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Diseases of the male penis



The distal part of the penis normal urethra, which is most often affected, is lined with stratified squamous epithelium. This character of the epithelium is found in the urethra only at a distance of 2-4 cm from the external opening (Fig. 19.1).

Inflammatory (balanoposthitis, i.e., inflammation of the skin of the glans penis and the inner leaf of the foreskin) and fibrous (phimosis, i.e., pathological narrowing of the orifice of the foreskin, which does not allow exposing the head of the penis) are rarely found, therefore we We turn to the male penis tumors.

Neoplasms of the penis also belong to a rare pathology. The most common are cancer and a benign epithelial tumor - genital warts. There are also diseases related to the intermediate group between benign and malignant tumors in their biological potencies. This is a giant condyloma with local invasive growth (warty or verrucous condyloma) and Bowen's disease (Boven dyskeratosis; JTBowen).

Benign tumors. Genital warts. This neoplasm causes human papillomavirus (HPV). It belongs to the group of common skin warts and can occur on any wet, skin or mucous surface of the external genital organs of men and women. There is ample evidence that HPV and the diseases it causes are sexually transmitted. Among the numerous antigenic and genetic types of this pathogen, only types 6 and 11 are undoubtedly related to the induction of genital warts. Using immunoperoxidase techniques and polymerase chain reaction (see Chapter 1) in the histological



Fig. 19.1.

Distal third of the penile area of ​​a normal urethra of an adult male

.

The congenital structures of the condyloma constantly determine the antigenic structures and components of the genome of these viruses. On the penis, condylomas usually appear in the area of ​​the coronary sulcus of the head and the inner surface of the foreskin. They are single or multiple, reddish-pink, warty, papillary growths protruding outward on the stem or broad base. These growths may resemble a cauliflower in miniature. Their diameter varies from I to several millimeters. Under a microscope, genital warts resemble papilloma of the skin (see Chapter 7). However, the nipples and stromal (fibro-vascular) rods in them are usually thicker than in papillomas. Hyperplastic stratified squamous epithelium covering the villi, as in papillomas, has signs of hyperkeratosis and acanthosis. Its differentiation is preserved. However, light vacuoles appear in the cells of the spinous layer (this feature is called koilocytosis), which is considered characteristic of the lesion caused by HPV. The basement membrane remains intact, and no invasion of epithelial structures occurs.

Giant condyloma (Bushke-Levenstein tumor; A.Buschke, K.Loewenstein). This tumor is much larger than the previous one. As a rule, it manifests itself in the form of a single exophytic node, which can cover and destroy a significant part of the penis. In the parenchyma of this tumor, HPV types 6 and 11 were also detected. In contrast to genital warts, the giant warts are capable of local invasion and recurrence after removal. Fortunately, it does not metastasize; therefore, it is regarded as a neoplasm of “intermediate” biological activity (between genital warts and penile squamous cell carcinoma). Under the microscope, two directions of growth of the neoplasm are detected: exophytic with the formation of villezno-papillary structures, hyperkeratosis and koilocytosis and endophytic with a wide front, in some places not so much with germination as with the expansion of the underlying tissues. Along the edge of the surface invasion of the tumor parenchyma, signs of atypia and polymorphism of epithelial cells are noticeable. Many experts call this neoplasm verrucous (warty) carcinoma, since the morphologically identical neoplasm is found in the oral cavity, and in this case it has just such a name.

In situ carcinoma (intraepithelial cancer).
In the external male genitalia, this form of non-invasive cancer manifests itself in three variants: Bowen's disease, Keyr's erythroplasia, and bovenoid papulese. It is still unclear whether they are variants of the same process or not.

Bowen's disease (Boven dyskeratosis; JTBowen). The disease is observed in persons over 35 years old, both men and women. In men, it affects the body of the penis and scrotum. Externally, the tumor is a single, dense, grayish-white plaque with superficial ulceration and scab. Microscopically, all signs of carcinoma in situ are revealed in a stratified squamous epithelium (see Chapter 7). In 10–20% of patients, carcinoma is transformed in situ into invasive cancer.

Erythroplasia Keira (ALVJQueyrat). A tumor appears on the skin of the penis head and foreskin in the form of single or multiple pink-red foci, often with a velvety, sometimes scaly surface. Under a microscope, these foci show dysplasia of varying degrees, as well as signs of carcinoma in situ (Fig. 19.2).

Bovenoid (bouenoid) p a p u le s. It occurs in adult, sexually active men; differs from Bowen's disease not only by the defeat of younger people, but also by the appearance of usually multiple, pigmented, reddish-brown, papular lesions (papule is an element of the skin rash in the form of a seal that rises above the epidermis). Occasionally there are verrucous changes similar to genital warts. Microscopic differences from Bowen's Disease Bovenoid



Fig. 19.2.

Erythroplasia keira

(drug D.I.Holovina).

papulosis does not have. Using the polymerase chain reaction, portions of E6 and E7 of HPV type 16 DNA were detected in papules epithelial cells,

Invasive cancer of the penis. Currently in industrialized countries, penile squamous cell carcinoma accounts for about 1% of all malignant neoplasms in men. This disease is exceptionally rare in Jews, Muslims, and representatives of certain peoples of Australia, Oceania, and Africa, who were circumcised (circular excision) of the foreskin in infancy or early childhood. It is believed that circumcision prevents accumulation on the coronary sulcus, under the foreskin of smegma (a specific, lubricant secretion of the glands of the foreskin that accumulates under its inner leaflet), containing as yet unrevealed carcinogens. In 1992, data were obtained on the etiological role in the development of cancer of the penis of the HPV type 16 virus and, to a lesser extent, of type 18.

Cancer of the penis affects men aged 40-70 years. The tumor is found on the head of the organ or the inner surface of the foreskin, near the coronary sulcus. The first option: the initial changes are represented by a small foci of thickening of the mucous membrane of grayish color, containing barely noticeable cracks or cracks. Over time, a raised papule with ulceration develops. Despite the obvious seriousness of the progressing changes, by the time of seeking medical help, most patients already have a rather large ulcer with a necrotic, secondarily infected bottom and elevated, dense edges of irregular shape. The ulcer often bleeds. In advanced cases, the destruction of the head and a large part of the penis can occur. The second option: cancer grows in the form of villezo-papillary structures, simulating condyloma and progressively increasing with the gradual formation of a mushroom node of the "cauliflower" type. In this node, secondary ulceration also occurs.

Under a microscope, in both variants of growth, the tumor is a typical squamous cell carcinoma with varying degrees of histological differentiation. This carcinoma is characterized by a slow growth rate and limited distribution. In the initial stages of tumor growth, metastases are found in the inguinal and iliac lymph nodes, but beyond this level lymphogenous metastasis does not develop. Sometimes the disease is accompanied by hematogenous metastases.

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Diseases of the male penis

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