BERKELEY, CA (UroToday.com) - The appropriate treatment of penile cancer requires an accurate assessment of pathological stage and grade. Unfortunately, pathological staging in penile cancer may be difficult due to the complexity of the penile anatomy, a fact that is further complicated by the relatively few penectomy specimens presented to most pathologists. Whole-mount processing uses large tissue cassettes and slides for histologic processing, approximately double the size that are routinely used. Because the cassettes and slides are larger, tissue such as a cross section of the penis can be submitted in its entirety. This technique has previously been described for the submission of prostatectomy tissue, but has not been reported for the evaluation of penectomy specimens. We theorized that looking at intact cross sections of the penis would be helpful to identify anatomical structures.
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In our study, we compared penectomy specimens, which were processed using whole mounting, to those processed in the routine way. We found that whole mounting was a feasible technique for penectomies with an increased processing cost of only $40 per case and one day longer turnaround time. Advantages identified included that whole mounts had less recuts, less immunostaining, and fewer additional blocks requested compared to routinely processed specimens. We were also able to show that whole mounting might improve staging. Staging discrepancies occurred in 16% of routinely processed cases but no whole-mount cases. This improvement in staging comes with the added benefit of a subjectively reduced time required for pathologists to evaluate cases. Our method also allowed better differentiation of invasion into the corpora cavernosa from invasion into the corpus spongiosum, a distinction that is being increasingly reported as potentially impacting prognosis, and has even been recommended for separation in pT staging.
Based on our experience, we recommend this technique to institutions that have already adopted whole mounting for other organs such as prostate, as a method to reduce errors and potentially improve patient outcomes.
Joshua J. Ebel, BS and Debra L. Zynger, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Debra L. Zynger, MD
Department of Pathology
The Ohio State University Medical Center
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E401 Doan Hall
Columbus, OH 43210