Border: pushing/infiltrative. Lymphocytic reaction: prominent/sparse.
Microscopic growth patterns are verruciform, superficial spreading, vertical with deep penetration or multicentric.
pTis carcinoma in situ pTa non-invasive verrucous carcinoma pT1 tumour in subepithelial connective tissue pT2 tumour in corpus spongiosum or cavernosum*
pT3 tumour in urethra or prostate pT4 tumour in other adjacent structures (scrotum, testis, skin).
Initial spread is local and intercompartmental into the prepuce, coronal sulcus, glans and penile shaft and the depth or extent of this and the pattern of infiltrative spread correlate with the incidence of nodal metastases. Despite the vascularity of the structures, haematogenous spread to the liver, lung and bone is rare (2%).
*Optional descriptors are a. corpus spongiosum and b. corpus cavernosum.
5. LYMPHOVASCULAR INVASION
Vascular invasion is an important adverse factor.
6. LYMPH NODES
Site/number/size/number involved/limit node/extracapsular spread. Regional nodes: superficial and deep inguinal and pelvic.
pN0 no regional lymph node metastasis pN1 metastasis in one superficial inguinal lymph node pN2 metastasis in multiple or bilateral superficial inguinal lymph nodes pN3 metastasis in deep inguinal or pelvic lymph node(s).
The incidence of nodal metastases is greater (>80%) in deeply invasive than superficially spreading carcinomas (42%). Lymphadenectomy improves prognosis but is carried out only when there are known metas-
tases or in high-grade disease, e.g. basaloid, sarcomatoid or undifferentiated carcinoma. Low-grade tumours such as verrucous carcinoma seldom result in nodal disease, although there may be lymphadenopathy due to inflammation or infection.
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