Squamous cell carcinoma with sarcomatous transformation of the penis
DOI:
https://doi.org/10.4322/acr.2021.303Abstract
Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.
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References
Calonje JE, Brenn T, Lazar A, Billings S. McKee’s Pathology of the Skin. 5th ed. London: Elsevier; 2019.
Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO Classification of tumors of the urinary system and male genital organs. 4th ed. Lyon: International Agency for Research on Cancer; 2016.
Dillner J, Krogh G, Horenblas S, Meijer CJ. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol Suppl. 2000;34(205):189-93. http://dx.doi.org/10.1080/00365590050509913. PMid:11144896.
Bovolim G, Costa WH, Guimaraes GC, Soares FA, Cunha IW. Mixed papillary-sarcomatoid carcinoma of the penis: report of an agressive subtype. Virchows Arch. 2017;471(6):815-8. http://dx.doi.org/10.1007/s00428-017-2191-2. PMid:28689224.
Chaux A, Reuter V, Lezcano C, Velazquez EF, Torres J, Cubilla AL. Comparison of morphologic features and outcome of resected recurrent and nonrecurrent squamous cell carcinoma of the penis: a study of 81 cases. Am J Surg Pathol. 2009;33(9):1299-306. http://dx.doi.org/10.1097/PAS.0b013e3181a418ae. PMid:19471153.
Deem S, Keane T, Bhavsar R, El-Zawahary A, Savage S. Contemporary diagnosis and management of squamous cell carcinoma (SCC) of the penis. BJU Int. 2011;108(9):1378-92. http://dx.doi.org/10.1111/j.1464-410X.2011.10647.x. PMid:22023060.
Olesen TB, Sand FL, Rasmussen CL, et al. Prevalence of human papillomavirus DNA and p16INK4a in penile cancer and penile intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol. 2019;20(1):145-58. http://dx.doi.org/10.1016/S1470-2045(18)30682-X. PMid:30573285.
Morse DC, Tschen JA, Silapunt S. A rare variant of penile squamous cell carcinoma in a man with Paraplegia. Cureus. 2018;10(9):e3244. http://dx.doi.org/10.7759/cureus.3244. PMid:30416897.
Hui G, Ghafouri SN, Shen J, Liu S, Drakaki A. Treating penile cancer in the immunotherapy and targeted therapy era. Case Rep Oncol Med. 2019;2019:8349793. http://dx.doi.org/10.1155/2019/8349793. PMid:31019822.
Cocks M, Taheri D, Ball MW, et al. Immune-checkpoint status in penile squamous cell carcinoma: a North American cohort. Hum Pathol. 2017;59:55-61. http://dx.doi.org/10.1016/j.humpath.2016.09.003. PMid:27663086.
Trafalis DT, Alifieris CE, Kalantzis A, Verigos KE, Vergadis C, Sauvage S. evidence for efficacy of treatment with the Anti-PD-1 Mab Nivolumab in radiation and multichemorefractory advanced penile squamous cell carcinoma. J Immunother. 2018;41(6):300-5. http://dx.doi.org/10.1097/CJI.0000000000000221. PMid:29642086.
Cocco E, Scaltriti M, Drilon A. NTRK fusion-positive cancers and TRK inhibitor therapy. Nat Rev Clin Oncol. 2018;15(12):731-47. http://dx.doi.org/10.1038/s41571-018-0113-0. PMid:30333516.
Masferrer E, Ferrándiz-Pulido C, Masferrer-Niubò M, et al. Epithelial-to-mesenchymal transition in penile squamous cell carcinoma. J Urol. 2015;193(2):699-705. http://dx.doi.org/10.1016/j.juro.2014.07.083. PMid:25063494.
May M, Brookman-May S, Burger M, et al. A switch from epithelial to mesenchymal properties correlates with lymphovascular invasion in squamous cell carcinoma of the penis. Pathol Res Pract. 2015;211(9):641-5. http://dx.doi.org/10.1016/j.prp.2015.05.007. PMid:26092595.
Cunha IW, Souza MJL, Costa WH, et al. Epithelial-mesenchymal transition (EMT) phenotype at invasion front of squamous cell carcinoma of the penis influences oncological outcomes. Urol Oncol. 2016;34(10):433.e19-26. http://dx.doi.org/10.1016/j.urolonc.2016.05.015. PMid:27381894.
Campos RSM, Lopes A, Guimarães GC, Carvalho AL, Soares FA. E-cadherin, MMP-2, and MMP-9 as prognostic markers in penile cancer: analysis of 125 patients. Urology. 2006;67(4):797-802. http://dx.doi.org/10.1016/j.urology.2005.10.026. PMid:16566971.
Guimarães GC, Cunha IW, Soares FA, et al. Penile squamous cell carcinoma clinicopathological features, nodal metastasis and outcome In 333 cases. J Urol. 2009;182(2):528-34. http://dx.doi.org/10.1016/j.juro.2009.04.028. PMid:19524964.
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