PENIS CONGENITAL ANOMALIES RANGE FROM CONGENITAL ABSENCE HYPOPLASIA

PENIS – CONGENITAL ANOMALIES RANGE FROM CONGENITAL ABSENCE, HYPOPLASIA, DUPLICATION AND OTHER ABERRATIONS IN SIZE AND FORM, ALL OF THESE ARE EXTREMELY UNCOMMON

PENIS – CONGENITAL ANOMALIES - HYPOSPADIAS AND EPISPADIAS • ARE MALFORMATION OF URETHRAL GROOVE ANDURETHRAL CANAL AND MAY CREATE ABNORMAL OPENINGS EITHER ON THE VENTRAL SURFACE OF THE PENIS(HYPOSPADIAS) OR ON THE DORSAL SURFACE(EPISPADIAS). MAY BE ASSOCIATED WITH UNDESCENDED TESTIS AND URINARY TRACT MALFORMATIONS.

PENIS – CONGENITAL ANOMALIES- PHIMOSIS ORIFICE OF PREPUCE IS TOO SMALL TO PERMIT IT’S NORMAL RETRACTION – CAN BE A DEVELOPMENTAL ANOMALY OR MORE FREQUEWNTLY DUE TO INFECTIONCAUSING SCARRING OF THE PREPUTIAL RING. PHIMOSIS INTERFERES WITH CLEANLINESS AND PERMITS ACCUMULATION OF SECRETIONS UNDER THE PRERUCE FAVOURING DEVELOPMENT OF SECONDARY INFECTIONS AND CAUSE POSSIBLY CARCINOMA PENIS.

INFLAMMATION OF PENIS INVARIABLY INVOLVE THE GLANS & PREPUCE AND INCLUDE A WIDE VARIETY OF SPECIFIC & NONSPECIFIC INFECTIONS ARE SEXUALLY TRANSMITTED AND ARE SYPHILIS, GONORRHEA, CHANCROID, , GRANULOMA INGUINALE, LYMPHOPATHIA VENEREA, GENITAL HERPES

INFLAMMATION OF PENIS NONSPECIFIC INFECTIONS ARE SO CALLED BALANOPOSSTHITIS WHICH REFERS TO INFECTION OF THE GLANS AND PREPUCE CAUSED BY A WIDE VARIETY OF ORGANISMS, AMONG MORE COMMON ONES ARE CANDIDA ALBICANS, ANAEROBIC BACTERIA , GARDNERELLA & PYOGENIC BACTERIA

INFLAMMATION OF PENIS MOST CASES ARE DUE TO POOR HYGIENE IN UNCIRCUMCISED MALE, WITH ACCUMULATION OF DISSQUAMATED EPITHELIAL CELLS, SWEAT, AND DEBRIS , TERMED SMEGMA, ACTING AS LOCAL IRRITANT. PERSISTANCE OF INFECTIONS LEAD TO INFLAMMATION AND SCARRIING

PENIS BENIGN TUMOURS CONDYLOMA ACUMINATUM (VENEREAL WART) HPV VIRUS TYPE 6 & 11

CONDYLOMA ACUMINATUM (VENEREAL WART) SINGLE OR CONGLOMERATED PAPILLOMAS

CONDYLOMA ACUMINATUM (VENEREAL WART) EXOPHYTIC CAULIFLOWER LIKE WARTY MASS IS TERMED BUSCHKE – LOWENSTEIN TUMOUR (GIANT CONDYLOMA) OR VERRUCOUS CARCINOMA RELATED TO THE COMMON WART (VERRUCA VULGARIS)

CONDYLOMA ACUMINATUM (VENEREAL WART) OF THE VARIOUS ANTIGENETICALLY AND GENETICLLY DISTINCT TYPES OF HPV , THAT HAVE BEEN IDENTIFIED, TYPE 6 AND LESS FREQUENTLY TYPE 11 HAVE BEEN CLEARLY ASSOCIATED WITH CONDYLOMA ACUMINATUM

CONDYLOMA ACUMINATUM (VENEREAL WART) ANTIGENS & GENOME OF THESE HPV TYPES CAN BE DEMONSTRATED BY IMMUNOPEROXIDASE & BY DNA HYBRIDIZATION

HYBRIDIZATION IS THE PROCESS OF COMBINING TWO COMPLEMENTARY SINGLESTRANDED DNA OR RNA MOLECULES AND ALLOWING THEM TO FORM A SINGLE DOUBLE-STRANDED MOLECULE THROUGH BASE PAIRING.

CONDYLOMA ACUMINATUM MORPHOLOGY SITE – CORONAL SULCUS OF PENIS INNER SURFACE OF THE PREPUCE OR PERINEAL AREAS

CONDYLOMA ACUMINATUM MORPHOLOGY GROSSLY- SINGLE OR MULTIPLE SESSILE OR PEDUNCULATED , RED PAPILLARYLESIONS VARY FROM 1 mm TO SEVERAL mms IN DIAMETERS

CONDYLOMA ACUMINATUM OF PENIS

MICROSCOPY BRANCHING PAPILLARY STRUCTURES WITH CENTRAL CONNECTIVE TISSUE CORE COVERED BY HYPERPLASTIC HYPERKERATOTIC STRATIFIED SQUAMOUS EPITHELIUM

MICROSCOPY EPITHELIUM SHOWS HYPERKERATOSIS, PARAKERATOSIS, ACANTHOSIS (INCREASE PRICKLE CELL LAYER).

MICROSCOPY MANY PRICKLE CELLS SHOW CLEAR VACUOLISATION OF CYTOPLASM (KOILOCYTES) – INDICATIVE OF HPV INFECTION.

CONDYLOMA ACUMINATUM -KOILOCYTES

CONDYLOMA ACCUMINATUM PAPILLOMATOUS GROWTH

CONDYLOMA ACUMINATUM -KOILOCYTES

CONDYLOMA ACUMINATUM (KOILOCYTES & ATYPICAL NUCLEI)

GIANT CONDYLOMA FIRST DESCRIBED BY BUSCHKE AND LÖWENSTEIN IN 1925, THE GIANT CONDYLOMA OF BUSCHKE AND LÖWENSTEIN (GCBL) IS A SLOWGROWING, LOCALLY DESTRUCTIVE VERRUCOUS PLAQUE THAT TYPICALLY APPEARS ON THE PENIS.

GIANT CONDYLOMA MAY OCCUR ELSEWHERE IN THE ANOGENITAL REGION. IT MOST COMMONLY IS CONSIDERED TO BE A REGIONAL VARIANT OF VERRUCOUS CARCINOMA

GIANT CONDYLOMA BOTH --UPWARD & DOWNWARD GROWTH. OTHERWISE HISTOLOGICALLY RESEMBLE CONDYLOMA ACUMINATUM. CLINICALLY LOW GRADE MALIGNANT LESION. LOCAL RECURRENCES COMMON.

PREMALIGNANT LESIONS OF PENIS(CARCINOMA IN SITU) 3 LESIONS OF PENISDISPLAY CYTOLOGICAL CHANGES OF MALIGNANCY CONFINED TO EPITHELIAL LAYERS WITHOUT INVASION.

PREMALIGNANT LESIONS OF PENIS(CARCINOMA IN SITU THEY ARE 1. BOWEN’S DISEASE 2. ERYTHROPLASIA OF QUEYRAT 3. BOWENOID PAPULOSIS.

BOWEN’S DISEASE OFTEN ASSOCIATED WITH INTERNAL VISCERAL CANCER SHAFT OF THE PENIS SCROTUM AND SUN EXPOSED AREAS OF THE SKIN

BOWEN’S DISEASE(SQUAMOUS CELL CARCINOMA IN SITU) IT WAS NAMED AFTER MARK BOWEN. GROSS- SOLITARY CERCUMSCRIBED PLAQUE WITH ULCERATION

BOWEN’S DISEASE MICROSCOPY – CHANGES ONLY IN EPITHELIUM. HYPERKERATOSIS, PARAKE RATOSIS ACANTHOSIS WITH DYSKERATOTIC CELLS.

ERYTHROPLASIA OF QUEYRAT PENILE MUCOSA GROSS – PINK SHINY VELVETY SOFT MICROSCOPY – SAME AS BOWEN’S DESEASE.

ERYTHROPLASIA OF QUEYRAT

ERYTHROPLASIA OF QUEYRAT NO RELATIONSHIP BETWEEN ERYTHROPLASIA OF QUEYRAT & INTERNAL MALIGNANCY

ERYTHROPLASIA OF QUEYRAT

BOWENOID PAPULOSIS PENILE SHAFT & ADJACENT GENITAL SKIN GROSS- SOLITARY OR MULTIPLE SHINY RED BROWN PAPULAR LESIONS MICROSCOPY – SAME AS BOWEN’S DISEASE

BOWENOID PAPULOSIS

MALIGNANT TUMOURS OF PENIS SQUAMOUS CELL CARCINOMA INCIDENCE VARIES WITH DIFFERENT POPULATION LESS THAN 2% OF ALL CANCERS

MALIGNANT TUMOUR OF PENIS BLACKS ARE AFFECTED MORE THAN WHITES INCIDENCE VARIES FROM 10 – 20% OF MALE MALIGNANCIES A STRIKING CORRELATION EXISTS BETWEEN THE PACTICE OF CIRCUMCISION & OCCURANCE OF PENILE CANCER

MALIGNANT TUMOUR OF PENIS RARE IN JEWS & MUSLIMS WHO HAVE RITUAL OF CIRCUMCISION EARLY IN LIFE BY PREVENTING ACCUMULATION OF SMEGMA.

MALIGNANT TUMOUR OF PENIS CIRCUMCISION IS ASSOCIATED WITH BETTER GENITAL HYGIENE. IT REDUCES EXPOSURE TO CARCINOGENS THAT MAY BE CONCENTRATED IN SMEGMA, DECREASES THE LIKELIHOOD OF INFECTION BY HPV.

MALIGNANT TUMOUR OF PENIS 50% OF PATIENTS WITH CARCINOMA PENIS SHOW HPV DNA IN THE CANCER CELLS HPV 16 IS THE MOST FREQUENT CULPRIT HPV 18 ALSO IS IMPLICATED

MALIGNANT TUMOUR OF PENIS INFECTION WITH HPV IS NOT SUFFICIENT FOR TRANSFORMATION. IT PROBABLY ACTS IN CONCERT WITH OTHER CARCINOGENIC INFLUENCES LIKE CIGARETTE SMOKING

MALIGNANT TUMOUR OF PENIS PENILE CARCINOMAS ARE USUALLY FOUND IN PATIENTS BETWEEN 40 & 70 YEARS

MORPHOLOGY GROSS – LOCATED IN DECREASING FREQUENCY ON FRENUM, PREPUCE, GLANS & CORONAL SULCUS

MORPHOLOGY CARCINOMA PENIS USUALLY BEGINS ON THE GLANS OR INNER SURFACE OF THE PREPUCE NEAR THE CORONAL SULCUS.

MORPHOLOGY 2 MACROSCOPIC PATTERNS ARE SEEN 1. PAPILLARY CAULIFLOWER LIKE FUNGATING MASS 2. FLAT ULCERATINNG TYPE BOTH TYPES ARE SQUAMOUS CELL CARCINOMAS WITH VARYING DEGREE OF DIFFERENTIATION

MICROSCOPY WELL DIFFERENTIATED TO MODERATELY DIFFERENTIATED TYPE

CARCINOMA PENIS –CAULIFLOWER LIKE FUNGATING

CARCINOMA PENIS-FLAT ULCERATING TYPE

CARCINOMA PENIS –WELL DIFFERENTIATED SQUAMOUS CELL CARCINOMA –MULTIPLE KERATIN PEARLS

VERRUCOUS CARCINOMA • A WELL DIFFERENTIATED VARIANT OF SQUAMOUS CELL CARCINOMA ALSO KNOWN AS THE GIANT CONDYLOMA OF BUSCHKE AND LÖWENSTEIN (GCBL)

VERRUCOUS CARCINOMA IS A SLOW-GROWING, LOCALLY DESTRUCTIVE VERRUCOUS PLAQUE THAT TYPICALLY APPEARS ON THE PENIS

VERRUCOUS CARCINOMA HAS VERRUCOUS PAPILLARY APPEARANCE SIMILAR TO CONDYLOMA ACUMINATUA BUT THEY ARE LARGER CAUSED BY HPV 6 &11

CARCINOMA PENIS SLOWLY GROWING, LOCALLY METASTASIZING LESION , PRESENT FOR A YEAR OR MORE BEFORE BROUGHT TO MEDICAL ATTENSION, NONPAINFUL SECONDARY ULCERATION AND INFECTION OCCURS

SPREAD OF TUMOUR METASTASIS – TO REGIONAL LYMPH NODES INGUINAL & ILIAC LYMPH NODES OCCUR IN THE EARLY STAGE.

SPREAD OF TUMOUR WIDESPREAD METASTASIS IS EXTREMELY UNCOMMON VISCERAL METASTASIS BY HEMATOGENOUS IS UNCOMMON. BUT OCCUR IN ADVANCED CASES

PROGNOSTIC FACTORS 1. HISTOLOGIC GRADE 2. DEPTH OF PENETRATION INTO PENILE ANATOMIC LAYERS.

PROGNOSTIC FACTORS LOW GRADE DEPTH-<6 mm. NO REGIONAL METASTASIS HIGH GRADE- DEEP INVATION –HIGH RATE OF METASTASIS

PROGNOSIS LIMITED LESIONS, NO LYMPH NODE METASTASIS 5 YEAR SURVIVAL IS 66 % WITH METASTASIS TO LYMPH NODES 27% 5 YEAR SURVIVAL

PROGNOSTIC FACTORS 3. VASCULAR OR LYMPHATIC INVASION, 4. HIGH MITOTIC RATE 5. HISTOLOGIC SUBTYPESARCOMATOID, SOLID ANAPLASTIC, BASALOID