Squamous cell carcinoma of the penis

Squamous cell carcinoma of the penis is the most common malignancy of the penis.

Squamous cell carcinoma of the penis
Diagnosis in short
Squamous carcinoma of the penis. H&E stain.
Subtypes	HPV-related SCC, Non-HPV-related SCC
LM DDx	penile intraepithelial neoplasia, pseudoepitheliomatous hyperplasia
Gross	mass lesion, scaly patches/nodules, usu. erythematous, +/-ulceration.
Grossing notes	penectomy
Site	penis
Clinical history	uncircumcised
Prevalence	uncommon overall, most common form of penis cancer
Prognosis	good
Treatment	surgery

Penile cancer redirects to this article.

General

• Not very common overall.
• Most common form of penile cancer.
  • Non-squamous penis cancer only ~5% of cases.

Epidemiology:

• Median age ~ 67 years old.
• Usually a good outcome - 5 year cause specific survival ~ 81%.
• Possible association with sex with animals.

Gross

• Scaly patches/nodules.
• Usually erythematous.
• +/-Ulceration.

Microscopic

Features:

• See squamous cell carcinoma.

Notes:

• Lymphovascular invasion - prognostically important, and changes the T-stage for pT1a tumours to pT1b.

DDx:

• Penile intraepithelial neoplasia (squamous dysplasia).
• Pseudoepitheliomatous hyperplasia.

Subtyping

• Non-HPV-related squamous cell carcinoma.
  • p16 -ve, p53 +ve.^{[citation needed]}
• HPV-related squamous cell carcinoma.
  • p16 +ve, p53 -ve.^{[citation needed]}

Grading

• G1 - well differentiated. §
  • Almost normal appearing - diagnosis of malignancy may be challenging.
• G2 - moderately differentiated. §
• G3 - poorly differentiated.
  • Anaplastic cells.
  • Typically little or no keratinization.
• GX - cannot be assessed.

Notes:

• § The differentiation between G1 and G2 is similar to squamous cell carcinoma of the head and neck.
• G2 (moderately differentiated) is the most common.

Staging

T-stage:

• pT1a - subepithelial tissue involved, no LVI, not poorly differentiated (G3).
• pT1b - subepithelial tissue involved with LVI or poorly differentiated.
• pT2 - corpus spongiosum or cavernosum involved.
• pT3 - urethral involvement.
• pT4 - adjacent structure(s) involved.

Images

• 

  Penile SCC - low mag.

• 

  Penile SCC - high mag.

• 

  Penile SCC - high mag.

• 

  Penile SCC - intermed. mag.

• 

  Penile SCC - high mag.

IHC

• p16 +ve - in types associated with HPV (basaloid SCC, warty SCC and warty-basaloid SCC).

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Biopsy

Penis, Biopsy:
- INVASIVE SQUAMOUS CELL CARCINOMA, well differentiated.

Comment:
The tumour has differentiated penile intraepithelial neoplasia adjacent to it. The tumour is p16 negative and p53 positive.

Resection

Tip of Penis, Partial Penectomy:
- Invasive squamous cell carcinoma, moderately differentiated (G2).
-- Invasion into the lamina propria.
-- Surgical margins negative for dysplasia and negative for malignancy.
-- TNM stage: pT1a pNx.
-- Please see tumour summary.

All caps

TIP OF PENIS, PARTIAL PENECTOMY:
- INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED.
-- SURGICAL MARGINS NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.

TIP OF PENIS, PARTIAL PENECTOMY:
- INVASIVE SQUAMOUS CELL CARCINOMA OF CORONAL SULCUS, MODERATELY DIFFERENTIATED.
-- SURGICAL MARGINS NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
- LICHEN SCLEROSIS.
- POST-SURGICAL CHANGES (GRANULOMATOUS INFLAMMATION (NON-NECROTIZING), SIDEROPHAGES).

COMMENT:
This lesion was previously excised. The surgical clearance is 1 mm. The tumour 
thickness is approximately 4 mm. No lymphovascular invasion is identified. No 
lymphovascular invasion is identified. No corpus spongiosum or corpus cavernosum
invasion is seen. The staging is unchanged.

See also

• Penis.
• Squamous cell carcinoma.