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Grossing & features to report

Authors: Shaheed W. Hakim, M.D., Trevor A. Flood, M.D.

Last author update: 1 June 2014

Last staff update: 28 November 2022 (update in progress)

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PubMed Search: Gross penectomy

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Table of Contents

Cite this page: Hakim SW, Flood TA. Grossing & features to report. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumgrossingpenect.html. Accessed December 3rd, 2022.

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)