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Urology > B/9. Penile tumors > Flashcards

B/9. Penile tumors Flashcards

1
Q

Penile tumors
peak age incidence

A

Disease of older male (peak incidence 60 yrs)

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2
Q

Epidemiology penile tumors

A

Rare tumor in the US, Europe, and other industrialized countries

Incidence is much higher in some parts of Asia, South America, and Africa

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3
Q

Risk factors of penile tumor

A
  • Uncircumcised men
  • Untreated phimosis
  • Smoking
  • HPV infection, other STDs
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4
Q

Clinical findings penile tumors

A
  • 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
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5
Q

Majority of penile cancers arise on the

A

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

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6
Q

percentage of patients with penile tumors which present with inguinal lymphadenopathy

A

Inguinal lymphadenopathy is present in 30-60% of cases at diagnosis

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7
Q

Diagnostics penile tumors-

A
  • 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
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8
Q

For men presenting with a penile lesion suspicious for malignancy or with a penile lesion and associated lymphadenopathy proceed

A

with an immediate biopsy of the penile lesion (punch, incisional, or excisional biopsy techniques)

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9
Q

If penile biopsy is positive what to evaluate next?

A

evaluation of the regional LNs is indicated (biopsy)

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10
Q

biopsy techniques of penile lesions

A
  1. punch
  2. incisional
  3. or excisional biopsy techniques)
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11
Q

which imaging used for penile tumor staging

A

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.

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12
Q

If a penile infection appears to be more likely (erythema, swelling, discharge)
what to do in this case?

A
  • 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
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13
Q

Types of penile tumors

A
  • > 90% of cases are squamous cell carcinoma,
  • Melanoma
  • Basal cell carcinoma of the skin
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14
Q

microscopic differentiation of penile tumors

A
  • Microscopically, tumors vary from
    1. well-differentiated keratinizing tumors
    2. to solid anaplastic carcinomas with limited keratinization
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15
Q

which HPV strain causes penile tumors?

A

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

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16
Q

Low risk HPV carcinogenic strains

A
  • 6
  • 11
  • 42
  • 43
  • 44
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17
Q

HIGH risk HPV carcinogenic strains

A

16, 18, 31, 33

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18
Q

neoplastic transformation in low risk hpv strain

A

E5 viral protein : enhances PDGF and EGFR expression
E6 viral protein: inhibits p53

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19
Q

neoplastic transformation in High risk hpv strain

A

E7 viral protein: inhibits pRb

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20
Q

Premalignant lesions of penile tumors

A
  • 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)
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21
Q

Staging of penile tumors

A

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

22
Q

which LN involved in penile tumors

A

inguinal nodes
pelvic nodes

23
Q

where does penile tumor metastasis to

A

lung
liver
lymph nodes
bone
brain

24
Q

treatment of penile tumors depend on

A

depends on the
1. stage of the disease
2. and the risk of recurrence;
initial approach most often involves surgery.

25
Q

Local disease with
primary penile tumor < 3 cm treatment

A
  • 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
26
Q

Invasive or bulky
primary penile tumor treatment

A
  • 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
27
Q

Treatment of Metastatic or
recurrent penile tumor

A
  • Radical penectomy or
  • Palliative chemotherapy
28
Q

1st line chemotherapy for penile tumors

A

cisplatin,
bleomycin,
MTX,
5-FU

(C B M5)

29
Q

initial treatment approach of penile tumors?

A

surgery!!!

30
Q

Erythroplasia of Queyrat def

A

*squamous cell carcinoma in situ (SCCIS) of the penile mucosa (glans and prepuce)

31
Q

Erythroplasia of Queyrat appearance

A

typical velvety red,
well-marginated

32
Q

Erythroplasia of Queyrat lesions features

A
  • Lesions are usually solitary
  • and occasionally erode or ulcerate
  • but pain is uncommon
33
Q

is pain common in Erythroplasia of Queyrat?

A

solitary and occasionally erode or ulcerate, but pain is uncommon

34
Q

Erythroplasia of Queyrat is associated with

A

chronic irritation and HPV infection

35
Q

Erythroplasia of Queyrat is associated with

A

chronic irritation and HPV infection

36
Q

Erythroplasia of Queyrat treatment

A

topically with 5-FU or imiquimod,
or
by surgical excision

37
Q

Erythroplasia of Queyrat prognosis

A

progress to invasive carcinoma if left untreated

38
Q

Bowen disease def

A
  • squamous cell carcinoma in situ (SCCIS) of the skin

Carcinoma in situ occurring within follicle-bearing epithelium (penile shaft)

39
Q

Bowen disease appearance

A

solitary,
dull-red plaque with areas of crusting and oozing

40
Q

Bowen disease associated with

A

HPV Infection

41
Q

Bowen disease treatment

A

Treated topically with 5-FU or imiquimod,
or
by surgical excision

42
Q

Bowen disease prognosis

A

progress to invasive carcinoma if left untreated

43
Q

Bowenoid papulosis def

A

Represents transitional stage between genital wart (HPV) and Bowen disease

44
Q

Bowenoid papulosis histologically resembles

A

resembles carcinoma in situ;

however, seen most often in younger males and
usually behaves in a benign fashion

45
Q

Bowenoid papulosis characterized by

A

multiple slightly elevated papules that are red to violet in color

46
Q

age presentation of Bowenoid papulosis

A

seen most often in younger males and
usually behaves in a benign fashion

47
Q

Buschke-Löwenstein tumor (giant condyloma acuminatum) what is it

A

Well-differentiated,
low-grade form of SCC (locally invasive, no metastasis) associated with HPV-6 and -11

48
Q

Buschke-Löwenstein tumor (giant condyloma acuminatum) is associated with

A

HPV-6 and -11

49
Q

Buschke-Löwenstein tumor (giant condyloma acuminatum) manifests on

A
  • glans penis
  • foreskin
  • and perianal regions
    as a large cauliflower-shape lesion;
    can form fistulas and/or abscesses with local neoplastic invasion
50
Q

Buschke-Löwenstein tumor (giant condyloma acuminatum) treatment

A

surgical excision

Urology (30 decks)

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