Radical Penectomy
RADICAL PENECTOMY
Resection of a cancer on the skin or within the penile body. Many times the extent of the cancer is not known and the margin is sampled separately in a frozen section. Most cancers involve the glans and/or coronal sulcus, or the foreskin if it is present. Tumors can be warty/papillary or can be flat and deeply invasive, the growth pattern is important to note for prognosis. The vast majority of penile cancers are squamous cell carcinomas, although penectomies can also be performed for urothelial carcinomas of the urethra, or for other rare malignancies.
Staging of penile cancers is based predominantly on depth of invasion.
- Ta: Non-invasive
- T1: Tumor invades subepithelial connective tissue but does not invade corpus spongiosum
- T2: Tumor invades corpus spongiosum or cavernosum
- T3: Tumor invades urethra or prostate
- T4: Tumor invades other adjacent structures.
Procedure
- Measure the entire specimen.
- Examine the skin of the margin, shaft and the glans penis. Identify whether foreskin is present or not.
Identify the cut surface components of the specimen:
- The corpus spongiosum is the cylindrical tissue segment surrounding the urethra near the ventral surface.
- The larger, paired segments on the dorsal surface are the corpora cavernosa.
- The cut surfaces form sort of a triangle, with the corpus spongiosum as the apex.
- If there is no skin, ink the ventral surface one color and the dorsal surface another color.
Cutaneous cancer:
- Measure the cutaneous lesion(s)
- Mention their color and appearance
- Distance to the surgical margin
- Depth of invasion into the cut surface (does it involve any of the cut surface components such as corpus spongiosum or cavernosum?)
- Submit a shave margin if it has not been done for frozen section
Urothelial tumors:
- Use the scissors to open the urethra along the ventral surface (the closer surface).
- Measure the lesion
- Describe its appearance
- Measure distance to the surgical margin.
- Measure the extent of its involvement/depth of invasion with the surrounding fibrous tissue or other penile bodies.
Sections for Histology
- Consult the GU attending for sections, but at least include:
- Surgical margin - one cassette, if not taken at frozen section
- If the tumor is close to the margin, submit a section showing relationship of tumor to margin.
- For cutaneous lesion(s). If more than one lesion, samples of all must be submitted unless otherwise instructed
- one cassette per 3 mm section
- sections of the deepest invasion
- sections near or abutting the vasculature
- section of the glans penis parallel to the long axis, showing the distal urethral opening
Sample dictation
"Penis and urethra, stitch marks proximal urethral margin"
A 12.7 x 5.2 x 4.7 cm penectomy specimen. The proximal urethral margin is
shaved for frozen section. The ventral surface is inked blue and the dorsal is
inked green. The cut surface shows a 1.3 x 1 x 0.5 cm focally hemorrhagic area
that comes to within less than 0.1 cm of the proximal margin. This area is
somewhat friable and fibrous, surrounding the proximal hyperemic urethra,
which is also slightly dilated to 0.4 cm. The neoplastic tissue is glistening,
yet does not appear to penetrate through the corpus spongiosum into the
surrounding fibrous tissue. The corpora cavernosa are red-brown, partly
hemorrhagic, showing no evidence of neoplastic involvement. The fibrous tissue
surrounding the corpora cavernosa is thickened to 0.9 cm, yet no evidence of
neoplastic tissue is readily seen. The distal 4.8 cm portion of the specimen
is covered with brown-gray, unremarkable skin, and the glans penis is unremarkable.
4A. Shave margin of proximal urethra. (ns)
4B-F. Proximal 1.5 cm of urethra. (ns)
4G. Dorsal half of 4F. (ns)
4H-I. One full thickness middle portion of penis. (ns)
4J-K. Additional urethral sections of middle portion of penis. (ss)
4L-M. One full thickness of distal penis. (ss)
4N. Glans penis. (ss)
Modified February 2009