Squamous Hyperplasia (SH), Lichen Sclerosus (LS), Differentiated PeIN (PeIN) and Low Grade Variants of Squamous Cell Carcinoma (SCC): Distinctive Preputial Lesions in a Survey of 99 Circumcision Specimens from a Region of High Incidence of Penile Cancer
J Oertel, M Iglesias, L Amat, E Ayala, EF Velazquez, JE Barreto, G Ayala, AL Cubilla. Instituto de Prevision Social, Asuncion, Paraguay; Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Baylor College of Medicine, Houston, TX; Instituto de Patologia e Investigacion, Asuncion, Paraguay
Background: About half of penile cancers affect the foreskin and 20% originate at this site. It has been hypothesized that carcinomas of inner foreskin mucosa are histologically and perhaps etiologically different from those of the glans.
Design: To determine morphological features and prevalence of foreskin precancerous and cancerous lesions in circumcision specimens from phimotic patients at high risk to develop such lesions. 116 consecutive circumcision specimens (2-5 sections per case) were evaluated. Excluded were: condylomas (15 cases), verruciform xanthoma and an epidermoid cyst (1 case each). PeINs were classified in differentiated (HPV unrelated), 20 cases and undifferentiated (HPV related); no case found in the later group. Invasive SCCs were: usual (4), pseudohyperplastic (3), verrucous (1), papillary (1), basaloid (1).
*13 cases with LS; ** 6 cases with LS
|No lesion||SH||LS||Diff PeIN||SCC|
Conclusions: Preputial precancerous and cancerous lesions are distinctive and different from those of the glans. LS was found as an isolated lesion, associated with differentiated PeIN or SCC in 45% of the cases. Differentiated PeIN was present in 20 and SCC in 10% of the cases. HPV related lesions (undifferentiated PeIN and basaloid carcinoma), usually frequent in the glans, were absent or very unusual in the foreskin. Patients with SH, LS and differentiated PeIN were 12-15 years younger than those with carcinomas. Patients with phimosis in this endemic population for penile cancer are at risk for precancerous or cancerous lesions and we believe they should be circumcised.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 122, Tuesday Afternoon