Squamous Cell Carcinoma, Usual Type



Squamous Cell Carcinoma, Usual Type


Antonio L. Cubilla, MD

Alcides Chaux, MD

Elsa F. Velazquez, MD





Key Facts


Etiology/Pathogenesis



  • HPV infection in about 1/4 of cases


Macroscopic Features



  • Glans frequently affected


  • Superficial pattern of growth in most cases


  • Gross features are nondistinctive


Microscopic Pathology



  • Most common histological subtype of penile SCC


  • Keratinization evident in most cases


  • Mostly well-to-moderately differentiated



    • Pure grade 1 or 3 is very rare


  • Heterogeneous tumors in about 1/2 of all cases



    • Focal presence of anaplastic cells is enough for grade 3


  • Frequent invasion of penile erectile tissues


  • Frequent extension to multiple compartments


  • SH and differentiated PeIN commonly found


  • Most important prognostic factors



    • Histologic grade


    • Anatomical level of infiltration


    • Vascular invasion


    • Perineural invasion


  • Inguinal nodal metastases in 1/3 of patients


Top Differential Diagnoses



  • Pseudoepitheliomatous hyperplasia


  • Pseudohyperplastic carcinoma


  • Urothelial carcinoma of distal urethra


  • High-grade SCC


  • Mixed SCC


  • Metastatic SCC to penis







Gross photograph of a penile SCC image with an exoendophytic pattern of growth invades up to the corpus spongiosum image of glans but spares urethra image and corpus cavernosum image.






Tumor nests of well-differentiated usual SCC are composed of neoplastic cells with ample, eosinophilic and keratinized cytoplasm, distinctive cellular borders, and retained epithelial maturation.


TERMINOLOGY


Abbreviations



  • Squamous cell carcinoma (SCC)


Synonyms



  • Conventional/typical SCC


  • Epidermoid carcinoma


  • SCC, not otherwise specified (NOS)


Definitions



  • Invasive carcinoma with features of keratinization (intracellular keratin pearls and intracellular bridges)


ETIOLOGY/PATHOGENESIS


Infectious Agents



  • Human papillomavirus (HPV) infection in about 1/4 of cases


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Most common histologic subtype of penile SCC (60-65%)


  • Age



    • Average: 58 years


Presentation



  • Solid tumoral mass usually affecting glans


  • Ulceration, pain, bleeding, or erythema may be seen


Treatment



  • Primary treatment is surgical


  • Penile-preserving therapy in low-grade superficial tumors


  • Radiotherapy as adjuvant or neoadjuvant therapy


  • Chemotherapy for advanced cases (irresectable primary tumor &/or regional involvement)


  • Inguinal lymphadenectomy according to risk group


Prognosis



  • Most important prognostic factors include



    • Histologic grade


    • Anatomic level of infiltration (pathologic stage)


    • Vascular, lymphatic, and perineural invasion


  • Recurrences in 1/4 of cases


  • Inguinal nodal metastases in 1/3 of patients


MACROSCOPIC FEATURES


General Features



  • Most tumors affect glans


  • Tumors exclusive of foreskin are less common


  • Superficial spreading is predominant pattern of growth


  • Gross features are nondistinctive


  • Average size is 2-4.8 cm

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Squamous Cell Carcinoma, Usual Type

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