Superpage - Images

Adenosquamous carcinoma
Gross images

AFIP images

Various images

Microscopic (histologic) images

Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.
Nests and differentiation

Nests and differentiation



AFIP images

Infiltrating tumor
has squamous
and glandular
features

Glandular portion is CEA+

Cervix: poorly formed glands and squamous components (arrows)



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Cervix: malignant glandular (arrow) and squamous components (star)


Anatomy & histology-male urethra
Diagrams / tables

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Male urethra Male urethra

Male urethra

Male urethra

Male urethra

Prostatic urethra

Prostatic urethra

Male urethra development

Male urethra development

Gross images

Contributed by Debra L. Zynger, M.D.
Prostatic urethra

Prostatic urethra

Penile urethra Penile urethra

Penile urethra

Microscopic (histologic) images

Contributed by Debra L. Zynger, M.D.
Prostate, cross section with prostatic urethra

Prostate, cross section with prostatic urethra

Prostatic urethra

Prostatic urethra

Prostatic verumontanum and prostatic urethra

Prostatic
verumontanum
and prostatic
urethra

Bulbourethral (Cowper) glands Bulbourethral (Cowper) glands

Bulbourethral (Cowper) glands


Penile urethra

Penile urethra

Penile intraepithelial (juxtaepithelial) glands

Penile intraepithelial (juxtaepithelial) glands

Penile glands of Littre

Penile glands of Littré

Fossa navicularis

Fossa navicularis


Anatomy & histology-penis
Diagrams / tables

AFIP images

Transverse section

Meatus

Glans

Cut section

Shaft cross section



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Compartments

Local anatomy

Arteries


Veins

Urethra

Corpora cavernosa

Transverse sections

Gross images

AFIP images
Mucosal and wrinkled portion of foreskin

Mucosal and wrinkled portion of foreskin

Cross section

Cross section

Microscopic (histologic) images

Contributed by Diego F. Sanchez, M.D. and Antonio L. Cubilla, M.D.
Penile shaft surgical margin

Penile shaft surgical margin

Surgical margin connective tissue

Surgical margin connective tissue

Erectile corpora

Erectile corpora

Albuginea and corpus cavernosum

Albuginea and corpus cavernosum

Corpora cavernosa

Corpora cavernosa

Corpus spongiosum

Corpus spongiosum


Glans

Glans

Foreskin in anatomical position

Foreskin in anatomical position

Foreskin epithelium

Foreskin epithelium

Foreskin epithelium

Foreskin dartos

Penile urethra

Penile urethra

Littre glands

Littre glands


Anatomy & histology-scrotum
Diagrams / tables

AFIP images

Cross section of the scrotal wall



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Embryologic development

Clinical images

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Constricted human
scrotum (without
hair) with the raphe
clearly exposed

Microscopic (histologic) images

AFIP images

Muscle bundles of the
dartos are beneath
the keratinized
squamous epithelium

Thick bundles of
conspicuous smooth
muscle in the deep
reticular dermis


Balanitis / phimosis
Clinical images

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Intractable, thickened foreskin

Intractable, thickened foreskin

Erythematous plaque on glans (Zoon balanitis)

Erythematous plaque on glans (Zoon balanitis)

Marked ulceration with tissue destruction

Microscopic (histologic) images

Contributed by Angelle Jolly, M.D.
Chronic inflammatory infiltrate Chronic inflammatory infiltrate

Chronic inflammatory infiltrate

Lichenoid inflammation

Lichenoid inflammation

Intraepithelial inflammation

Intraepithelial inflammation


Plasma cell infiltrate

Plasma cell infiltrate

Florid plasma cells

Florid plasma cells

Mucosal ulceration

Mucosal ulceration


Basal cell carcinoma
Clinical images

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Ulcer almost circumscribing penis and causing penis / scrotal edema

Microscopic (histologic) images

AFIP images

Skin: not necessarily penis



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Skin - not necessarily penis


Bowenoid papulosis
Clinical images

AFIP images

2 small papules with irregular margins



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Penile lesions

Typical appearance in female


Microscopic (histologic) images

Contributed by Liwei Jia, M.D., Ph.D.

Intact basement membrane

Mitotic figures

Proliferation


AFIP images

Acanthosis and spotty distribution of atypical cells

Videos

Microscopic findings of bowenoid papulosis / HSIL


Cellulitis
Clinical images

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Acute erythema and edema


Chancroid
Clinical images

AFIP images

Slightly raised flat disc with central ulceration



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Ulcers

Regional adenopathy

Microscopic (histologic) images

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Gram stain

Gentian violet stain


Condyloma acuminatum
Clinical images

AFIP images
Multiple exophytic lesions

Multiple exophytic lesions



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Multiple exophytic and warty lesions on the shaft and glans of the penis Multiple exophytic and warty lesions on the shaft and glans of the penis

Multiple exophytic and warty lesions on the shaft and glans of the penis

Gross images

Contributed by Debra L. Zynger, M.D.
Giant condyloma acuminatum Giant condyloma acuminatum

Giant condyloma acuminatum

Microscopic (histologic) images

Contributed by Asra Feroze, M.B.B.S. and Ritu Bhalla, M.D.
Exophytic growth

Exophytic growth

Cauliflower-like lesion

Cauliflower-like lesion

Fibrovascular cores

Fibrovascular cores

Hyperkeratosis and parakeratosis

Hyperkeratosis and parakeratosis


Koilocytes Koilocytes on medium power Koilocytes on high power

Characteristic koilocytes

p16

p16

Videos

Condyloma histopathology

Genital warts under microscope


Congenital anomalies
Clinical images

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Classification

Epispadias: male baby

Proximal shaft

Penoscrotal

43 year old man with median raphe cyst

Microscopic (histologic) images

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Median raphe cysts:

Pseudostratified columnar epithelium

Single larger mucinous cell

Cyst lining cells are CK7+


Extramammary Paget disease
Radiology images

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Scrotal MR and ultrasound

Scrotal ultrasound

Clinical images

AFIP images

Scrotal lesion



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Erythematous penile patches

Gross images

Contributed by Debra L. Zynger, M.D.
White lesion White lesion

White lesion

Microscopic (histologic) images

Contributed by Debra L. Zynger, M.D.
Intraepithelial growth

Intraepithelial growth

Nests and single cells

Nests and single cells

Basal location

Basal location

Nuclear features

Nuclear features

Microinvasion Microinvasion

Microinvasion


Deep invasion Deep invasion

Deep invasion

Comedonecrosis Comedonecrosis

Comedonecrosis

Muscle invasion

Muscle invasion


H&E for comparison with IHC

H&E for comparison with IHC

CK7

CK7

GATA3

GATA3

CK5/6

CK5/6

p63

p63

S100

S100


Fournier gangrene
Diagrams / tables

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Fournier gangrene severity index

Clinical images

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Necrosis spreading along fascial planes

Paraphimosis

Lesions on penis and scrotum

Gross images

AFIP images
Extensive sloughing

Extensive sloughing

Corbus disease: necrosis of glans

Corbus disease: necrosis of glans

Corbus disease: cut surface

Corbus disease: cut surface

Microscopic (histologic) images

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Bacteria, neutrophils and necrotic tissue


Granuloma inguinale
Clinical images

AFIP images
Figure 10-76 Figure 10-76

Figure 10-76

Scrotum and inner thigh skin

Scrotum and inner thigh skin



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Ulcerated lesion with hypertrophic borders

Various images


Beefy red penile ulcer

Multiple ulcers on the penile shaft, pubis and scrotum

Raw granulation tissue

Diffuse ulceration

Microscopic (histologic) images

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Donovan bodies

Squamous cells and keratin pearls


Grossing & features to report
Gross images

Contributed by Shaheed W. Hakim, M.D. and AFIP
Mapped partial penectomy specimen

Mapped partial penectomy specimen

Foreskin

Foreskin

SCC involves corpora cavernosa

SCC involves corpora cavernosa

Partial penectomy specimen

Partial penectomy specimen

Microscopic (histologic) images

Contributed by Shaheed W. Hakim, M.D. and AFIP

Grade 1

Grade 2, more disorganized growth

Grade 3

Missing Image

Lamina propria invasion

Missing Image

Urethral mucosal involvement

Diagrams / tables

AFIP images
Periurethral corpus spongiosum involvement

Periurethral corpus spongiosum involvement

Possible sites of involvement

Possible sites of involvement

Tumor involvement in yellow

Tumor involvement in yellow



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Penis anatomy

Penis anatomy


Herpes simplex virus
Diagrams / tables

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Herpesvirus structure

Herpesvirus structure

Clinical images

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Multiple vesicles and ulcerations on surface

Multiple vesicles and ulcerations on surface

Herpetic vesicles of penis

Herpetic vesicles of penis

Herpes vegetans

Herpes vegetans

Microscopic (histologic) images

Contributed by Daniel Anderson, M.D., M.B.A. and Garrison Pease, M.D.
HSV infected cells HSV infected cells

HSV infected cells

HSV infected cells

HSV infected cells

HSV1 / HSV2 IHC

HSV1 / HSV2 IHC

Ulcer interface, virally infected cells

Ulcer interface, virally infected cells

Ulcer interface, viral changes

Ulcer interface, viral changes


HSV1 / HSV2 IHC HSV1 /HSV2 IHC

HSV1 / HSV2 IHC

HSV1 / HSV2 IHC

HSV1 / HSV2 IHC

HSV ulcer, mixed inflammation

HSV ulcer, mixed inflammation

Necrotic virally infected cells

Necrotic virally infected cells

Viral multinucleation, margination, molding

Viral multinucleation, margination, molding


Hypertrophic epidermis, dense inflammation

Hypertrophic epidermis, dense inflammation

Dense inflammation and ulcer

Dense inflammation and ulcer

Ulcer interface, dense inflammation

Ulcer interface, dense inflammation

Mixed inflammation and ulceration

Mixed inflammation and ulceration

Cell in ulcer, viral change

Cell in ulcer, viral change

Ulcer interface, viral changes

Ulcer interface, viral changes


Details viral changes

Details viral changes

Multinucleation, margination, molding

Multinucleation, margination, molding

Virally infected cells at interface

Virally infected cells at interface

Multinucleation, margination, molding

Multinucleation, margination, molding

Vulva ulcer

Ulcer and viral changes

Vulva ulcer

Viral changes at interface

Cytology images

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HSV infected squamous cells HSV infected squamous cells

HSV infected squamous cells

Videos

Herpes under the microscope
by Dr. Jared Gardner


Lichen sclerosus (balanitis xerotica obliterans)
Clinical images

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Lichen sclerosus and melanosis

Lichen sclerosus and phimosis

Depigmentation, glans atrophy and ecchymoses

Severe sclerosis, scarring and ulceration

Microscopic (histologic) images

Contributed by Diego F. Sanchez, M.D. and Antonio L. Cubilla, M.D.

Atrophy and sclerosis

Hyperplasia and sclerosis

Linear sclerosis

Vacuolization and perivascular sclerosis

Edema and hyalinization


Classic lichen sclerosus

Lichenoid lichen sclerosus

Lymphocytic depleted lichen sclerosus

PeIN and lichen sclerosus

Pseudohyperplastic carcinoma, lichen sclerosus

Videos

Lichen sclerosus et atrophicus


Lymphogranuloma venereum
Clinical images

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Sinus tract

Microscopic (histologic) images

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Lymph nodes


Melanosis and lentiginosis
Clinical images

AFIP images
Melanosis

Melanosis

Microscopic (histologic) images

AFIP images
Melanosis

Melanosis


Molluscum contagiosum
Clinical images

Contributed by Harry Ioachim, M.D.

Multiple lesions on shaft of 30 year old drug abuser



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Lesions on shaft of penis

Skin lesions (site unspecified)


Microscopic (histologic) images

AFIP images

Henderson-Patterson bodies



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Henderson-Patterson bodies

Molluscum bodies

Cytology images

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Pap stain

Electron microscopy images

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Viral particles


Mucoid cyst
Clinical images

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Median raphe cysts

Microscopic (histologic) images

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Pseudostratified columnar epithelium

Single larger mucinous cell within epithelium

CK7

CK13

CEA


Myointimoma
Diagrams / tables

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Anatomy of corpus spongiosum in glans penis

Histology of intima

Clinical images

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Nodule on the left side of glans penis

Gross images

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Excised nodule

Microscopic (histologic) images

Contributed by Maria Tretiakova, M.D., Ph.D.

Plexiform architecture

Intravascular proliferation

Intravascular intimal proliferation

Fibromyxoid stroma

Bland myofibroblastic cells

SMA staining


Ossification
Clinical images

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Raccoon

Dog

Walrus

Figure F: obvious distal ligament within the glans penis

Microscopic (histologic) images

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Figure C: distal ligament


Pearly penile papules
Clinical images

AFIP images

Regular rows of
small papules
form a ring
around the corona



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1 - 2 cm papules

Microscopic (histologic) images

AFIP images

Benign epithelial hyperplasia with vascular fibrous stroma


Penile intraepithelial neoplasia (PeIN)
Clinical images

AFIP images

Erythroplasia of Queyrat: moist red lesion involving glans

Bowen disease



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Erythematous lesion in the glans

Erythroplasia of Queyrat

PeIN with lichen sclerosus

PeIN in multiple compartments

Microscopic (histologic) images

Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.

Squamous cell atypia

Small basaloid cells

Basaloid nonkeratinized cells

Small blue cells and koilocytes

Basaloid type

Warty type


Atypical lichen sclerosus

Differentiated type

Ki67 positivity

Strong en bloc cytoplasmic and nuclear p16 immunostaining

Molecular / cytogenetics images

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p16 and HPV ISH


Peyronie disease
Radiology images

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Penile deformation

Dorsal plaque

Clinical images

AFIP images

Penile curvature



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Penile curvature

Gross images

AFIP images

Tunica albuginea

Microscopic (histologic) images

AFIP images

Thickening of tunica albuginea

Fibrosis

Videos

Penile fibromatosis


Sclerosing lipogranuloma
Clinical images

AFIP images

Marked deformity of penis

Gross images

Contributed by Debra L. Zynger, M.D. and AFIP images

Scrotoplasty

Replacement of entire scrotal wall by solid yellow-white tissue with interspersed cysts

Microscopic (histologic) images

AFIP images

Characteristic vacuoles,
sclerotic stroma and
occasional foreign body
giant cells

Numerous, variably sized vacuolated spaces

Oil Red O stain


Scrotal calcinosis
Radiology images

Contributed by Nasir Ud Din, M.B.B.S.

Incidentally found scrotal calcinosis

Clinical images

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Scrotal calcinosis with vitiligo

Pre and postoperative scrotum

Scrotal skin showing calcifications

Multiple white scrotal nodules

Gross images

Contributed by Debra Zynger, M.D.
White nodule

White nodule

Microscopic (histologic) images

Contributed by Nasir Ud Din, M.B.B.S., Debra Zynger, M.D. and @katcollmd on Twitter

Skin tissue showing calcium deposits

Multiple calcium deposits

Calcium deposits with granulomatous reaction

Dermal calcium deposits with epidermis


Scrotal calcinosis Scrotal calcinosis

Scrotal calcinosis

Scrotal calcinosis Scrotal calcinosis

Scrotal calcinosis

Cytology images

Contributed by Sleiman Khal, M.D. (Case #468)

FNA smear of scrotal calcinosis



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FNA smear of scrotal calcinosis

Videos

Scrotal calcinosis: pathology mini tutorial


Squamous cell carcinoma-general
Diagrams / tables

AFIP images

Schematic representation of effect of anatomic depth of invasion on risk of lymph node metastasis in carcinoma

Possible sites of
resection margin
involvement at time
of frozen section

Verruciform lesions

Frozen section evaluation of surgical margins

Clinical images

Contributed by Stewart F. Cramer, M.D. and AFIP images

Large bosselated mass

Tumor at junction of scrotum and penis



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Arising on genital lichen sclerosus

Papillary SCC

Ulcerated SCC on glans

Verrucous carcinoma

Gross images

AFIP images

Glans:

Exophytic cauliflower-like mass

Glans extensively
involved by a
multinodular mass
with focal ulceration


Foreskin:

Circumcision
specimen shows a
flat, granular and
beige neoplasm

Massive involvement
has caused multiple
foci of ulceration



Coronal sulcus:

Nodular white
tumor extensively
involves the sulcus

Cut section
shows 2
discrete nodules
of tumor


Verruciform lesions:

Verrucous
carcinoma



Cobblestone:

Cobblestone appearance representing condyloma


Multiple compartments:

Massive involvement
of glans, coronal
sulcus and foreskin

Massive involvement
has resulted in
autoamputation

4 separate
foci of
carcinoma
are present



Superficial spreading (SCC):

Tumor involves
the glans with
extension to
coronal sulcus

Tumor is white,
involves the mucosa
of the foreskin
and coronal sulcus


Assessment of depth of invasion:

Penile carcinoma has
been transversely
sectioned

Assessment of
depth of invasion
of tumor in
resected specimen



Vertical growth (SCC):

Solid yellow-tan
neoplasm in
the dorsal half
of the glans


Mixed low and high grade (SCC):

Neoplasm shows
superficial, white,
serrated papillary


Margin involvement:

Frozen section evaluation of surgical margins



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Red-tan ulcerated tumor

Fungating mass

Microscopic (histologic) images

Contributed by Antonio L. Cubilla, M.D., Alcides Chaux, M.D. and AFIP images

Scrotum: well, moderately and poorly differentiated tumors

Mucosa is involved by carcinoma

Invasion of the lamina propria

Mixed (hybrid) usual: verrucous carcinoma


Usual type: well differentiated (left, grade 1); moderately differentiated (middle, grade 2); poorly differentiated (right, grade 3)

Pseudoglandular growth


Low grade keratinizing (A, B); moderate to high grade nonkeratinizing (C); high grade nonkeratinizing tumor (D); and carcinoma with prominent glycogenated clear cells (E)



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Pseudoglandular growth:

Conjunctiva: acantholysis of neoplastic squamous cells

Head and neck: pseudolumina are present but no true glands


Squamous hyperplasia
Microscopic (histologic) images

Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.

Flat: hyperkeratosis and acanthosis but also normal maturation without atypia

Papillary: hyperkeratosis, papillomatosis and acanthosis

Pseudoepitheliomatous



AFIP images

Acanthosis, absence
of nuclear atypias
and hyperkeratosis


Staging-penis
Gross images

Contributed by Debra Zynger, M.D.
pTis

pTis

pT1a

pT1a

pT2

pT2

pT3

pT3

pT3 partial penectomy pT3 partial penectomy

pT3 partial penectomy


pT3 penectomy pT3 penectomy

pT3 penectomy

pT4 penectomy, orchiectomy and scrotal excision pT4 penectomy, orchiectomy and scrotal excision pT4 penectomy, orchiectomy and scrotal excision

pT4 penectomy, orchiectomy and scrotal excision

Microscopic (histologic) images

Contributed by Debra Zynger, M.D.
CIS / PeIN (pTis)

CIS / PeIN (pTis)

Subepithelial invasion (pT1a)

Subepithelial invasion (pT1a)

Perineural invasion (pT1b)

Perineural invasion (pT1b)

Invasion of corpora spongiosum (pT2)

Invasion of corpora spongiosum (pT2)

Invasion of corpora spongiosum (pT2) Inguinal lymph node metastasis (pN1)

Inguinal lymph node metastasis (pN1)


Syphilis
Clinical images

AFIP images
Sharply delineated lesion

Sharply delineated lesion

Two well circumscribed, minimally elevated lesions



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Primary chancre

Atrophic scar with condylomata lata


Secondary rash / lesions:

Palm, limbs and hands

Back


Face, teeth

"Kissing" lesions

Various images

Microscopic (histologic) images

AFIP images

Lesion characterized by acanthosis



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Perivascular dermal infiltrate

Chorioretinitis of congenital syphilis

Darkfield microscopy


Patchy infiltrate

Epithelioid cells surrounded by lymphomono-nuclear cells

Various images

Electron microscopy images

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Spirochete in culture


Tancho nodules / paraffinomas / lipogranulomas
Clinical images

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Intraurethral paraffin


Verruciform xanthoma
Clinical images

AFIP images

Granular, elevated
tan white mass
of distal shaft and
coronal sulcus

Microscopic (histologic) images

Contributed by Liwei Jia, M.D., Ph.D. and @JMGardnerMD on Twitter

Verrucous epithelial hyperplasia

Band-like plasma cells

Neutrophilic infiltrates

Foamy histiocytes

Verruciform xanthoma

Verruciform xanthoma

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Recent Penis & scrotum Pathology books

Amin: 2022

Cheng: 2019

Colecchia : 2016

Epstein: 2020

IARC: 2022

Wobker: 2021

Yang: 2020

Zhou: 2022



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