Penectomy grossing

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Penectomy grossing deals with the cut-up of penile surgical specimens. It includes both total and partial penectomies.

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 formalin.

Notes:

  • ‡ Lester (2nd Ed.) suggests opening along the urethra on the ventral aspect prior to fixation.[1]

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.
  • Sagittal section of glans penis.
  • Parasagittal sections of glans penis (left, right).
  • Tumour - 1 section/cm.

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.[2]

Alternate approaches

See also

Related protocols

References

  1. Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 549-550. ISBN 978-0443066450.
  2. Cubilla, AL.; Piris, A.; Pfannl, R.; Rodriguez, I.; Agüero, F.; Young, RH. (Aug 2001). "Anatomic levels: important landmarks in penectomy specimens: a detailed anatomic and histologic study based on examination of 44 cases.". Am J Surg Pathol 25 (8): 1091-4. PMID 11474296.
  3. URL: http://www.cap.org/web/home/resources/cancer-reporting-tools/cancer-protocol-templates. Accessed on: 2 March 2015.