Histological Grade G

Penile cancer histological grading is usually assigned according to the classification published by Broders in 1921, defining grade 1 or well differentiated, grade 2 or moderately differentiated, and grade 3 or poorly differentiated tumors (Fig. 10.2 a, b).30

The histological tumor grade was shown to be a powerful predictor of metastatic involvement of the regional lymph nodes. The proportion of patients with pathological lymph node involvement ranged from 0% to 48% in grade 1, from 30% to 79% in grade 2, and from 47% to 100% in grade 3 tumors.8

In 2001 Slaton et al. used the Broders classification in association with two further parameters: the percentage of poorly differentiated tumor and nuclear grades.31 As regards nuclear grade, it was possible to classify penile cancer into three different categories based on nuclear size, nucleolar polymorphism, and nucleus/cytoplasm ratio. The study showed that only a cut-off percentage < or >50% of poorly differentiated tumor was related to significantly different percentages in inguinal metastases. No significant differences were observed between Broders or nuclear grading systems, but the study included only 48 patients.31 Most of the studies failed to identify statistically significant differences in 5-year cancer-specific survival across the different histological grades. Only Horenblas et al. showed significantly different 5-year survival rates among patients with grade 1 and grade 3 tumors (79% vs. 47%), respectively.27 More recent studies reported 5-year cancer-specific survival rates of 53-83% in well-differentiated tumors and 47-74% in moderately and poorly differentiated ones.10-20-24

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