11. Penis neoplasms

Question 1

Types of penis neoplasms

Answer 1

1. Condyloma acuminatum

2. Squamous cell carcinoma of the penis

Question 2

Definition of condyloma acuminatum

Answer 2

Benign sexually-transmitted tumour of the penis

Question 3

Associations with condyloma acuminatum

Answer 3

HPV types 6 & 11

Question 4

Morphology of condyloma acuminatum

Answer 4

1. Grossly:
   - Lesion found on the coronal sulcus, on the inner surface of the prepuce
   - Single/multiple, sessile/pedunculated red papillary excrescences
2. Histologically:
   - Branching, villous papillary stroma
   - Covered by epithelium which may have superficial hyperkeratosis & thickening of the underlying epidermis (acanthosis)
   - Normal orderly maturation of epithelial cells is present
   - Cytoplasmic vacuolization of squamous cells (koilocytosis) characteristic of HPV infection

Question 5

Epidemiology & associations with squamous cell carcinoma of the penis

Answer 5

1. Geographical variations (10-20% of male malignancies in high risk areas)
2. Circumcision is protective (rare in Jews & Muslims)
3. HPV types 16 & 18

Question 6

Morphology of squamous cell carcinoma of the penis

Answer 6

1. Grossly:
   - Lesion on the glans of the inner surface of prepuce
   near the coronal sulcus
2. Histologically: (2 patterns)
   - Papillary (simulates condyloma acuminatum, may produce cauliflower-like mass)
   - Flat (areas of epithelial thickening with graying & fissuring of mucosal surface)

Question 7

Clinical features of squamous cell carcinoma of the penis

Answer 7

1. Slow growing, locally invasive
2. Metastases to inguinal & iliac lymph nodes indicates a poor prognosis
3. Pain develops after tumours undergo secondary ulceration & infection