14.1 Penis

Question 1

lymphogranuloma venereum

• what is it
• cause
• what rectal complication can occur

Answer 1

• necrotizing granulomatous inflamm of inguinal lymphatics and lymph nodes
• STI from chlamydia (serotypes L1-L3)
• heals with fibrosis, perianal involvement can result in rectal stricture

Question 2

You suspect possible SCC on the penis of your pt

-what CIS lesions come to mind, and how to differentiate?

Answer 2

1. Bowen’s disease
   - shaft/scrotum, leukoplakia
2. Erythroplakia of Queyrat
   - glans, erythroplakia
3. Bowenoid papulosis
   - pts are younger (40s), multiple red nodules

Question 3

Squamous cell carcinoma of Penis

-risk factors (2)

Answer 3

1. high risk HPV infection (16,18,31,33)
2. no circumcision (foreskin can be inflammed and be source of irritation if not properly maintained)

Question 3

Which CIS SCC penile lesion does not advance to invasic SCC?

Answer 3

Bowenoid papulosis

Question 4

Bowenoid papulosis

-presentation

Answer 4

in situ SCC of penis

• mulitple reddish nodules on penile skin
• seen in younger pts (40s) compared to Bowen’s disease and Erythroplakia of Queyrat
• does not progress to invasive carcinoma

Question 5

Bowen disease

-presentation

Answer 5

in situ carcinoma of penis shaft/scrotum

• leukoplakia
• precursor to SCC

Question 7

condyloma acuminatum

• what is it
• cause
• histology

Answer 7

Genital warts

• benign warty growth on genital skin
• HPV 6,11
• characterized by koilocytic change (raisin koilocyic change)

Question 7

Erythroplakia of Queyrat

-presentation

Answer 7

• in situ carcinoma of glans
• erythroplakia
• precursor to SCC

Question 9

Squamous cell carcinoma of penis

• precursor lesions (3)
• location, appearance

Answer 9

All in situ carcinomas:

1. Bowen disease
   - penile shaft/scrotum. presents as leukopakia
2. Erythroplasia of Queyrat
   - glans, presents as erythroplakia
3. Bowenoid papulosis
   - multiple reddish papules, younger pts (40s) than the othe r2
   - does NOT progress to invasive carcinoma

Question 10

Hypospadias

-failure of what to close

Answer 10

Urethra opens on inferior surface of penis

-failure of urethral folds to close

Question 11

Chlamydia

-life cycle

Answer 11

• obligate intracellular
• elementary bodies infect cells, then become reticulate bodies.
• Then, infected cells make elementary bodies to disperse to new cells

Question 12

Epispadias

• due to abnormal positioning of what?
• assoc with what

Answer 12

• urethra opens on superior surface of penis
• abnormal positioning of genital tubercle
• assoc with bladder exstrophy