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Male penis diseases



The distal part of the penis of the normal urethra, which is most often affected, is lined with stratified squamous epithelium. This type of 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 inner sheet of the foreskin) and fibrotic (phimosis, i.e. pathological narrowing of the aperture of the foreskin, which does not allow the head of the penis to be exposed), penile diseases are relatively rare, so we immediately move on to the tumors of the male penis.

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

Benign tumors. Genital warts. This neoplasm causes the human papillomavirus (HPV). It belongs to the group of ordinary skin warts and can occur on any wet, skin or mucous surface of the external genitalia of men and women. There is sufficient 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 associated with the induction of genital warts. Using immunoperoxidase techniques and the polymerase chain reaction (see Chapter 1) in histological



Fig. 19.1.

The distal third of the penis of the normal urethra of an adult male

.

The genetic structures of warts are constantly determined by the antigenic structures and components of the genome of these viruses. On the penis, condylomas usually appear in the zone 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 wide base. These sprawls can resemble miniature cauliflower. Their diameter varies from I to several millimeters. Under a microscope, genital warts resembles papilloma of the skin (see chapter 7). However, the papillae and stromal (fibro-vascular) rods in them are usually thicker than in papillomas. The 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 spiky layer (this symptom is called coilocytosis), which is considered characteristic of the lesion caused by HPV. The basement membrane remains intact, and no invasion of epithelial structures occurs.

Giant condyloma (Buschke – 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. HPV types 6 and 11 were also detected in the parenchyma of this tumor. Unlike genital warts, giant condylomas are capable of local invasion and relapse after removal. Fortunately, it does not metastasize, therefore, it is regarded as a neoplasm of “intermediate” biological activity (between genital warts and squamous cell carcinoma of the penis). Under the microscope, two growth directions of the neoplasm are found: exophytic with the formation of villous-papillary structures, hyperkeratosis and coilocytosis and endophytic along a wide front, sometimes not so much with germination as with extension of the underlying tissues. Along the edge of the surface invasion of the tumor parenchyma, signs of atypia and epithelial polymorphism are noticeable. Many experts call this neoplasm verrucous (warty) carcinoma, since a 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 is manifested in three variants: Bowen’s disease, Keir erythroplasia, and bauvenoid papulosis. It is still unclear whether they are variants of the same process or not.

Bowen's disease (Boven's diskeratosis; JTBowen). The disease is observed in people older than 35 years, both men and women. In men, it affects the body of the penis and scrotum. Externally, the neoplasm is a single, dense, grayish-white plaque with superficial ulceration and scab. Microscopically reveals all signs of carcinoma in situ in the stratified squamous epithelium (see chapter 7). In 10-20% of patients, carcinoma in situ turns into invasive cancer.

Keir erythroplasia (ALVJQueyrat). The tumor appears on the skin of the head of the penis and foreskin in the form of single or multiple pink-red foci, often having a velvety, sometimes flaky surface. Under a microscope, these foci reveal dysplasia of varying degrees, as well as signs of carcinoma in situ (Fig. 19.2).

Bowenoid (bowenoid) p and p at lez. It occurs in adult men who are sexually active; differs from Bowen's disease not only in lesions of younger faces, but also in the appearance of usually multiple, pigmented, reddish-brown, papular lesions (the papule is an element of the skin rash in the form of a seal that rises above the epidermis). Verrucous changes similar to genital warts are rare. Microscopic Differences from Bowen's Bowenoid Disease



Fig. 19.2.

Keir erythroplasia

(preparation of D.I. Golovin).

papulosis does not have. Using a polymerase chain reaction, portions of HPV type 16 E6 and E7 DNA were found in papule epithelial cells,

Invasive penile cancer. Currently, in industrialized countries, squamous cell carcinoma of the penis accounts for about 1% of all malignant neoplasms in men. This disease is extremely rare in Jews, Muslims, and representatives of certain peoples of Australia, Oceania, and Africa, who underwent circumcision (circular excision) of the foreskin in infancy or early childhood. It is believed that circumcision protects against accumulation on the coronal groove, under the foreskin of smegma (a specific, lubricating secretion of the glands of the foreskin that accumulates under its inner leaf), containing carcinogens not yet discovered. In 1992, data were obtained on the etiological role in the development of penile cancer of the HPV virus type 16 and, to a lesser extent, type 18.

Penile cancer affects men aged 40–70 years. A tumor is found on the head of the organ or the inner surface of the foreskin, near the coronal groove. The first option: the initial changes are represented by a small focal point of a thickening of the mucous membrane of a grayish color, containing subtle cracks or cracks. Over time, an elevated papule develops with ulceration. Despite the obvious seriousness of the progressive changes, by the time they seek medical help, most patients already have a rather large ulcer with a necrotic, secondarily infected bottom and raised, dense, irregularly shaped edges. The ulcer often bleeds. In advanced cases, destruction of the head and a significant part of the body of the penis can occur. The second option: cancer grows in the form of villous-papillary structures that simulate genital warts and progressively increase with the gradual formation of a mushroom-shaped node of the type “cauliflower”. In this node, secondary ulceration also occurs.

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

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Male penis diseases

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