Table of Contents
Grossing - Penectomy specimens | Grossing - Circumcision | Features to report | Diagrams / tables | Gross images | Microscopic (histologic) images | Additional referencesCite this page: Hakim SW, Flood TA. Grossing & features to report. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumgrossingpenect.html. Accessed January 22nd, 2021.
Grossing - Penectomy specimens
- In the fresh state, cut the proximal resection margin en face
- Three important areas of the resection margin need to sampled:
- Proximal urethra and surrounding periurethral cylinder composed of epithelium, subepithelial connective tissue (lamina propria), corpus spongiosum and penile fascia
- The urethra may be retracted but it is important to locate it and submit its circumference entirely
- Corpora cavernosa separated and surrounded by tunica albuginea and Buck fascia
- Skin of shaft with underlying corporal dartos
- Proximal urethra and surrounding periurethral cylinder composed of epithelium, subepithelial connective tissue (lamina propria), corpus spongiosum and penile fascia
- Fix the remaining specimen in 10% buffered formalin overnight
- After fixation, section the glans and shaft longitudinally (sagitally) in two halves, using the meatus and anterior urethra as a guide
- Do NOT probe the urethra as doing so can result in distortion of the urethral mucosa
- If foreskin is present:
- Measure its length and identify the presence / absence of phimosis
- If not affected by tumor, separate the foreskin leaving a 3 mm margin from the coronal sulcus and include it as a circumcision specimen
- Do NOT remove foreskin if it is affected by tumor
- Document the tumor size, location, color, growth pattern and distance from resection margin
- Take a photograph of the specimen showing the maximum tumor depth of invasion
- Map the photograph according to sections submitted
- Section each half longitudinally along the specimens' longest axis, at 3 to 5 mm intervals
- Submit entirely the section which depicts the deepest anatomical level infiltrated by tumor
- If tumor affects multiple anatomical compartments, submit at least three sections of each compartment affected
- Sections should always attempt to include adjacent nontumoral mucosa
Grossing - Circumcision
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Benign circumcision specimens:
- Sample with routine sections (1 - 2) including any grossly identified lesions / abnormalities
- Lightly stretch and pin the specimen to cardboard / sheet of cork
- Fix in 10% buffered formalin overnight
- Measure and describe the specimen, identifying:
- Color, consistency
- Areas of flattening / thickening / indurations
- Describing focal lesions, hemorrhage, exudates and edema
- Describing the tumor and its relation / distance to surgical resection margins
- Ink the mucosal and cutaneous margins of resection with different colors
- Take a photograph of the specimen
- Section the specimen transversally
- Map the photograph according to sections submitted, labeling each section in a clockwise fashion
- Submit the entire tumor and sample each surgical resection margin
- References: Eur Urol 2004;46:434, Am J Surg Pathol 2001;25:1091, Am J Surg Pathol 2003;27:994
Circumcision specimens containing tumor / suspicious for tumor:
Features to report
- Features to report are according to the College of American Pathologists Cancer Protocols (CAP: Cancer Protocol Templates [Accessed 6 April 2018])
- Foreskin: presence and type (Am J Surg Pathol 2003;27:994)
- Uncircumcised
- Phimosis
- Circumcised
- Uncircumcised
- Number of lymph nodes examined and involved
- Specimen size
- Tumor site
- Glans
- Foreskin (mucosal surface or skin surface)
- Coronal sulcus
- Skin of shaft
- Penile urethra
- Tumor size (greatest dimension + additional dimensions)
- Tumor focality
- Unicentric
- Multicentric
- Macroscopic features
- Flat
- Ulcerated
- Polypoid
- Verruciform
- Necrosis
- Hemorrhage
- Tumor deep borders
- Pushing
- Infiltrative
- Anatomic level of involvement: macroscopic and microscopic
- Glans
- Involving subepithelial connective tissue (lamina propria)
- Involving corpus spongiosum
- Involving tunica albuginea
- Involving corpus cavernosum
- Involving distal (penile) urethra
- Foreskin
- Involving subepithelial connective tissue (lamina propria)
- Involving tunica albuginea
- Involving corpus cavernosum
- Involving distal (penile) urethra
- Shaft
- Involves skin
- Involves dartos
- Involves Buck fascia
- Involves corpus spongiosum
- Involves corpus cavernosum
- Involves proximal urethra
- Glans
- Gross assessment of surgical resection margins
- Tumor type (invasive, noninvasive, in situ)
- Histological type
- Squamous cell carcinoma
- Usual
- Basaloid
- Warty
- Verrucous
- Cuniculatum
- Sarcomatoid
- Pseudohyperplastic
- Acantholytic
- Mixed SCCs
- Adenosquamous
- Primary neuroendocrine carcinoma
- Paget disease
- Adnexal carcinoma
- Clear cell carcinoma
- Carcinoma, NOS
- Squamous cell carcinoma
- Histological grade
- Well differentiated (G1)
- Moderately differentiated (G2)
- Poorly differentiated (G3); % present (J Urol 2001;165:1138)
- Tumor thickness
- Lymph - vascular invasion
- Perineural invasion
- Presence of associated lesions
- Squamous hyperplasia
- PeIN (differentiated, basaloid, warty, warty basaloid)
- Lichen sclerosus
- Depth of invasion (Mod Pathol 2001;14:963)
- From deepest malignant cell to highest overlying dermal papilla
- Note: if tumor replaces most of penis, measure tumor thickness from nonkeratinized tumor surface to deepest point of invasion
- Prognostic index optional (Am J Surg Pathol 2009;33:1049)
Diagrams / tables
Gross images
Microscopic (histologic) images
Additional references