Growth Pattern

The growth pattern in penile cancer can be classified into verrucous, superficial, and vertical patterns (Fig. 10.4a, b).34 In 1997 Villavicencio et al. reported inguinal metastases in no patients with verrucous tumors, in 35% of those with superficial, and in 100% of those with vertical growth patterns (p = 0.0009). Similarly, they reported significantly better survival in patients with superficial compared to those with vertical growth tumors (p = 0.0004). In contrast, survival was similar in patients with verrucous and superficial growth pattern tumors.9

An interesting study was peformed in 2006 by Guimaraes et al. 2 1 These authors classified their patients according to the classification proposed by Anneroth et al.35 and Bryne et al..6 for oral cavity squamous cell cancers. This classification describes the pattern of invasion at the tumor-host interface and therefore demonstrates the infiltra-tive characteristics of the neoplasm. This pattern was defined as either infiltrating (invasion in blocks of small solid strands of cells broadly infiltrating the organ's stroma) or pushing (tumor cells invading large cell blocks with well-defined tumor-host interfaces). Patients with an infiltrating pattern of invasion had node metastases in 64.6%, significantly higher than the 23% reported in patients with a pushing pattern of invasion (p < 0.001). This pathological parameter was an independent predictor of node involvement (HR 4.18-95% CI 1.5-11.3), as well as lymphatic embolization (HR 3.95-95% CI 1.5-10.4) and clinical lymph node stage (HR 3.85-95% CI 1.4-10).21

Penile Cancer
Fig. 10.4 Vertical (a) and superficial (b) growth pattern according to Cubilla classification
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