Penis
Background
Amputations of penis are rare but occasionally necessary for the resection of squamous cell carcinoma.1-3 Wedge resections of glans penis and glansectomy specimens may also be received.2 Small biopsies specimens are included in GU small biopsy instructions.
Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.
- No
- Non-routine fixation (not formalin), describe.
- Yes
- Special studies required, describe.
- Ensure samples are taken prior to fixation.
- Not performed
- Performed, describe type and result
- Frozen section
- Imprints
- Other, describe
See general information for more detail on specimen handling procedures.
Inspect the specimen and dictate a macroscopic description.
External Inspection
Orientate and identify anatomical features of the specimen (glans, coronal sulcus, foreskin, corpus spongiosum, corpora cavernosa, penile urethra). Orientate and designate margins.
Record additional orientation or designation provided by operating clinician:
- Absent
- Present
- Method of designation (e.g. suture, incision)
- Featured denoted
Photograph the intact specimen.
Describe the following features of the specimen:1-4
Procedure
Record as stated by the clinician.
- Biopsy; punch, incisional or excisional biopsy4 see GU small biopsy instructions
- Foreskin/circumcision
- Glans, wedge resection
- Glansectomy
- Penectomy
Anatomical components included (more than one may apply) and specimen size
- Entire specimen, in three dimensions
Describe and measure components (as applicable) in three dimensions:
- Glans
- Shaft
- Foreskin
- Coronal sulcus
- Scrotal skin
- Testicles
Specimen integrity
- Intact
- Disrupted, describe
Photograph the intact specimen.
Dissection
Paint all relevant surgical margin(s) with ink and record the colours applied.
Section longitudinally along the skin surface.
One cassette of representative with representative sections will suffice if no lesions have been identified.
If suspicious lesions are present or clinical history indicates, submission of the entire specimen may be appropriate.
Paint all relevant surgical margins with ink and record the colours applied.
Serially section in the transverse plane at 3mm intervals. Often submission of the entire specimen may be appropriate.
These specimens usually include the corona, skin margins, urethral meatus and occasionally the tunica.
Paint all relevant surgical margin(s) with ink. Serially section parallel to the urethra (parasagitally) to demonstrate the relationship of tumour to urethra and skin ventrally and dorsally.
Take coronal sections of left and right sides to demonstrate the lateral skin limits.
Submit all sections of entire specimen.
Paint all relevant surgical margin(s), including the proximal urethra, with ink and record the colours applied.
Open the specimen longitudinally along the centre of the ventral surface bisecting the urethra and dividing the specimen into right and left sections.
Section parasagitally along the entire specimen. The urethra should be closely examined for evidence of tumour involvement as this will upstage the tumour.
After opening the specimen may require longer fixation in larger quantity of formalin.
Take longitudinal section(s) to demonstrate urethral, spongiosus, cavernosal and skin margins.
Internal Inspection
Describe the cut surface appearance including the following items: 1-4
Tumour
- Absent
- Present
- Number; if more than one tumour, designate and describe each tumour separately
Tumour location(s)
- Foreskin
- Mucosal surface
- Skin surface
- Sulcus
- Glans
- Skin of shaft
- Penile urethra
Tumour size (mm)
- Maximum dimension
- Other dimension
Tumour appearance
- Nodule
- Endophytic
- Exophytic
- Polyp
- Papillary
- Verruciform
- Plaque
- Ulcer
- Pigmented macule, describe
- Irregular edge
- Circumscribed edge
- Uniform pigmentation
- Variegated pigmentation
Invasion
- Absent
- Present
- Lamina propria
- Corpus spongiosum
- Tunica albuginea
- Corpora cavernosa
- Urethral meatus/urethra
Surgical margins
- Distance of tumour to the closest margin (mm)
- Specify margin
Non-tumour lesion
Retrieved from resection specimen
- Describe site(s)
- Number retrieved
Separately submitted
- For each specimen container, record specimen number and designation
- Collective size of tissue in three dimensions (mm)
- Number of grossly identified lymph nodes submitted
- Maximum diameter of each (mm)
Photograph the dissected specimen.
Processing
Dissect the specimen further and submit sections for processing as follows:1-4
- Submit representative sections if no suspicious lesions are present.
- If suspicious lesions are present, submit all sections in sequential order.
- If orientated, submit shave sections from margins in separately designated cassettes.
- Submit all sections in sequential order.
- If orientated, submit shave sections from the margin(s) in separately designated cassettes.
- Submit all sections in sequential order.
- If orientated, submit shave sections from the margin(s) in separately designated cassettes.
Submit representative sections of:
- Surgical margins, at least two cassettes of proximal margin including skin, corpora and urethra (more if tumour is close, in which case longitudinal sections may be used)
- Tumour and adjacent tissue demonstrating deepest level of invasion, 3-4 blocks
- Longitudinal section through glans and urethra to demonstrate any urethral involvement
- Uninvolved skin
Submit all lymph nodes
Record details of each cassette.
An illustrated block key similar to those provided below may be useful.
Block allocation keys
|
Cassette id
|
Site
|
No. of pieces
|
|
A
|
Foreskin
|
|
|
B
|
Margins (if applicable)
|
|
|
Cassette id
|
Site
|
No. of pieces
|
|
A
|
Glans penis
|
|
|
B
|
Margins
|
|
|
Cassette id
|
Site
|
No. of pieces
|
|
A-B
|
Surgical margins, including skin, corpora and urethra
|
|
|
C-E
|
Tumour and adjacent tissue including deepest level of invasion and tumour closest to the urethra
|
|
|
F-G
|
Skin and corpus cavernosum
|
|
| H |
Urethral meatus (further)
|
|
Acknowledgements
A/Prof Hemamali Samaratunga for her contribution in reviewing and editing this protocol.
References
-
Lester SC. Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
-
-
Mikuz G, Winstanley AM, Schulman CC, Debruyne FM and Parkinson CM. Handling and pathology reporting of circumcision and penectomy specimens.
Eur Urol 2004;46(4):434-439.
-