Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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A B Fig. 5.05 A Well differentiated squamous cell carcinoma with invasion of corpus spongiosum. B Squamous cell carcinoma. Large neoplasm replacing glans surface. C Squamous cell carcinoma. Massive replacement of penile corpus spongiosum and cavernosum by a white neoplasm. C (primary tumour to pelvic inguinal nodes) are extremely unusual. Systemic blood borne dissemination occurs late. Common general sites of metastatic involvement are liver, heart, lungs and bone {2905}. Prognosis Pathologic factors related to prognosis of penile carcinomas are site of primary tumour, pattern of growth, tumour size, histological type, grade, depth and vascular invasion. Tumours exclusively in the foreskin, carry a better prognosis {1933} because of low grade and frequent superficially invasive growth {514}. The incidence of metastasis in verruciform tumours is minimal. Mortality in patients with superficially spreading carcinomas is 10% compared with 67% for patients with vertical growth pattern {521}. The 3 most important pathological factors to predict final outcome are histological grade, depth of invasion and vascular invasion especially the combination of grade and depth. There is no consensus regarding method of grading {1121, 1608,2438}. The depths of invasion should be evaluated on penectomy specimens {2719}. Measurement of depth of invasion in mm should be performed from the basement membrane of adjacent squamous epithelium to deepest point of invasion {693}. The large destructive lesions or bulky exophytic tumours especially those of the verruciform group should be measured from the nonkeratinizing surface of the tumour to the deepest point of invasion. Evaluation of the anatomical levels of tumour invasion is limited by the variation in thickness of the corpus spongiosum. The threshold for penile metastasis is about 4-6 mm invasion into the corpus spongiosum {520}. When possible, more than one method should be utilized. A combination of histologic grade and depth is thought to better predict metastasis and mortality, including micrometastasis {1672,2458}. One system utilizes a prognostic index from 1 to 6, combining numerical values for histologic grade (1- 3) and anatomical level of invasion (1-3, LP, CS and CC in glans and LP, dartos and skin in the foreskin). Low indices (1- 3) are associated with no mortality. Metastatic and mortality rates are high in patients with indexes 5 and 6 {519}. Molecular markers have been studied as prognostic predictors. Ploidy was not found to be useful as a predictor of prognosis {1002}. P53, however, appeared to be an independent risk factor for nodal metastasis, progression of disease and survival in 2 studies {1546,1640}. HPV was not found to be prognostically important {236}. Tissue associated eosinophilia has been linked with improved survival in patients with penile cancer {1961}. Squamous cell carcinoma Definition A malignant epithelial neoplasm with squamous differentiation. ICD-O codes Squamous cell carcinoma 8070/3 Basaloid carcinoma 8083/3 Warty (condylomatous) carcinoma 8051/3 Verrucous carcinoma 8051/3 Papillary carcinoma (NOS) 8050/3 Sarcomatoid (spindle cell) carcinoma 8074/3 Adenosquamous carcinoma 8560/3 Fig. 5.06 Routes of local spread: Lines and arrows depict pathways of local tumour (CA) progression, from distal glans (GL), foreskin (F) and coronal sulcus (COS) to proximal corpus spongiosum (CS), corpora cavernosa (CC), penile fascia (PF), skin and urethra (U). (ALB) tunica albuginea. Macroscopy Average tumour size varies from 3 to 4 cm. Three main growth patterns are noted: superficially spreading with horizontal growth and superficial invasion, Malignant epithelial tumours 283
deformed by an exophytic mass. In some patients the foreskin is abutted by underlying tumour and may show skin ulcerations. The contrast between the pale invasive tumour and the dark red colour of CS or CC permits determination of the deepest point of invasion, which is prognostically important {520}. Adjacent hyperplastic or precancerous lesions often can be visualized as a marble white 1-2 mm thickening. Mixed tumours should be suspected when different growth patterns are present. A B Fig. 5.07 , Squamous cell carcinoma. A An irregular granular flat neoplasm involving the mucosal aspect of the foreskin. B Well differentiated SCC with irregular infiltrating borders. C Well differentiated keratinizing SCC. A Fig. 5.08 A Squamous cell carcinoma, grade 1. B Clear cell carcinoma, a poorly differentiated squamous cell carcinoma with cytoplasmic clearing. A Fig. 5.09 Squamous cell carcinoma of the penis. A Squamous cell carcinoma infiltrating urethra. B Squamous cell carcinoma infiltrating periurethral glands. vertical growth deeply invasive and multicentric. Any combination may occur {517}. Multicentric carcinomas are more frequent in the foreskin {1933}. The C B B tumours are usually white, grey, granular irregular masses partially or totally replacing the glans or foreskin. The glans surface may be flat, ulcerated or Local spread Penile tumours may spread from one mucosal compartment to the other. Typically, foreskin carcinomas spread to coronal sulcus or glans and carcinomas originating in the glans may spread to the foreskin. Penile SCC may spread horizontally and externally to skin of the shaft and internally to proximal urethral margin of resection. This is the characteristic spread of superficially spreading carcinomas. The vertical spread may progress from surface to deep areas {517}. An important, under recognized route of spread is the penile fascia, a common site of positive surgical margin of resection. The fascial involvement in tumours of the glans is usually through the coronal sulcus. Tumour in the fascia may secondarily penetrate into corpus cavernosum via nutritional vessels and adipose tissue traversing the tunica albugina. It is not unusual to find "satellite nodules", frequently associated with regional metastasis. Multiple urethral sites may be involved at the resection margins {2720}. Pagetoid intraepithelial spread may simulate carcinoma in situ or Paget disease. In more advanced cases penile carcinomas may spread directly to inguinal, pubic or scrotal skin. Histopathology There is a variable spectrum of differentiation from well to poorly differentiated. Most frequently there is keratinization and a moderate degree of differentiation. Very well differentiated and solid nonkeratinizing poorly differentiated carcinomas are unusual. Invasion can be as individual cells, small irregular nests of atypical cells, cords or large cohesive sheets present in the lamina propria or corpus spongiosum. Infrequently (about a fourth of cases) the corpus cavernosum is affected. The boundaries 284 Tumours of the penis
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World Health Organization Classific
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This volume was produced in collabo
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Contents 1 Tumours of the kidney 9
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CHAPTER 1 Tumours of the Kidney Can
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TNM classification of renal cell ca
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one quarter of kidney cancers in bo
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Familial renal cell carcinoma M.J.
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Table 1.02 Genotype - phenotype cor
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A B Fig. 1.11 A Multiple cutaneous
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A B Fig. 1.14 Birt-Hogg-Dubé syndr
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Clear cell renal cell carcinoma D.J
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Fig. 1.20 Clear cell renal cell car
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Papillary renal cell carcinoma B. D
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A B Fig. 1.29 Papillary renal cell
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Fig. 1.33 Chromophobe RCC with sarc
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Carcinoma of the collecting ducts o
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Renal medullary carcinoma C.J. Davi
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Renal carcinomas associated with Xp
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Renal cell carcinoma associated wit
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Papillary adenoma of the kidney J.N
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of this tumour. Microscopic extensi
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A B Fig. 1.59 Metanephric adenoma.
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esults in intratumoral aneurysms. O
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peritumoural fibrous pseudocapsule.
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increases in prevalence to approxim
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Nephrogenic rests and nephroblastom
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Cystic partially differentiated nep
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A B Fig. 1.80 Clear cell sarcoma of
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A B Fig. 1.85 Rhabdoid tumour of th
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transcription factor is fused to th
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Leiomyosarcoma S.M. Bonsib Definiti
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Angiomyolipoma G. Martignoni M.B. A
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melanocytic and smooth muscle marke
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Multinucleated and enlarged ganglio
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Haemangioma P. Tamboli Definition H
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Fig. 1.107 Juxtaglomerular cell tum
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Intrarenal schwannoma I. Alvarado-C
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Mixed epithelial and stromal tumour
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Synovial sarcoma of the kidney J.Y.
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Renal carcinoid tumour L.R. Bégin
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Primitive neuroectodermal tumour (E
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Paraganglioma / Phaeochromocytoma P
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Leukaemia A. Orazi Interstitial inf
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WHO histological classification of
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TNM classification of carcinomas of
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The risk of bladder cancer goes dow
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Tumour spread and staging Urinary b
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feature in such patients undergoing
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A Fig. 2.12 Infiltrative urothelial
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A Fig. 2.15 A Infiltrating urotheli
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A B Fig. 2.19 A Infiltrative urothe
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Fig. 2.23 Infiltrative urothelial c
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ing systems have been proposed on t
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Non-invasive urothelial tumours G.
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chronically inflamed urothelium and
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Inverted papilloma G. Sauter Defini
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muscle invasive disease, but there
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Fig. 2.42 Non-invasive urothelial n
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A Fig. 2.45 Non-invasive urothelial
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for DBCCR1 silencing {984,2476}. Th
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Squamous cell carcinoma D.J. Grigno
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Fig. 2.51 Squamous cell carcinoma.
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Adenocarcinoma A.G. Ayala P. Tambol
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A B Fig. 2.61 A Adenocarcinoma in s
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A B Fig. 2.65 Intramural urachal ca
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Müllerian origin is postulated for
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A Fig. 2.69 Small cell carcinoma. A
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Carcinoid L. Cheng Definition Carci
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Leiomyosarcoma J. Cheville Definiti
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Osteosarcoma L. Guillou Definition
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Leiomyoma J. Cheville Definition A
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Haemangioma L. Cheng Definition Hae
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Metastatic tumours and secondary ex
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Tumours of the renal pelvis and ure
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nodular, ulcerative or infiltrative
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Tumours of the urethra F. Hofstädt
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usually show enteric, colloid or si
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CHAPTER 3X Tumours of of the the Pr
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TNM classification of carcinomas of
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contrast, mortality among migrants
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Fig. 3.06 Transrectal ultrasound of
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PSA-related diagnostic strategies.
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A B C Fig. 3.10 A,B Section of pros
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pale-clear, similar to benign gland
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A B Fig. 3.20 A, B Adenocarcinoma w
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prostate adenocarcinomas exhibit AR
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A Fig. 3.27 A, B Foamy gland adenoc
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A B Fig. 3.32 A Sarcomatoid carcino
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A B Fig. 3.37 A Gleason score 1+1=2
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A B Fig. 3.43 A Prostate cancer Gle
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Fig. 3.48 Heat map-nature. From S.M
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Fig. 3.51 Prostate cancer. Major su
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many stage T1b cancers. Stage T2 Mo
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Fig. 3.58 Patterns of seminal vesic
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Prostatic intraepithelial neoplasia
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A B Fig. 3.63 A Micropapillary high
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A B Fig. 3.68 A Ductal carcinoma in
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Ductal adenocarcinoma X.J. Yang L.
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Papillary pattern can be seen in bo
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A B Fig. 3.74 A Inflammation withou
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Squamous neoplasms T.H. Van der Kwa
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Neuroendocrine tumours P.A. di Sant
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Mesenchymal tumours J. Cheville F.
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Fig. 3.89 Sarcoma of the prostate.
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Miscellaneous tumours P.H. Tan L. C
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A Fig. 3.96 A Adenocarcinoma of the
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WHO histological classification of
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Introduction F.K. Mostofi I.A. Sest
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wartime birth cohorts illustrate th
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Similar tumours as those of group 1
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crucial for the development of this
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A B Fig. 4.09 Spermatocytic seminom
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A B Fig. 4.14 Intratubular germ cel
Page 227 and 228: A B Fig. 4.19 Seminoma. A Typical s
Page 229 and 230: Fig. 4.24 Seminoma. Vascular invasi
Page 231 and 232: Fig. 4.28 Spermatocytic seminoma wi
Page 233 and 234: A B Fig. 4.33 Embryonal carcinoma.
Page 235 and 236: A B Fig. 4.38 Yolk sac tumour. A En
Page 237 and 238: have cytoplasmic lacunae that conta
Page 239 and 240: A Fig. 4.46 Teratoma. A Longitudina
Page 241 and 242: A B Fig. 4.51 A Cut surface of derm
Page 243 and 244: Fig. 4.54 Mixed germ cell tumour. L
Page 245 and 246: Sex cord / gonadal stromal tumours
Page 247 and 248: A B C Fig. 4.67 Malignant Leydig ce
Page 249 and 250: A Fig. 4.73 A Sertoli cell tumour.
Page 251 and 252: ICD-O codes Granulosa cell tumour 8
Page 253 and 254: ICD-O code 8592/1 Clinical features
Page 255 and 256: A B Fig. 4.83 Germ cell-sex cord/go
Page 257 and 258: A Fig. 4.85 A, B Brenner tumour of
Page 259 and 260: typical grade III follicular morpho
Page 261 and 262: testicular parenchyma and tumour te
Page 263 and 264: A B the surgical scar and adjacent
Page 265 and 266: Immunoprofile Ordóñez and associa
Page 267 and 268: often have a grey-white cut surface
Page 269 and 270: Fig. 4.111 Angiomyofibroblastoma-li
Page 271 and 272: A B Fig. 4.119 Embryonal rhabdomyos
Page 273 and 274: Table 4.05 Secondary tumours of the
Page 275 and 276: WHO histological classification of
Page 277: A Fig. 5.04 A, B Squamous cell carc
Page 281 and 282: A B C Fig. 5.12 A Warty (condylomat
Page 283 and 284: A Fig. 5.20 Bowenoid papulosis. A,
Page 285 and 286: three had been circumcized by 9 yea
Page 287 and 288: Mesenchymal tumours J.F. Fetsch M.
Page 289 and 290: Fig. 5.31 Neurofibroma of the penis
Page 291 and 292: oectodermal tumour/Ewing sarcoma [p
Page 293 and 294: Secondary tumours of the penis C.J.
Page 295 and 296: Dr John N. EBLE* Dept. of Pathology
Page 297 and 298: Dr Ricardo PANIAGUA Department of C
Page 299 and 300: Source of charts and photographs 1.
Page 301 and 302: References 1. Anon. (1955). Case re
Page 303 and 304: 115. Ariel I, Sughayer M, Fellig Y,
Page 305 and 306: 246. Birt AR, Hogg GR, Dube WJ (197
Page 307 and 308: 374. Cardone G, Malventi M, Roffi M
Page 309 and 310: 502. Corti B, Carella R, Gabusi E,
Page 311 and 312: 633. Donhuijsen K, Schmidt U, Richt
Page 313 and 314: 768. Fischer J, Palmedo G, von Knob
Page 315 and 316: 900. Goedert JJ, Cote TR, Virgo P,
Page 317 and 318: 1028. Hartmann A, Dietmaier W, Hofs
Page 319 and 320: 1162. Iezzoni JC, Fechner RE, Wong
Page 321 and 322: 1293. Keetch DW, Catalona WJ (1995)
Page 323 and 324: 1424. Ladanyi M, Lui MY, Antonescu
Page 325 and 326: 1548. Lopez-Beltran A, Croghan GA,
Page 327 and 328: 1681. McLaughlin JK, Silverman DT,
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1816. Moudouni SM, En-Nia I, Rioux-
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1945. Ohori M, Wheeler TM, Kattan M
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2070. Phillips G, Kumari-Subaiya S,
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2199. Riou G, Barrois M, Prost S, T
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2327. Schmidt L, Junker K, Weirich
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2450. Smith G, Elton RA, Beynon LL,
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2572. Tamboli P, Mohsin SK, Hailema
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2693. van Echten J, Timmer A, van d
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2816. Wick MR, Berg LC, Hertz MI (1
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2937. Zhuang Z, Park WS, Pack S, Sc
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CCNB, 226 CCND1, 105, 108 CCND2, 22
Page 351 and 352:
J Juvenile type granulosa cell tumo
Page 353 and 354:
Promoter methylation, 21 Prostate s
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Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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