Sarcomatoid Carcinoma, Penis
Elsa F. Velazquez, MD
Antonio L. Cubilla, MD
Key Facts
Terminology
-
Synonyms
-
Spindle cell carcinoma, carcinosarcoma
-
Macroscopic Features
-
Large polypoid mass usually affecting glans, coronal sulcus, and foreskin
-
Deeply invading into corpora spongiosa and cavernosa
-
Separate satellite nodules may be present
Microscopic Pathology
-
Predominantly composed of atypical spindle cells disposed in interlacing fascicles
-
Myxoid changes may be marked
-
Pseudovascular spaces may be prominent mimicking angiosarcoma
-
Carcinoma in situ or clear-cut invasive SCC may be only very focally present
Ancillary Tests
-
Immunohistochemical studies are often necessary to make diagnosis
-
Spindle cells are positive for vimentin, cytokeratins, and p63
-
Cytokeratin expression (especially PAN-CK[AE1/AE3] and Cam5.2) by spindle cells may be only focal
-
PAN-CK(AE1/AE3) and HMCK(34βE12) tend to be more diffusely expressed by spindle cells
-
Top Differential Diagnoses
-
Spindle cell melanoma
-
Sarcoma
Partial penectomy specimen shows a large and hemorrhagic, deeply invasive tumor  arising from the distal portion of the organ. The tumor extensively invades the corpora cavernosa  . |
This sarcomatoid carcinoma is predominantly composed of fascicles of atypical spindle cells with pleomorphic nuclei and mitoses. |
TERMINOLOGY
Abbreviations
-
Sarcomatoid squamous cell carcinoma (SCC)
Synonyms
-
Spindle cell carcinoma, carcinosarcoma, metaplastic carcinoma
Definitions
-
Undifferentiated carcinoma arising from squamous epithelium composed of malignant spindle cells
ETIOLOGY/PATHOGENESIS
Pathogenesis
-
Uncertain
-
HPV association unknown; unlikely
CLINICAL ISSUES
Epidemiology
-
Incidence
-
Approximately 4% of penile SCCs
-
-
Age
-
Mean is 60 years
-
Site
-
Glans, often extending to coronal sulcus and foreskin
Presentation
-
Large, polypoid, and ulcerated mass deeply invading corpora spongiosum and cavernosa
Treatment
-
Surgical or multimodal
Prognosis
-
Usually associated with lymph node metastasis
-
Poor prognosis
MACROSCOPIC FEATURES
General Features
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
