Tumor of penis

Tumor

Benign tumor:

Condyloma  Acuminatum

•         Caused by HPV type 6 & 11.

•         Occurs on the external genital & peri anal.

•         In penis occurs most often about the coronal sulcus & inner surface of the prepuce.

•         Grossly: single or multiple sessile or pedunculated red papillary excrescencies from 1 to few millimeter.

•         Histology: branching villous, papillary connective tissue stroma covered by epithelium with hyperkeratosis & koilocytosis (irregular nuclei &per nuclear vacuole).

Carcinoma In Situ

•         Epithelial lesions having cytological changes of malignancy confined to the epithelium with no evidence of local invasion or distal metastases.

•         3 types

•         Bowens  disease.

•         Erythroplagia of Queyrat.

•         Bowenoid  papulosis.

Bowens  Disease

•         Occurs in age over 15 years.

•         Strong association with HPV 16 & 18 ( 80 %).

•         Occurs in skin of shaft of penis & scrotum.

•         Grossly: plaque with shallow ulceration & crusting.

•         Histology: proliferation of epidermis with numerous mitosis & lack of orderly maturation. Cell are dysplastic with hyper chromatic nuclei.

•         10 % change to invasive squamous cell carcinoma .

Erythroplagia of Queyrat

•         Occurs on the glans & prepuce.

•         Grossly: single or multiple, shiny red velvety plaque.

•         Histology: as in Bowens  disease.

Bowenoid papulosis

•         Sexually active young men (mean age 30), usually on skin of shaft, glans or scrotum.

•         Associated with HPV 16 or 18.

•         Almost never becomes invasive.

•         May spontaneously regress.

•         Gross: multiple, small, pigmented papular lesions, may resemble condyloma accuminatum.

•         Micro: histologically resembles Bowen’s disease, but may have mild / heavy melanin pigmentation within the lesion; often spiky or flat appearance, may have less cytological atypia .

Squamous cell carcinoma

•         Occurs between 40 - 70 years.

•         10 - 20 %  of male malignancies in some parts of Asia, Africa & south America.

•         < than 1 % in U.S.

•         Circumcision confers protection so it is rare in Moslems & Jews.

•         50 % of cases associated with HPV 16 & 18

•         Cigarette smoking is another risk factor. 

•         Commonly occurs in glans or inner surface of the prepuce near the coronal sulcus.

•         Grossly: either papillary or ulcerated lesion.

•         Histology: invasion of nest of squamous cell of varying degree of differentiation with desmoplasia & inflammation.

•         It is slowly growing tumor with early metastasis to the inquinal lymph node.