B/9. Penile tumors Flashcards
Penile tumors
peak age incidence
Disease of older male (peak incidence 60 yrs)
Epidemiology penile tumors
Rare tumor in the US, Europe, and other industrialized countries
Incidence is much higher in some parts of Asia, South America, and Africa
Risk factors of penile tumor
- Uncircumcised men
- Untreated phimosis
- Smoking
- HPV infection, other STDs
Clinical findings penile tumors
- Most common presentation is a skin abnormality or palpable lesion on the penis
- Majority of cancers arise on the glans, in the coronal sulcus, or on the prepuce as either a mass or ulceration, and they may be associated with a secondary infection
- Inguinal lymphadenopathy is present in 30-60% of cases at diagnosis
- Distant metastases are uncommon until late in the disease course, with only 1-10% of cases having distant metastases at presentation
Majority of penile cancers arise on the
arise on the :
* glans
* in the coronal sulcus
* or on the prepuce
as either a mass or ulceration,
and they may be associated with a secondary infection
percentage of patients with penile tumors which present with inguinal lymphadenopathy
Inguinal lymphadenopathy is present in 30-60% of cases at diagnosis
Diagnostics penile tumors-
- For men presenting with a penile lesion suspicious for malignancy or with a penile lesion and associated lymphadenopathy > proceed with an immediate biopsy of the penile lesion (punch,
incisional, or excisional biopsy techniques) - If penile biopsy is positive, evaluation of the regional LNs is indicated (biopsy)
- Further imaging studies for tumor staging may include penile US/MRI, abdominal and pelvic CT,
chest X-ray or CT, and bone scan
For men presenting with a penile lesion suspicious for malignancy or with a penile lesion and associated lymphadenopathy proceed
with an immediate biopsy of the penile lesion (punch, incisional, or excisional biopsy techniques)
If penile biopsy is positive what to evaluate next?
evaluation of the regional LNs is indicated (biopsy)
biopsy techniques of penile lesions
- punch
- incisional
- or excisional biopsy techniques)
which imaging used for penile tumor staging
Further imaging studies for tumor staging may include
1. penile US/MRI,
2. abdominal and pelvic CT,
3. chest X-ray or CT,
4. and bone scan.
If a penile infection appears to be more likely (erythema, swelling, discharge)
what to do in this case?
- 4-6 weeks course of antifungals or antibiotics may be indicated, depending on the clinical setting.
- Lesions that do not resolve after 6 weeks or
that progress at any time during antibiotic or antifungal therapy should be biopsied
Types of penile tumors
- > 90% of cases are squamous cell carcinoma,
- Melanoma
- Basal cell carcinoma of the skin
microscopic differentiation of penile tumors
- Microscopically, tumors vary from
1. well-differentiated keratinizing tumors
2. to solid anaplastic carcinomas with limited keratinization
which HPV strain causes penile tumors?
role in the pathogenesis of penile cancers
(HPV-16 or -18 have been identified in 1/3 of men with penile cancer)
HPV 31, 33
Low risk HPV carcinogenic strains
- 6
- 11
- 42
- 43
- 44
HIGH risk HPV carcinogenic strains
16, 18, 31, 33
neoplastic transformation in low risk hpv strain
E5 viral protein : enhances PDGF and EGFR expression
E6 viral protein: inhibits p53
neoplastic transformation in High risk hpv strain
E7 viral protein: inhibits pRb
Premalignant lesions of penile tumors
- Several penile lesions are recognized as premalignant or carcinoma in-situ: have the malignant potential and capacity to evolve into frankly invasive squamous cell carcinoma (SCC)
1. Erythroplasia of Queyrat
2. Bowen disease
3. Bowenoid papulosis
4. Buschke-Löwenstein tumor (giant condyloma acuminatum)
Staging of penile tumors
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in-situ
T1 Invasion of subepithelial CT
T2 Invasion of one or more corpora (cavernosum or spongiosum)
T3 Invasion of urethra and prostate
T4 Invasion of other adjacent structures
which LN involved in penile tumors
inguinal nodes
pelvic nodes
where does penile tumor metastasis to
lung
liver
lymph nodes
bone
brain
treatment of penile tumors depend on
depends on the
1. stage of the disease
2. and the risk of recurrence;
initial approach most often involves surgery.
Local disease with
primary penile tumor < 3 cm treatment
- Limited local excision +/- circumcision (maintain penile length and sexual function while not compromising complete resection of the cancer) or
- Mohs microsurgery or
- Penile radiation therapy or
- Laser ablation or
- Topical treatment with imiquimod or 5-FU
Invasive or bulky
primary penile tumor treatment
- Partial penectomy (if penile length is adequate for voiding and sexual activity, after excision with 2 cm surgical margin) or
- Radical penectomy with perineal urethrostomy
- Regional LN dissection in patients with positive node biopsy +/- adjuvant chemotherapy
Treatment of Metastatic or
recurrent penile tumor
- Radical penectomy or
- Palliative chemotherapy
1st line chemotherapy for penile tumors
cisplatin,
bleomycin,
MTX,
5-FU
(C B M5)
initial treatment approach of penile tumors?
surgery!!!
Erythroplasia of Queyrat def
*squamous cell carcinoma in situ (SCCIS) of the penile mucosa (glans and prepuce)
Erythroplasia of Queyrat appearance
typical velvety red,
well-marginated
Erythroplasia of Queyrat lesions features
- Lesions are usually solitary
- and occasionally erode or ulcerate
- but pain is uncommon
is pain common in Erythroplasia of Queyrat?
solitary and occasionally erode or ulcerate, but pain is uncommon
Erythroplasia of Queyrat is associated with
chronic irritation and HPV infection
Erythroplasia of Queyrat is associated with
chronic irritation and HPV infection
Erythroplasia of Queyrat treatment
topically with 5-FU or imiquimod,
or
by surgical excision
Erythroplasia of Queyrat prognosis
progress to invasive carcinoma if left untreated
Bowen disease def
- squamous cell carcinoma in situ (SCCIS) of the skin
Carcinoma in situ occurring within follicle-bearing epithelium (penile shaft)
Bowen disease appearance
solitary,
dull-red plaque with areas of crusting and oozing
Bowen disease associated with
HPV Infection
Bowen disease treatment
Treated topically with 5-FU or imiquimod,
or
by surgical excision
Bowen disease prognosis
progress to invasive carcinoma if left untreated
Bowenoid papulosis def
Represents transitional stage between genital wart (HPV) and Bowen disease
Bowenoid papulosis histologically resembles
resembles carcinoma in situ;
however, seen most often in younger males and
usually behaves in a benign fashion
Bowenoid papulosis characterized by
multiple slightly elevated papules that are red to violet in color
age presentation of Bowenoid papulosis
seen most often in younger males and
usually behaves in a benign fashion
Buschke-Löwenstein tumor (giant condyloma acuminatum) what is it
Well-differentiated,
low-grade form of SCC (locally invasive, no metastasis) associated with HPV-6 and -11
Buschke-Löwenstein tumor (giant condyloma acuminatum) is associated with
HPV-6 and -11
Buschke-Löwenstein tumor (giant condyloma acuminatum) manifests on
- glans penis
- foreskin
- and perianal regions
as a large cauliflower-shape lesion;
can form fistulas and/or abscesses with local neoplastic invasion
Buschke-Löwenstein tumor (giant condyloma acuminatum) treatment
surgical excision
