Difference between revisions of "Squamous cell carcinoma of the penis"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Squamous carcinoma of the penis -- low mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = Squamous carcinoma of the penis. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      =
| Micro      =
| Subtypes  =
| Subtypes  = HPV-related SCC, Non-HPV-related SCC
| LMDDx      =
| LMDDx      = [[penile intraepithelial neoplasia]], [[pseudoepitheliomatous hyperplasia]]
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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| IF        =
| IF        =
| Gross      = mass lesion, scaly patches/nodules, usu. erythematous, +/-ulceration.
| Gross      = mass lesion, scaly patches/nodules, usu. erythematous, +/-ulceration.
| Grossing  =
| Grossing  = [[penectomy]]
| Site      = [[penis]]
| Site      = [[penis]]
| Assdx      =
| Assdx      =
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}}
}}
'''Squamous cell carcinoma of the penis''' is the most common malignancy of the [[penis]].
'''Squamous cell carcinoma of the penis''' is the most common malignancy of the [[penis]].
''Penile cancer'' redirects to this article.


==General==
==General==
*Not very common overall.<ref name=pmid24119832>{{Cite journal  | last1 = Burt | first1 = LM. | last2 = Shrieve | first2 = DC. | last3 = Tward | first3 = JD. | title = Stage presentation, care patterns, and treatment outcomes for squamous cell carcinoma of the penis. | journal = Int J Radiat Oncol Biol Phys | volume = 88 | issue = 1 | pages = 94-100 | month = Jan | year = 2014 | doi = 10.1016/j.ijrobp.2013.08.013 | PMID = 24119832 }}</ref>
*Not very common overall.<ref name=pmid24119832>{{Cite journal  | last1 = Burt | first1 = LM. | last2 = Shrieve | first2 = DC. | last3 = Tward | first3 = JD. | title = Stage presentation, care patterns, and treatment outcomes for squamous cell carcinoma of the penis. | journal = Int J Radiat Oncol Biol Phys | volume = 88 | issue = 1 | pages = 94-100 | month = Jan | year = 2014 | doi = 10.1016/j.ijrobp.2013.08.013 | PMID = 24119832 }}</ref>
*Most common form of penis cancer.
*Most common form of penile cancer.
**Non-squamous penis cancer only ~5% of cases.<ref name=pmid24292119>{{Cite journal  | last1 = Moses | first1 = KA. | last2 = Sfakianos | first2 = JP. | last3 = Winer | first3 = A. | last4 = Bernstein | first4 = M. | last5 = Russo | first5 = P. | last6 = Dalbagni | first6 = G. | title = Non-squamous cell carcinoma of the penis: single-center, 15-year experience. | journal = World J Urol | volume =  | issue =  | pages =  | month = Dec | year = 2013 | doi = 10.1007/s00345-013-1216-y | PMID = 24292119 }}</ref>
**Non-squamous penis cancer only ~5% of cases.<ref name=pmid24292119>{{Cite journal  | last1 = Moses | first1 = KA. | last2 = Sfakianos | first2 = JP. | last3 = Winer | first3 = A. | last4 = Bernstein | first4 = M. | last5 = Russo | first5 = P. | last6 = Dalbagni | first6 = G. | title = Non-squamous cell carcinoma of the penis: single-center, 15-year experience. | journal = World J Urol | volume =  | issue =  | pages =  | month = Dec | year = 2013 | doi = 10.1007/s00345-013-1216-y | PMID = 24292119 }}</ref>


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*Median age ~ 67 years old.
*Median age ~ 67 years old.
*Usually a good outcome - 5 year cause specific survival ~ 81%.<ref name=pmid24119832/>
*Usually a good outcome - 5 year cause specific survival ~ 81%.<ref name=pmid24119832/>
*Possible association with sex with animals.<ref>{{Cite journal  | last1 = Zequi | first1 = Sde C. | last2 = Guimarães | first2 = GC. | last3 = da Fonseca | first3 = FP. | last4 = Ferreira | first4 = U. | last5 = de Matheus | first5 = WE. | last6 = Reis | first6 = LO. | last7 = Aita | first7 = GA. | last8 = Glina | first8 = S. | last9 = Fanni | first9 = VS. | title = Sex with animals (SWA): behavioral characteristics and possible association with penile cancer. A multicenter study. | journal = J Sex Med | volume = 9 | issue = 7 | pages = 1860-7 | month = Jul | year = 2012 | doi = 10.1111/j.1743-6109.2011.02512.x | PMID = 22023719 }}</ref>


==Gross==
==Gross==
*Scaly patches/nodules.
*Scaly patches/nodules.
*Usu. erythematous.
*Usually erythematous.
*+/-Ulceration.
*+/-Ulceration.


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Notes:
Notes:
*Usually grade 2.<ref name=pmid24119832/>
*[[Lymphovascular invasion]] - prognostically important,<ref name=pmid19488760>{{Cite journal  | last1 = Bhagat | first1 = SK. | last2 = Gopalakrishnan | first2 = G. | last3 = Kekre | first3 = NS. | last4 = Chacko | first4 = NK. | last5 = Kumar | first5 = S. | last6 = Manipadam | first6 = MT. | last7 = Samuel | first7 = P. | title = Factors predicting inguinal node metastasis in squamous cell cancer of penis. | journal = World J Urol | volume = 28 | issue = 1 | pages = 93-8 | month = Feb | year = 2010 | doi = 10.1007/s00345-009-0421-1 | PMID = 19488760 }}</ref> and changes the T-stage for pT1a tumours to pT1b.
*[[Lymphovascular invasion]] - prognostically important,<ref name=pmid19488760>{{Cite journal  | last1 = Bhagat | first1 = SK. | last2 = Gopalakrishnan | first2 = G. | last3 = Kekre | first3 = NS. | last4 = Chacko | first4 = NK. | last5 = Kumar | first5 = S. | last6 = Manipadam | first6 = MT. | last7 = Samuel | first7 = P. | title = Factors predicting inguinal node metastasis in squamous cell cancer of penis. | journal = World J Urol | volume = 28 | issue = 1 | pages = 93-8 | month = Feb | year = 2010 | doi = 10.1007/s00345-009-0421-1 | PMID = 19488760 }}</ref> and changes the T-stage for pT1a tumours to pT1b.


DDx:
DDx:
*Squamous dysplasia.
*[[Penile intraepithelial neoplasia]] (squamous dysplasia).
*[[Pseudoepitheliomatous hyperplasia]].
 
===Subtyping===
*''Non-HPV-related squamous cell carcinoma.
**p16 -ve, p53 +ve.{{fact}}
*''HPV-related squamous cell carcinoma''.
**p16 +ve, p53 -ve.{{fact}}
 
===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.<ref name=pmid24119832/>


===Staging===
===Staging===
T-stage:
T-stage:
*pT1a - subepithelial tissue involved, no [[LVI]], not poorly differentiated (G3 or G4).
*pT1a - subepithelial tissue involved, no [[LVI]], not poorly differentiated (G3).
*pT1b - subepithelial tissue involved with [[LVI]] ''or'' poorly differentiated.
*pT1b - subepithelial tissue involved with [[LVI]] ''or'' poorly differentiated.
*pT2 - corpus spongiosum or cavernosum involved.
*pT2 - corpus spongiosum or cavernosum involved.
*pT3 - urethral involvement.
*pT3 - urethral involvement.
*pT4 - adjacent structure(s) involved.
*pT4 - adjacent structure(s) involved.
===Images===
<gallery>
Image: Squamous carcinoma of the penis -- low mag.jpg | Penile SCC - low mag.
Image: Squamous carcinoma of the penis -- high mag.jpg | Penile SCC - high mag.
Image: Squamous carcinoma of the penis - alt -- high mag.jpg | Penile SCC - high mag.
Image: Squamous carcinoma of the penis - 2 -- intermed mag.jpg | Penile SCC - intermed. mag.
Image: Squamous carcinoma of the penis - 2 -- high mag.jpg | Penile SCC - high mag.
</gallery>
==IHC==
*p16 +ve - in types associated with [[HPV]] (basaloid SCC, warty SCC and warty-basaloid SCC).<ref name=pmid22367299>{{Cite journal  | last1 = Cubilla | first1 = AL. | last2 = Lloveras | first2 = B. | last3 = Alemany | first3 = L. | last4 = Alejo | first4 = M. | last5 = Vidal | first5 = A. | last6 = Kasamatsu | first6 = E. | last7 = Clavero | first7 = O. | last8 = Alvarado-Cabrero | first8 = I. | last9 = Lynch | first9 = C. | title = Basaloid squamous cell carcinoma of the penis with papillary features: a clinicopathologic study of 12 cases. | journal = Am J Surg Pathol | volume = 36 | issue = 6 | pages = 869-75 | month = Jun | year = 2012 | doi = 10.1097/PAS.0b013e318249c6f3 | PMID = 22367299 }}</ref>


==Sign out==
==Sign out==
===Biopsy===
<pre>
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.
</pre>
===Resection===
<pre>
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.
</pre>
===All caps===
<pre>
<pre>
TIP OF PENIS, PARTIAL PENECTOMY:
TIP OF PENIS, PARTIAL PENECTOMY:

Latest revision as of 20:19, 21 September 2021

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

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

Penile cancer redirects to this article.

General

  • Not very common overall.[1]
  • Most common form of penile cancer.
    • Non-squamous penis cancer only ~5% of cases.[2]

Epidemiology:[1]

  • Median age ~ 67 years old.
  • Usually a good outcome - 5 year cause specific survival ~ 81%.[1]
  • Possible association with sex with animals.[3]

Gross

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

Microscopic

Features:

Notes:

DDx:

Subtyping

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:

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).[5]

Sign out

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

References

  1. ↑ 1.0 1.1 1.2 1.3 Burt, LM.; Shrieve, DC.; Tward, JD. (Jan 2014). "Stage presentation, care patterns, and treatment outcomes for squamous cell carcinoma of the penis.". Int J Radiat Oncol Biol Phys 88 (1): 94-100. doi:10.1016/j.ijrobp.2013.08.013. PMID 24119832.
  2. ↑ Moses, KA.; Sfakianos, JP.; Winer, A.; Bernstein, M.; Russo, P.; Dalbagni, G. (Dec 2013). "Non-squamous cell carcinoma of the penis: single-center, 15-year experience.". World J Urol. doi:10.1007/s00345-013-1216-y. PMID 24292119.
  3. ↑ Zequi, Sde C.; Guimarães, GC.; da Fonseca, FP.; Ferreira, U.; de Matheus, WE.; Reis, LO.; Aita, GA.; Glina, S. et al. (Jul 2012). "Sex with animals (SWA): behavioral characteristics and possible association with penile cancer. A multicenter study.". J Sex Med 9 (7): 1860-7. doi:10.1111/j.1743-6109.2011.02512.x. PMID 22023719.
  4. ↑ Bhagat, SK.; Gopalakrishnan, G.; Kekre, NS.; Chacko, NK.; Kumar, S.; Manipadam, MT.; Samuel, P. (Feb 2010). "Factors predicting inguinal node metastasis in squamous cell cancer of penis.". World J Urol 28 (1): 93-8. doi:10.1007/s00345-009-0421-1. PMID 19488760.
  5. ↑ Cubilla, AL.; Lloveras, B.; Alemany, L.; Alejo, M.; Vidal, A.; Kasamatsu, E.; Clavero, O.; Alvarado-Cabrero, I. et al. (Jun 2012). "Basaloid squamous cell carcinoma of the penis with papillary features: a clinicopathologic study of 12 cases.". Am J Surg Pathol 36 (6): 869-75. doi:10.1097/PAS.0b013e318249c6f3. PMID 22367299.
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