Clinicopathologic and outcome features of superficial high-grade and deep low-grade squamous cell carcinomas of the penis

Abstract

PurposeTo report the clinicopathologic and outcome features of superficial high-grade and deep low-grade penile squamous cell carcinomas.MethodsFrom a retrospectively-collected series of patients with penile cancer we identified 41 cases corresponding to 12 superficial high-grade tumors and 29 deep low-grade tumors. As outcomes we evaluated inguinal lymph node status, presence of tumor relapse, final nodal status, and cancer-specific death. Follow-up ranged from 0.8 to 386.7 months (mean 152.5 months, median 157.3 months).ResultsClinicopathologic features were similar between superficial high-grade and deep low-grade tumors, except for a tendency (Fisher’s exact ) of the former to include tumors with a verruciform pattern of growth. A significantly higher proportion of inguinal lymph node metastasis was found in superficial high-grade tumors compared to deep low-grade tumors [4/5 (80%) vs. 1/5 (20%) respectively, Fisher’s exact ]. No significant differences were found regarding tumor relapse (Fisher’s exact ), final nodal status (Mantel-Cox’s ), or cancer-related death (Mantel-Cox’s ).ConclusionsPatients with superficial high-grade tumors had a significantly higher proportion of inguinal lymph node metastasis compared to patients with deep low-grade tumors. On this regard, prophylactic inguinal lymphadenectomy might be indicated in cases of superficial tumors with high-grade histology while in deeply invasive low-grade penile carcinomas a more conservative approach may be considered.

What Is New in the Pathologic Staging of Penile Carcinoma in the 8th Edition of AJCC TNM Model: Rationale for Changes With Practical Stage-by-stage Category Diagnostic Considerations

“…Even less frequent are grade III tumors invading only LP. 22 In a large study, we found only 2 cases of superficial grade III carcinomas among 333 consecutive cases. 13 It is posible that in future models LVI, PNI and grade would be inserted for substratification of stages pT2 and pT3.…”

“…According to this view, there are no metastases in grade 1 tumors, disregarding their invasion depth and there is a high incidence of metastasis in grade 3 tumors. 15,22 The separation of stages T2 and T3 according to tumor invasion of CS or CC need to be reevaluated. In our experience, tumor invading superficial CS, that is, no more than 5 mm in depth, and low-grade (grade 1 or 2) behaves as those invading LP, with minimal rate of nodal metastasis.…”

Diagnosis and Pathology of Penile Cancer

“…In these cases the diagnosis of "verruciform tumor, not otherwise specified" may be appropriate. Histological grading is particularly useful in these situations since it seems that it has a greater impact on prognosis than tumor depth or thickness [13].…”

“…Histologic grade has been repeatedly reported as an important prognostic factor [4,15]. High grade tumors tend to metastasize and disseminate much more frequently than low-grade tumors, even if superficially located [13]. For consistency we propose the use of a simple 3-tier system which emphasizes both ends of the spectrum [15]:…”

“…A second limitation is that it uses histological grade for substratification only of T1 tumors and not for all stages. Nonetheless, deeply invading low-grade tumors exhibit a lesser tendency for nodal metastatic compared with superficial highgrade tumors [13]. Finally, it considers infiltration of the penile urethra as an indicator of a high stage tumor (T3).…”