Penile malignancy is the third most common male-specific genitourinary malignancy, with squamous cell carcinoma representing the most common histologic type. Squamous cell carcinoma is an epithelial malignancy, frequently developing from the mucosal surfaces of the foreskin, glans, and coronal sulcus and manifesting as a distal infiltrative or ulcerated mass. This typically occurs in men from the 6th to 8th decades of life, and risk factors include human papillomavirus, phimosis, presence of foreskin and poor hygiene, chronic inflammatory conditions such as lichen sclerosus, trauma, and smoking. Primary urethral malignancies including urothelial carcinoma and adenocarcinoma can occur but may lack this distal predilection. Sarcoma, melanoma, leukemia or lymphoma, and metastatic disease are less common sources of penile malignancy. Because of the sensitive nature of penile malignancies, there may be delays in seeking care and in subsequent diagnosis. Recently, the staging guidelines for penile cancer have been updated concurrently with a shift toward more penile-preserving therapies, which have led to a larger role of imaging in diagnosis, staging, and treatment planning for penile malignancies. A variety of imaging modalities may play a role in the identification and staging of penile malignancy, including an increased use of MRI for local staging of tumors, CT and PET/CT for identification of nodal and distant disease, and US for image-guided biopsy. The authors discuss an imaging approach to a spectrum of penile malignancies, with an emphasis on radiologic and pathologic correlation and how knowledge of normal tissue types and anatomic structures can aid in the diagnosis and staging of these tumors. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Radiographics : a review publication of the Radiological Society of North America, Inc. 2023 Aug [Epub]
Meghan G Lubner, Jamie Marko, Rong Hu, Akira Kawashima, Theodora A Potretzke, Aletta Ann Frazier, Ryan Whiting, Aaron M Udager
From the Department of Radiology (M.G.L.) and Department of Pathology and Laboratory Medicine (R.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792; American College of Radiology Institute for Radiologic Pathology, Silver Spring, Md (M.G.L., J.M., A.A.F.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (A.K.); Department of Radiology, Mayo Clinic, Rochester, Minn (T.A.P.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (A.A.F.); Department of Radiology, Moncrief Army Health Clinic, Fort Jackson, Columbia, SC (R.W.); and Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.).