves sulcus
Massive involvement
of the glans, coronal
sulcus and foreskin
Autoamputation of penis
Multiple foci of
ulceration of
foreskin in an
uncircumcised man
Extensive squamous cell carcinoma in situ
Focal infiltration of the corpus spongiosum
Solid yellow-tan neoplasm
Superficial,
white, serrated
papillary
Four separate foci present
Cobblestone appearance representing condyloma
Images hosted on other servers:
Red-tan ulcerated tumor
Fungating mass
- Usually keratinized with moderate differentiation
- Up to 50% of cases are heterogeneous (more than one histological grade)
- Most cases have differentiated penile intraepithelial neoplasia and squamous hyperplasia
- Tumors composed exclusively of extremely well differentiated or poorly differentiated areas are uncommon
- In some cases clear glycogenated cells may predominate (but must differentiate from koilocytes)
- Stroma has variable lymphoplasmacytic infiltrate
- Foreign body type giant cells often seen in highly keratinized tumors
Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Usual type: well differentiated (left, grade 1); moderately differentiated (middle, grade 2); poorly differentiated (right, grade 3)
Mixed (hybrid) usual: verrucous carcinoma
AFIP images
Low grade keratinizing (A, B); moderate to high grade nonkeratinizing (C); high grade nonkeratinizing tumor (D); and carcinoma with prominent glycogenated clear cells (E)
Mucosa involved
by carcinoma
(top); uninvolved
epidermis (bottom)
- Basaloid carcinoma: basophilic cytoplasm, indistinctive cellular borders and mostly HPV+
- Clear cell carcinoma: exclusively composed of high grade large polygonal cells with clear PAS+ cytoplasm, extensive areas of geographical necrosis and HPV+
- Pseudoepitheliomatous hyperplasia: elongated rete ridges, no nuclear atypia, regular epithelial nests with evident peripheral palisading and no stromal reaction
- Urothelial carcinoma: ventral surface of penis, absence of squamous metaplasia, microglandular hyperplasia, lichen sclerosus or penile intraepithelial neoplasia, presence of urothelial carcinoma in situ or history of urothelial CIS or bladder tumor
