Penis & scrotum
Squamous cell carcinoma and variants
HPV independent squamous cell carcinoma
Papillary carcinoma
Authors: Alcides Chaux, M.D., Antonio L. Cubilla, M.D.
Last author update: 1 May 2010
Last staff update: 28 October 2020
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Papillary carcinoma penis
Table of Contents
Definition / general | Epidemiology | Sites | Etiology | Clinical features | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Negative stains | Differential diagnosisCite this page: Chaux A, Cubilla AL. Papillary carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumpenispap.html. Accessed June 1st, 2023.
Definition / general
- Slow growing, low grade verruciform variant of squamous cell carcinoma representing 5 - 15% of all penile carcinomas (Anal Quant Cytol Histol 2007;29:185) and 27 - 53% of all verruciform tumors
- Diagnosis is made after exclusion of other verruciform tumors
- ICD-O: 8050 / 3
Epidemiology
- Mean age 57 years (range 26 - 84 years)
Sites
- Usually involves glans, possibly with foreskin and coronal sulcus
Etiology
- Low HPV detection rate (Am J Surg Pathol 2010;34:104)
Clinical features
- Inguinal nodal metastases in 0 - 25% and local recurrence in 12% of all cases
- Low mortality rate (0 - 6%, Am J Surg Pathol 2010;34:223)
Gross description
- Usually in glans but extension to coronal sulcus and inner foreskin is common
- Large gray-white exophytic destructive lesion
- Mean tumor size 5.5 cm (range 1 - 9 cm)
- Cut surface shows pearly white papillomatous tissue, poor demarcation between tumor and stroma
Gross images
AFIP images
Tumor of foreskin
Longitudinal section after removal of foreskin
Microscopic (histologic) description
- Well differentiated papillary squamous neoplasm
- Prominent hyperkeratosis and acanthosis
- Complex papillae with irregular fibrovascular cores
- Irregular / infiltrative tumor base
- Frequent association with squamous hyperplasia (74%), differentiated penile intraepithelial neoplasia (46%) and lichen sclerosus (34%)
- May have keratin cysts and intraepithelial abscesses
- High grade foci are unusual
- No koilocytotic changes
Microscopic (histologic) images
Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Complex papillae
Papilla
AFIP images
Surface papillarity and focal invasion
Well differentiated papillae but no koilocytosis
Invasion at the base
Negative stains
Differential diagnosis
- Squamous cell carcinoma, NOS: no prominent papillary features, most cases are moderately differentiated
- Squamous hyperplasia: no atypia, no stromal reaction and no extension beyond lamina propria
- Verrucous carcinoma: inconspicuous fibrovascular cores, broad / bulbous boundary of tumor and stroma
- Warty carcinoma: prominent fibrovascular cores, pleomorphic cells with koilocytotic changes
