Penectomy grossing

Penectomy is the total or partial removal of the penis.

Introduction

It is done for penile cancer.

Orientation/anatomy note

• Dorsal aspect of penis = where the corpora cavernosa are; "anterior" when the penis is limp and hanging downward.
• Ventral aspect of penis = where the urethra/frenulum are; "posterior" when the penis is limp and hanging downward.

Opening

• +/-Insert probe into urethra from the proximal aspect (surgical margin).
• No cutting necessary. ‡
• Place in formulin.

Notes:

• ‡ Lester (2nd Ed.) suggests opening along the urethra on the ventral aspect prior to fixation.

Protocol

Dimensions, weight and inking:

• Type: [partial penectomy / penectomy].
• Size of specimen (length, left-right, dorsal-ventral): ___ x ___ x ___ cm.
• Foreskin size (length, thickness): ___ x ___ cm.
• Inking of margin: [colour].

Tumour:

• Dimensions (length, left-right, dorsal-ventral): ___ x ___ x ___ cm.
• Location: [glans / coronal sulcus].
• Colour: [tan / white].
• Growth pattern: [friable / fungating / papillary / verrucous / ulcerated].
• Consistency: [friable / soft / rubbery / hard ].
• Circumscription: [well demarcated / pushing border / infiltrative border].
• Hemorrhage: [present / absent].
• Necrosis: [present / absent].
• Margin: [nearest margin ___, distance ___ cm / positive margin, location ___].
• Extension into:
  • Frenulum: [absent / suspicious / present].
  • Glans penis: [absent / suspicious / present].
  • Corpora cavernosa: [absent / suspicious / present].
  • Corpora spongiosum: [absent / suspicious / present].
  • Urethra: [absent / suspicious / present].

Representative sections:

• Resection margin on edge serially sectioned.

Protocol notes

• Margin inked.
• A slice is cut-off the penis at the site of the resection margin. This slice is then divided into left and right with a sagittal cut. Each portion (left and right) is sectioned with parasagittal cuts such that it is submitted as an on edge margin. ‡
• The glans penis should be cut in the midline in the sagittal plane, and parasagittally.

Alternate approaches

• ‡ The CAP protocol for Penis (Version 3.2.0.0) suggests taking the margin en face.