Vascular Invasion

Several reports have established the value of vascular (either lymphatic or venous) invasion as a prognostic factor for penile cancer metastasis.133 135"138 155 Lymphatic invasion is observed more frequently (Fig. 3.20b) although venous invasion can

Table 3.3 2009 TNM classification of penile cancer T - primary tumor TX T0 Tis Ta

T2 T3 T4

N - regional lymph nodes

NX Regional lymph nodes cannot be accessed

N0 No palpable or visibly enlarged inguinal lymph node

N1 Palpable mobile unilateral inguinal lymph node

N2 Palpable mobile multiple or bilateral inguinal lymph nodes

N3 Fixed inguinal nodal mass or pelvic lymphadenopathy, unilateral or bilateral

M - distant metastases

M0 No distant metastasis

M1 Distant metastasis

2009 TNM pathological classification of penile cancer

The pT categories correspond to the T categories. The pN categories are based upon biopsy, or surgical excision pN - regional lymph nodes pNX pN0 pN1 pN2 pN3

pM - distant metastases pM0 pM1

G - histopathological grading

GX Grade of differentiation cannot be assessed

G1 Well differentiated

G2 Moderately differentiated

G3-4 Poorly differentiated/undifferentiated

Primary tumor cannot be assessed No evidence of primary tumor Carcinoma in situ

Non-invasive verrucous carcinoma, not associated with destructive invasion Tumor invades subepithelial connective tissue

Tumor invades subepithelial connective tissue without lymphovascular invasion and is not poorly differentiated or undifferentiated (T1G1-2)

Tumor invades subepithelial connective tissue without with lymphovascular invasion or is poorly differentiated or undifferentiated (T1G3-4) Tumor invades corpus spongiosum/corpora cavernosa Tumor invades urethra Tumor invades other adjacent structures

Regional lymph nodes cannot be assessed No regional lymph node metastasis Intranodal metastasis in a single inguinal lymph node Metastasis in multiple or bilateral inguinal lymph nodes Metastasis in pelvic lymph node(s), unilateral or bilateral or extranodal extension of regional lymph node metastasis

No distant metastasis Distant metastasis

Penile Lymphedema
Fig. 3.20 Pathological prognostic factors. (a) Perineural invasion is characterized by invasion of neoplastic cells into the perineural spaces of peripheral nerves. (b) A tumor embolus found within a lymphatic vascular space. Note the high-grade carcinoma in the lower right field

be present, especially in advanced stages. Neoplastic emboli can also be found in vascular erectile tissues. Attention should be paid for not confusing clear space artifacts surrounding tumor nests with true vascular spaces. The use of endothe-lial-specific markers could help in this matter but in practice they are rarely needed.

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