Page 511 - Concise Pathology for Exam Preparation ( PDFDrive )

496 SECTION II Diseases of Organ Systems

• Balanoposthitis patients are predisposed to phimosis (narrowing of the preputial orifice
resulting in nonretraction of the preputial skin over the glans) and penile cancer.
• Diagnosis and typing of inflammatory conditions of penis entails the following steps:
1. Physical examination
2. Blood sugar measurement (for diabetes)
3. KOH mount and culture for yeast infections
4. Specific tests for STDs
Q. Write briefly on the neoplasms involving penis.

Ans. Following are the commonly encountered benign and malignant lesions involving penis:
1. �Condyloma acuminatum
• Also known as ‘anogenital wart’, it is associated with HPV 6 and 11 and may present
as a solitary or multiple lesions. Common sites are the coronal sulcus of the penis
and the perianal area.
• Anogenital wart has a large cauliflower-like exophytic variant labelled ‘Buschke–
Lowenstein tumour’ (Verrucous carcinoma).
• Microscopy shows papillary projections composed of a connective tissue core lined
by squamous epithelium. The epithelium shows hyper-/parakeratosis with acantho-
sis of the stratum malphgium. Koilocytosis is the histopathologic hallmark.
2. �Premalignant conditions
• PeIN can occur on the glans or foreskin of the penis (erythroplasia of Queyrat) or
on the shaft (Bowen disease). Erythroplasia of Queyrat and Bowen disease have
similar clinical behaviour and are both associated with HPV. The former is common
in uncircumcised men and presents as reddish and velvety pigmentation on the
glans. Bowen disease is characterized by well-marginated, reddish plaques over the
shaft of penis which may ulcerate and crust.
• Bowenoid papulosis is histopathologically identical to the above two entities
(Bowen disease and erythroplasia of Queyrat) and all show severe dysplastic changes
on biopsy. Clinically, ‘Bowenoid papulosis’ is associated with HPV 16 and presents as
multiple reddish verrucous papules.
3. �Carcinoma penis
Salient features:
• Almost all penile cancers are squamous in origin.
• The overall incidence is less than 1% of all cancers of the male.
• It has an established causal association with high-risk HPV types (16 and 18).
• It is more common in blacks and rare in Jews and Muslims who customarily undergo
circumcision (as circumcision prevents accumulation of smegma which is thought to
be carcinogenic).
• Carcinoma penis usually affects men over 50 years.
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Gross morphology:
• The tumour may be exophytic (papillary or cauliflower type) or ulcerative.
• Usual locations are the fraenum, prepuce, glans and the coronal sulcus, in that order.
Microscopy:
In most cases, sections show a well-to-moderately differentiated squamous cell carci-
noma, which commonly metastasize to the regional lymph nodes as well as viscera.

PROSTATE
Normal Structure

• The prostate weighs about 20 gm in a normal adult. It surrounds the beginning of the
male urethra and has 3 lobes—a median and two lateral.
• Histologically it is constituted by 30–50 branched acini (tubule-alveolar structures)
lying in a fibromuscular stroma. The acini are lined by two layers, a basal cuboidal cell
layer and an inner layer of mucous-secreting columnar cells.

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