Primary Tumor Histological Subtypes

The WHO classification distinguishes the following histological subtypes: usual, basaloid, verrucous, warty, papillary, sarcomatoid, adenosquamous, and mixed squamous cell carcinoma (SCC).28 Some authors have reported a significant correlation between the WHO histological classification and the percentages of lymph nodes involved in addition to cancer-related mortality. Warty, verrucous, and papillary SCC of the penis are characterized by a relatively low tendency to metastasize to inguinal lymph nodes, ranging between 0-11% of cases. In contrast, sarcoma-toid, basaloid, and adenosquamous SCC have an exceptionally high tendency to metastasize to regional lymph nodes with percentages ranging from 50% to 75%. The typical SCC has an intermediate behavior with a 25% risk of lymph node involvement. Mixed forms are similar to typical SCC.

In typical SCC, regional lymph node involvement is mainly related to gross pathological features, such as pathological stage (>pT1), and depth of invasion (>6 mm).29 It should be noted that most published data refer to typical SCC, which represents the most frequent subtype of penile cancer. Hence, there is always a need to obtain adequate histological characterization of the primary tumor.

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