Penis & scrotum
General
Grossing & features to report


Topic Completed: 1 June 2014

Minor changes: 4 January 2021

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: Gross penectomy

Shaheed W. Hakim, M.D.
Trevor A. Flood, M.D.
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Cite 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:
    1. 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
    2. Corpora cavernosa separated and surrounded by tunica albuginea and Buck fascia
    3. Skin of shaft with underlying corporal dartos
  • 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
    Benign circumcision specimens:
    • Sample with routine sections (1 - 2) including any grossly identified lesions / abnormalities

    Circumcision specimens containing tumor / suspicious for tumor:
    • 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
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
  • 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
  • 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
  • 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

AFIP images
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Periurethral corpus spongiosum involvement

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Possible sites of involvement

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Tumor involvement in yellow



Images hosted on other servers:
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Penis anatomy

Gross images

Contributed by Shaheed W. Hakim, M.D.
Mapped partial penectomy specimen

Mapped partial penectomy specimen

Foreskin



AFIP images
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SCC involves corpora cavernosa

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Partial penectomy specimen

Microscopic (histologic) images

Contributed by Shaheed W. Hakim, M.D.

Grade 1

Grade 2, more disorganized growth

Grade 3



AFIP images
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Lamina propria invasion

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Urethral mucosal involvement

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