SE
M I N A R S I N
D
I A G N O S T I C
P
A T H O L O G Y
32 (2015) 197
Available online at www.sciencedirect.com
www.elsevier.com/locate/semdp
Seminars editorial Penile cancer is rare in USA and Europe (incidence of 1 100,000 population) but more frequent in tropical regions of Africa, Asia, and South America (2–4 100,000 population). Pathologically, however, tumors are identical in low- and high-frequency areas. The vast majority of penile cancers are squamous cell carcinoma arising in the squamous epithelium of the glans, coronal sulcus, or inner preputial surface. Thus penile tumors are mucosal in origin and should be distinguished and are different from adjacent skin tumors. However, their morphology is not uniform, and there are distinctive clinico-pathological variants reported along the years since the description of penile epithelioma by Paget in 1890s, of spindle cell carcinoma by Ewing in 1921, and of verrucous carcinoma by Ackerman in 1949. The majority of known tumor entities were more recently described, and the new WHO classification, now in its final stage of preparation, is presenting about 15 subtypes and variants of penile squamous cell carcinoma. They are described in detail in this report. A novel approach to this classification is the separation of penile carcinomas in 2 etiological groups, HPV and non-HPV related. There is a considerable evidence of the predictable relationship of subtypes of penile carcinomas and the presence or absence of the human papillomavirus. Another feature of this publication is the emphasis in the differential diagnosis of the subtypes of penile carcinomas, some of which are difficult to be differentiated from each other, especially the low-grade verruciform neoplasms. A summary of 3 major clinical and outcome studies according
to subtypes of carcinomas is also presented as well as the categorization of tumors in prognostic risk groups. Whereas classical surgical approaches for penile carcinomas were partial or total penectomies for tumors in the glans, earlier diagnosis are inducing to more conservative surgical treatments. We are presenting the largest experience on the subject and the techniques for pathological evaluation of these challenging specimens. Tumors of distal urethra, very rare, may simulate penile tumors and vice versa, penile cancers may simulate urethral tumors. This is related to the histology of the distal urothelium, which is different from urothelia elsewhere and embryologically related to penile tissues of the glans. We are presenting a review of distal urethral carcinomas, based on the largest series of cases studied. Penile cysts are uncommon, and when ventral they are usually referred to as median raphae cysts. We reviewed the literature, and based on our recent immunohistochemical studies, emphasized their urothelial origin.
Antonio L. Cubilla, MD Instituto de Patología e Investigación. Cap. Brizuela 325 y Cnel Ayala Velazquez. 1584. Asunción, Paraguay E-mail address: [email protected] (A. L. Cubilla) http://dx.doi.org/10.1053/j.semdp.2015.04.001 0740-2570/& 2015 Elsevier Inc. All rights reserved.
M I N A R S I N
D
I A G N O S T I C
P
A T H O L O G Y
32 (2015) 197
Available online at www.sciencedirect.com
www.elsevier.com/locate/semdp
Seminars editorial Penile cancer is rare in USA and Europe (incidence of 1 100,000 population) but more frequent in tropical regions of Africa, Asia, and South America (2–4 100,000 population). Pathologically, however, tumors are identical in low- and high-frequency areas. The vast majority of penile cancers are squamous cell carcinoma arising in the squamous epithelium of the glans, coronal sulcus, or inner preputial surface. Thus penile tumors are mucosal in origin and should be distinguished and are different from adjacent skin tumors. However, their morphology is not uniform, and there are distinctive clinico-pathological variants reported along the years since the description of penile epithelioma by Paget in 1890s, of spindle cell carcinoma by Ewing in 1921, and of verrucous carcinoma by Ackerman in 1949. The majority of known tumor entities were more recently described, and the new WHO classification, now in its final stage of preparation, is presenting about 15 subtypes and variants of penile squamous cell carcinoma. They are described in detail in this report. A novel approach to this classification is the separation of penile carcinomas in 2 etiological groups, HPV and non-HPV related. There is a considerable evidence of the predictable relationship of subtypes of penile carcinomas and the presence or absence of the human papillomavirus. Another feature of this publication is the emphasis in the differential diagnosis of the subtypes of penile carcinomas, some of which are difficult to be differentiated from each other, especially the low-grade verruciform neoplasms. A summary of 3 major clinical and outcome studies according
to subtypes of carcinomas is also presented as well as the categorization of tumors in prognostic risk groups. Whereas classical surgical approaches for penile carcinomas were partial or total penectomies for tumors in the glans, earlier diagnosis are inducing to more conservative surgical treatments. We are presenting the largest experience on the subject and the techniques for pathological evaluation of these challenging specimens. Tumors of distal urethra, very rare, may simulate penile tumors and vice versa, penile cancers may simulate urethral tumors. This is related to the histology of the distal urothelium, which is different from urothelia elsewhere and embryologically related to penile tissues of the glans. We are presenting a review of distal urethral carcinomas, based on the largest series of cases studied. Penile cysts are uncommon, and when ventral they are usually referred to as median raphae cysts. We reviewed the literature, and based on our recent immunohistochemical studies, emphasized their urothelial origin.
Antonio L. Cubilla, MD Instituto de Patología e Investigación. Cap. Brizuela 325 y Cnel Ayala Velazquez. 1584. Asunción, Paraguay E-mail address: [email protected] (A. L. Cubilla) http://dx.doi.org/10.1053/j.semdp.2015.04.001 0740-2570/& 2015 Elsevier Inc. All rights reserved.
