Carcinoma of the penis pathophysiology

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Joel Gelman, M.D. [2], Director of the Center for Reconstructive Urology and Associate Clinical Professor in the Department of Urology at the University of California,Irvine

Overview

On gross pathology, scaly patches or nodules, erythematous, and ulceration are characteristic findings of carcinoma of the penis. On microscopic histopathological analysis, keratinization and intercellular bridges are characteristic findings of carcinoma of the penis.

Pathogenesis

• Penile cancers traditionally begin as small lesions, most commonly on the glans or prepuce.
• About 95% of penile cancers develop from flat, scale-like cells called squamous cells. squamous cell carcinoma (SCC) can develop anywhere on the penis, but most develop on the foreskin (in uncircumcised men) or the glans. This type of cancer is typically slow growing. When found early, it is often curable.
• Penile cancer arises from precursor lesions, which generally progress from low-grade to high-grade lesions.
• Penile malignant lesions and tumors, can be divided into HPV-related and non–HPV-related groups.
• For HPV related penile cancers this sequence is as follows:

• Squamous hyperplasia
• Low-grade penile intraepithelial neoplasia (PIN)
• High-grade PIN (carcinoma in situ—Bowen's disease, erythroplasia of Queyrat and bowenoid papulosis (BP))
• Invasive carcinoma of the penis

• Non-HPV related penile squamous cell cancers include:

• SCC usual type/Not Otherwise Specified (NOS)
• Pseudohyperplastic carcinoma
• Pseudoglandular carcinoma
• Verrucous carcinoma
• Carcinoma cuniculatum
• Papillary carcinoma NOS
• Adenosquamous carcinoma
• Sarcomatoid carcinoma

• Tumors with basal and/or warty morphology display HPV more frequently.

Gross Pathology

• Scaly patches or nodules
• Usually erythematous
• Ulceration

Microscopic Pathology

• On microscopic histopathological analysis, keratinization and intercellular bridges are characteristic findings of carcinoma of the penis.

Grades of penile cancer

• Grading is a way of classifying penile cancer cells based on their appearance and behaviour when viewed under a microscope.

• The grade of penile cancer is based on the degree of differentiation of cells and their rate of growth.

Grade	Definition
GX	Grade of differentiation cannot be assessed
G1	Well differentiated or low grade
G2	Moderately well differentiated or moderate grade
G3	Poorly differentiated or high grade
G4	Undifferentiated or high grade

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