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Pseudohyperplastic Squamous Cell Carcinoma of the Penis Associated With Lichen Sclerosus

Velazquez, Elsa F. MD*; Cubilla, Antonio L. MD

doi: 10.1097/01.pcr.0000153238.49393.ac
Case Review
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Pseudohyperplastic carcinoma is a rare variant of squamous cell carcinoma of the penis that afflicts older men; it is often multicentric, frequently affects the foreskin, and is characterized by a well-differentiated morphology with minimal nuclear atypia. Grossly, the tumors are slightly elevated, white lesions, classically affecting the preputial mucosal surface. Histologically, they are nonverruciform, extremely well-differentiated tumors characterized by downward proliferation of interanastomosed keratinizing nests surrounded by fibrous stroma. The differential diagnosis with pseudoepitheliomatous hyperplasia may be problematic, especially in small and superficial biopsies. Due to its low-grade and foreskin preferential location, pseudohyperplastic carcinomas may be cured by circumcision. Occasionally, the neoplasm recurs, showing higher-grade areas. This may be due to insufficient surgery (positive coronal sulcus margin) or multicentricity. Pseudohyperplastic carcinomas represent a subset of nonverruciform, non–HPV-related, well-differentiated squamous cell carcinoma (SCC). Their frequent association with lichen sclerosus and squamous hyperplasia suggests that these lesions may play a precancerous role.

From the *Departments of Pathology and Dermatology, New York University Medical Center, New York, New York; and the †Department of Pathology, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion and Instituto de Patologia e Investigacion, Asuncion, Paraguay.

Reprints: Elsa F. Velazquez, MD, Dermatopathology Section, New York University Medical Center, 530 First Avenue, Suite 7J, New York, NY 10016. E-mail: elsa.velazquez@med.nyu.edu.

© 2005 Lippincott Williams & Wilkins, Inc.