Penis: Incisional Biopsy, Excisional Biopsy, Partial Penectomy, Total Penectomy, Circumcision

Surgical Pathology Cancer Case Summary (Checklist)

Procedure

____ Incisional biopsy

____ Excisional biopsy

____ Partial penectomy

____ Total penectomy

____ Circumcision

____ Other (specify): ______________________________

____ Not specified

Foreskin (Presence and Type) (select all that apply)

____ Present (uncircumcised)

^*____ Short

^*____ Medium

^*____ Long

^*____ Phimotic

____ Not identified (circumcised)

____ Cannot be determined

Lymphadenectomy

____ Not applicable

____ Sentinel node biopsy

____ Inguinal (superficial and deep)

____ External iliac

____ Pelvic nodes

____ Other (specify): _____________________________

Lymph Node Sampling

Number of involved lymph nodes: __________

Total number of lymph nodes examined: __________

Specimen Size

Specify: __________ x __________ cm

Tumor Site (if multiple sites are involved, select all that apply)

____ Glans

____ Foreskin mucosal surface

____ Foreskin skin surface

____ Coronal sulcus (balanopreputial sulcus)

____ Skin of the shaft

____ Penile urethra

Tumor Size

Greatest dimension: __________ cm

^*Additional dimensions: _________ x _____ cm

^*Tumor Focality

^*____ Unicentric

^*____ Multicentric

^*Tumor Macroscopic Features (select all that apply)

^*____ Flat

^*____ Ulcerated

^*____ Polypoid

^*____ Verruciform

^*____ Necrosis

^*____ Hemorrhage

^*____ Other (specify): _____________________________

^*Tumor Deep Borders (select all that apply)

^*____ Pushing (broadly base)

^*____ Infiltrative (jagged)

^*____ Other (specify): _____________________________

^*Macroscopic Extent of Tumor (select all that apply)

^*In the glans

^*____ Tumor involves lamina propria

^*____ Tumor involves corpus spongiosum

^*____ Tumor involves tunica albuginea

^*____ Tumor involves corpus cavernosum

^*____ Tumor involves distal (penile) urethra

^*____ Not applicable

^*In the foreskin

^*____ Tumor involves lamina propria

^*____ Tumor involves dartos

^*____ Tumor involves preputial skin

^*____ Not applicable

^*In the shaft

^*____ Tumor involves skin

^*____ Tumor involves dartos

^*____ Tumor involves Buck fascia

^*____ Tumor involves corpus spongiosum

^*____ Tumor involves corpus cavernosum

^*____ Tumor involves proximal urethra

^*____ Not applicable

Macroscopic Assessment of Resection Margins (select all that apply)

____ Cannot be assessed

____ Grossly uninvolved

____ Grossly involved (specify for penectomy or circumcision specimen below)

For penectomy specimens

____ Urethral

____ Periurethral tissues (lamina propria, corpus spongiosum, Buck fascia)

____ Corpora cavernosa

____ Buck fascia at penile shaft

____ Skin

____ Other (specify): __________________

For circumcision specimens

____ Coronal sulcus margin

____ Cutaneous margin

Histologic Type (select all that apply)

____ Squamous cell carcinoma (SCC)

____ Usual (keratinizing)

____ Basaloid

____ Verrucous

^*____ Cuniculatum

^*____ Papillary, not otherwise specified (NOS)

____ Sarcomatoid

^*____ Pseudohyperplastic

^*____ Acantholytic (pseudoglandular)

^*____ Mixed SCCs

____ Adenosquamous

____ Primary neuroendocrine carcinoma

____ Paget disease

____ Adnexal carcinoma (specify type): __________________________

Clear cell carcinoma

____ Carcinoma, type cannot be determined

____ Other (specify): _____________________________

Histologic Grade

____ Not applicable

____ GX: Cannot be assessed

____ G1: Well differentiated

____ G2: Moderately differentiated

____ G3: Poorly differentiated

Microscopic Tumor Extension (select all that apply)

Anatomical levels

In the glans

____ Tumor involves lamina propria

____ Tumor involves corpus spongiosum

____ Tumor involves tunica albuginea

____ Tumor involves corpus cavernosum

____ Not applicable

In the coronal sulcus

____ Tumor involves lamina propria

____ Tumor involves dartos

____ Tumor involves Buck fascia

____ Not applicable

In the foreskin

____ Tumor involves lamina propria

____ Tumor involves dartos

____ Tumor involves preputial skin

____ Not applicable

In the shaft

____ Tumor involves skin

____ Tumor involves dartos

____ Tumor involves Buck fascia

____ Tumor involves corpus spongiosum

____ Tumor involves corpus cavernosum

____ Not applicable

Other extension

____ Penile (distal) urethra

____ Proximal urethra

____ Prostate

____ Scrotum

____ Regional skin (pubis, inguinal)

^*Tumor Thickness/Depth

^*Specify: __________ mm

Margins of Resection (select all that apply)

____ Cannot be assessed

____ Histologically uninvolved

____ Histologically involved (specify for penectomy or circumcision specimens below)

For penectomy specimens

____ Urethral

____ Periurethral tissues (lamina propria, corpus spongiosum, Buck fascia)

____ Corpus cavernosum

____ Buck fascia at penile shaft

____ Skin

____ Other (specify): _____________________________

For circumcision specimens

____ Coronal sulcus margin

____ Cutaneous margin

Lymph-Vascular Invasion

____ Not identified

____ Present

____ Indeterminate

Perineural Invasion

____ Not identified

____ Present

____ Indeterminate

Pathologic Staging (pTNM)

TNM descriptors (required only if applicable) (select all that apply)

____ m (multiple primary tumors)

____ r (recurrent)

____ y (posttreatment)

Primary tumor (pT)

____ pTX: Primary tumor cannot be assessed

____ pT0: No evidence of primary tumor

____ pTis: Carcinoma in situ

____ pTa: Noninvasive verrucous carcinoma†

____ pT1a: Tumor invades subepithelial connective tissue without lymph vascular invasion and is not poorly differentiated (i.e., grade 3-4)

____ pT1b: Tumor invades subepithelial connective tissue with lymph vascular invasion or is poorly differentiated

____ pT2: Tumor invades corpus spongiosum or cavernosum

____ pT3: Tumor invades urethra

____ pT4: Tumor invades other adjacent structures

†Broad pushing penetration (invasion) is permitted, but destructive invasion argues against this diagnosis.

Regional lymph nodes (pN)

____ pNX: Regional lymph nodes cannot be assessed

____ pN0: No regional lymph node metastasis

____ pN1: Metastasis in a single inguinal lymph node

____ pN2: Metastasis in multiple or bilateral inguinal lymph nodes

____ pN3: Extranodal extension of lymph node metastasis or pelvic lymph node(s) unilateral or bilateral

Distant metastasis (pM)

____ Not applicable

____ pM1: Distant metastasis†

†Lymph node metastasis outside of the true pelvis in addition to visceral or bone sites

^*Additional Pathologic Findings (select all that apply)

^*____ None identified

^*____ Penile intraepithelial neoplasia (PeIN)

^*____ Differentiated (simplex)

^*____ Warty

^*____ Basaloid

^*____ Mixed (warty/basaloid)

^*____ Other (specify): ___________________________

^*____ Focal

^*____ Multifocal

^*____ Margins uninvolved

^*____ Margins involved (specify margin): _____________________________

^*____ Lichen sclerosus

^*____ Squamous hyperplasia

^*____ Condyloma acuminatum

^*____ Other (specify): _____________________________

^*Ancillary Studies

^*Specify: _____________________________

^*____ Not performed

^* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Carcinoma of the Penis.” Under development.