Advances in the pathology of penile carcinomas

Human Pathology (2012) 43, 771–789

www.elsevier.com/locate/humpath

Progress in pathology

Advances in the pathology of penile carcinomas☆
Alcides Chaux MD a,b,c , Antonio L. Cubilla MD b,⁎ a Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA Instituto de Patología e Investigación, Martin Brizuela 325, Asunción, Paraguay 1617 c Universidad del Norte School of Medicine, Gral. Santos 2409, Asunción, Paraguay 1614 b Received 8 November 2011; revised 18 January 2012; accepted 25 January 2012

Keywords:
Penile cancer; Squamous cell carcinoma; HPV; Penile intraepithelial neoplasia; Prognosis

Summary The incidence of penile cancer varies from country to country, with the highest figures reported for countries in Africa, South America, and Asia and lowest in the United States and Europe. Causes of this variation are not clear, but they are thought to be related to human papillomavirus infection, smoking, lack of circumcision, chronic inflammation, and poor genital hygiene. Most penile tumors are squamous cell carcinomas, and a variegated spectrum of distinct morphologies is currently recognized. Each one of these subtypes has distinctive pathologic and clinical features. About half of penile carcinomas are usual squamous cell carcinomas, and the rest corresponds to verrucous, warty, basaloid, warty-basaloid, papillary, pseudohyperplastic, pseudoglandular, adenosquamous, sarcomatoid, and cuniculatum carcinomas. Previous studies have found a consistent association of tumor cell morphology and human papillomavirus presence in penile carcinomas. Those tumors composed of small- to intermediate-sized, basaloid (“blue”) cells are often human papillomavirus positive, whereas human papillomavirus prevalence is lower in tumors showing large, keratinizing, maturing eosinophilic (“pink”) cells. Human papillomavirus–related tumors affect younger patients, whereas human papillomavirus–unrelated tumors are seen in older