Premalignant penile lesions.pptx
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Premalignant lesions of penis Penile premalignant lesions Premalignant conditions of penis Penile lesions Premalignant lesions Human papilloma virus related penile premalignant lesions
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Premalignant penile lesions.pptx
- 1. Premalignant penile lesions Dr. Rabindra Tamang MCh Resident Department of Urology and Kidney Transplant Surgery MMC, TUTH
- 2. Contents • Introduction • Types • Clinical presentation • Differential diagnosis • Treatment
- 3. Introduction • A morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart 1 • 42% with preexisting lesions 2 1 World Health Organization. Geneva: World Health Organization 1973 2 Bouchet et al, 1989
- 4. Types • Carcinoma in situ (CIS) • New classification 1 ▫ Human papilloma virus (HPV) related penile premalignant lesions ▫ Non – HPV related penile premalignant lesions 1 Shabbir et al, 2011b
- 5. Penile Intrepithelial Neoplasia (PIN) • Queyrat -1911 • Types 1: 1. Erythroplasia of Queyrat (EQ) 2. Bowen disease (BD) 3. Bowenoid papulosis (BP) 1 Potter et al, 2002
- 6. Erythroplasia of Queyrat (EQ) • Lesion 1: ▫ Glans or prepuce ▫ Red, velvety lesions, ulcerations • Discharge and pain • Progression to invasive carcinoma: 10 - 33% 2 1 Arogana et al, 1985 2 Bleeker et al, 2009
- 7. Bowen Disease (BD) • Lesion 1: ▫ Penile shaft or remainder ▫ Sharply defined plaques of scaly erythema ▫ Crusted or ulcerated variants • Progression to invasive carcinoma: 5% 2 1 Graham and Welwig, 1973 2 Buechner, 2002
- 8. Microscopic findings of CIS 1 • Atypical hyperplastic cells • Extension of rete pegs • Capillary proliferation and ectasia with surrounding inflammatory infiltrate 1 Buechner, 2002
- 9. Management • Biopsy – multiple • Treatment: ▫ Circumcision 1 ▫ Glans resurfacing 2 • Alternative strategies 3: • 5 FU cream • 5% imiquimod cream • Laser therapy: Nd: YAG, KTP, CO2 1 Bissada, 1992 2 Hadway et al, 2006 3 Danielson et al, 2003
- 10. Bowenoid Papulosis (BP) • Lesion 1: ▫ Multiple papules or pigmented lesions ▫ Penile shaft or glans • Second or third decade 1 • HPV 16 linkage 2 • Invariably benign 3 1 Patterson et al, 1986 2 Endo et al, 2003 3 Su and Shipley, 1997
- 11. Treatment of BP 1 • Electrodessication • Cryotherapy • Laser fulguration • Topical 5 FU cream • Excision 1 Campbell 12th edition
- 12. Non HPV penile premalignant lesions 1. Cutaneous horn 2. Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) 3. Male lichen sclerosus
- 13. Cutaneous horn • Rare – solid protuberance • Predisposing factors 1: ▫ Inflammation ▫ Poor hygiene ▫ Trauma ▫ Tumor 1 Gupta et al, 2014
- 14. Cutaneous horn • Clinical significance 1: ▫ Underlying lesion: Benign: Seborrheic keratitis Viral warts 1 Gupta et al, 2014
- 15. Cutaneous horn Premalignant Solar keratitis Bowen disease Malignant Squamous cell cancer (SCC) Basal cell cancer (BCC) Kaposi sarcoma 1 Gupta et al, 2014
- 16. Cutaneous horn • Treatment: ▫ Excision ▫ Issue: Recurrence 1 1 Fields et al, 1987
- 17. Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) • Scaly and micaceous growth • 4 stages 1: ▫ Initial plaque ▫ Late tumor stage ▫ Verrucous carcinoma ▫ Invasive SCC 1 Krunic et al, 1996
- 18. PKMB • Treatment 1: ▫ Topical 5 FU ▫ Excision ▫ Laser therapy ▫ Cryotherapy • Issue: ▫ Recurrence 1 Gray and Ansell, 1990
- 19. Male lichen sclerosus • Balanitis xerotica obliterans (BXO) • Genital variant • Etiology 1,2: ▫ Unknown ▫ Borrelia ▫ Autoimmunity ▫ Genetics 1 Esendle et al, 2008 2 Fistaro et al, 2014
- 20. BXO • Clinical features 1: ▫ Multiple whitish patches ▫ Mosaic appearance ▫ Glans, prepuce, meatus ▫ Dyspareunia, painful erection, urinary obstruction • Association 2: ▫ SCC 1 McKay et al, 1975 2 Velazquez and Cubilla, 2003
- 21. BXO • Treatment 1, 2: ▫ Clobetasol ▫ Meatal stenosis: Dilatation Corticosteroid injection Surgery 1 Pugliese et al, 2007 2 Pounter and Levy, 1967
- 22. HPV related penile lesions • HPV in malignant transformation • Buschke Lowenstein tumor • Kaposi sarcoma
- 23. HPV in malignant transformation • Condyloma accuminata • Genital warts • Site: glans, prepuce, shaft, urethra • Lesions 1: ▫ Soft, friable ▫ Single ▫ Moruloid cluster 1 Copulsky et al, 1975
- 24. Condyloma acuminata • Risk factors 1: ▫ Foreskin ▫ Multiple sexual partners ▫ No condom ▫ Smoking 1 Guiliano et al, 2009
- 25. Condyloma acuminata • HPV genotypes 1 ▫ 6, 11, 40, 44 : low grade ▫ 16, 18, 31, 33, 35, 39, 45, 51, 52, 58, 59 : malignant disease • Pathogenesis 2: ▫ E7 proteins pRB p16 INK4a 1 de Sanjose et al, 2010 2 Doorbar, 2006
- 26. Condyloma acuminata • Diagnosis: ▫ Examination ▫ Androscopy • Treatment 1: ▫ Podophyllotoxin ▫ TCA ▫ Cryotherapy •Electrofulguration •CO2 laser •Imiquimod 5% cream 1 Dupin, 2004
- 27. Condyloma • Surgery 1: ▫ Circumcision ▫ Fulguration and excision ▫ Intraurethral lesions: Resectoscope 1 Buechner, 2002
- 28. Condyloma • Newer treatments 1,2: ▫ Intralesional IFN alfa 2b ▫ Cidofovir 1 Eron et al, 1986 2 Snoeck et al, 2001
- 29. Buschke Lowenstein tumor • Buschke and Lowenstein - 1925 • Unlike condyloma 1: ▫ Invasive ▫ Topical therapy ineffective • Like condyloma: ▫ HPV 6, 11 linkage 1 Braga et al, 2012
- 30. • Diagnosis: ▫ Biopsy • Treatment 1,2: ▫ Surgery +/- skin graft ▫ Systemic IFN therapy • Vaccination: Quadrivalent Nanovalent 1 Hasid and Papadopoulos, 2017 2 Petrosky et al, 2015
- 31. Kaposi sarcoma KS • Dr. Mortiz Kaposi 1972 • 4 categories 1: ▫ Classic KS ▫ Immunosuppressive treatment related KS ▫ African KS ▫ Epidemic / AIDS related KS 1 Campbell 12th edition
- 32. KS • Raised, painful, bleeding papule or ulcer with bluish discoloration • Non epidemic KS • Human Herpes Virus 8 (HHV-8) 1 • KS and AIDS 2: ▫ 7000 factor ▫ Homosexuals: 44% 1 Sitas et al, 1999 2 Miles, 1994
- 33. KS • Treatment 1 ▫ Localised surgical excision ▫ Small field external beam or electron beam radiation ▫ Partial penectomy ▫ Systemic therapy: IFN therapy 1 Lowe et al, 1989
- 34. Thank you