Penis & scrotum

Squamous cell carcinoma and variants

Squamous cell carcinoma, NOS

Last author update: 1 May 2010
Last staff update: 28 October 2020

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PubMed Search: Squamous cell carcinoma, NOS penis[TI] free full text[sb]

Alcides Chaux, M.D.
Antonio L. Cubilla, M.D.
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Cite this page: Chaux A, Cubilla AL. Squamous cell carcinoma, NOS. website. Accessed May 18th, 2022.
Definition / general
  • 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
Clinical features
  • Inguinal nodal metastases in 28 - 39% and recurrences in 28% of all cases
  • Intermediate mortality rate (20 - 38%)
Case reports
Gross description
  • 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
Gross images

AFIP images

Exophytic cauliflower-like mass has effaced the glans, which is extensively involved by a multi- nodular mass with focal ulceration

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

white, serrated

Four separate foci present

Cobblestone appearance representing condyloma

Images hosted on other servers:

Red-tan ulcerated tumor

Fungating mass

Microscopic (histologic) description
  • 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
Microscopic (histologic) images

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)

Differential diagnosis
  • 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
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