Anatomical Level of Infiltration

The maximum anatomical level infiltrated by tumor should be grossly determined and histologically confirmed. Special attention should be given to distinguish corpus spongiosum from corpus cavernosum invasion. When it is carefully determined, there is a strong association between anatomical level of infiltration and the risk of nodal metastasis.140151 In addition, tumor staging is performed by determining the deepest anatomical structure invaded by tumor using the system proposed by the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC)152 (Table 3.3). There are some shortcomings with this system.153 154 It considers one single stage (T2) for tumors invading either corpus spongiosum or cavernosum. However, tumors invading the latter show a higher metastatic rate when compared with those limited to the former.140 A second limitation is that it utilizes histological grade for substratification of T1 tumors only and not for all stages. Nonetheless, deeply invading low-grade tumors exhibit a lesser tendency for nodal metastates compared with superficial high-grade tumors.56 Finally, it considers infiltration of the penile urethra as an indication of a high-stage tumor (T3). However, urethral invasion has proven neither to be an independent prognostic factor nor to have any impact in the metastatic rate or systemic dissemination of a penile cancer.9 The deepest anatomical level infiltrated by tumor should always be used in conjunction with other pathological factors such as histological subtype/grade and vascular/perineural invasion.

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