Tag: NEET PG

Phimosis

PHIMOSIS


PHIMOSIS

  • Inability to retract the preprucial skin over the glans.

ETIOLOGY-

  1. Congenital (MC)
  2. Balanitis (inflammation of the glans) & Balanoposthitis (inflammation of glans, prepuce and sac). Both are common in diabetics
  3. Chancre
  4. Carcinoma of penis

CLINICAL FEATURES-

  • Difficuluty in micturition
  • In children, ballooning of prepuce
  • Edema, erythema, tenderness of prepuce

TREATMENT-

  • Circumcision (especially recurrent infection >16- 18 years)
  • Local steroid cream (4- 6 weeks)
  • If phimosis is associated with considerable infection, it should be treated with broad-spectrum antimicrobial drugs. The dorsal slit of foreskin, if improved drainage is necessary.
  • Circumcision for phimosis should be avoided in children requiring general anesthesia; except in cases with recurrent infections.
  • The procedure should be postponed until the child reaches an age when local anesthesia can be used.

COMPLICATIONS-

  • Balanoposthitis, hydronephrosis
  • Prepucial calculi, carcinoma under foreskin or penis

Exam Important

TREATMENT-

  • Circumcision (especially recurrent infection >16- 18 years)
  • Local steroid cream (4- 6 weeks)
  • If phimosis is associated with considerable infection, it should be treated with broad-spectrum antimicrobial drugs. The dorsal slit of foreskin, if improved drainage is necessary.
  • Circumcision for phimosis should be avoided in children requiring general anesthesia; except in cases with recurrent infections.
  • The procedure should be postponed until the child reaches an age when local anesthesia can be used.
Don’t Forget to Solve all the previous Year Question asked on PHIMOSIS

Module Below Start Quiz

Phimosis

Phimosis

Q. 1 The recommended treatment for preputial adhesions producing ballooning of prepuce during micturition in a 5  years old boy is:
(AIIMS June 2003)

 A

 Wait and watch policy

 B

Circumcision

 C

 Dorsal slit

 D

Preputial adhesions release and dilatation

Q. 1

The recommended treatment for preputial adhesions producing ballooning of prepuce during micturition in a 5  years old boy is:
(AIIMS June 2003)

 A

 Wait and watch policy

 B

Circumcision

 C

 Dorsal slit

 D

Preputial adhesions release and dilatation

Ans. A

Explanation:

A
If phimosis is associated with considerable infection, it should be treated with broad-spectrum antimicrobial drugs. The dorsal slit of foreskin, if improved drainage is necessary.
• Circumcision for phimosis should be avoided in children requiring general anesthesia; except in cases with recurrent infections.
• The procedure should be postponed until the child reaches an age when local anesthesia can be used.

Quiz In Between



Paraphimosis

PARAPHIMOSIS


PARAPHIMOSIS

  • Inability to place back the retracted prepucial skin over the glans.
  • The retracted skin acts like a tight ring constricting proximal to the corona and prepuceal skin resulting in venous congestion.
  • Congestion results n glans swelling, oedematous with severe pain and tenderness.
  • Glans will undergo necrosis or gangrenous change.

ETIOLOGY

  • Catherization
  • After sexual intercourse

CLINICAL FEATURES-

  • Severe pain
  • Swelling and oedema

TREATMENT-

  • Sedation
  • Injection hyluronidase (250 units in 10- 15 ml of saline injected into constricting ring reduces oedema and paraphimosis also gets reduced)
  • Dorsal slit is given for reduction which is followed by circumcision later.

Exam Important

  • Inability to place back the retracted prepucial skin over the glans.
  • The retracted skin acts like a tight ring constricting proximal to the corona and prepuceal skin resulting in venous congestion.
  • Congestion results n glans swelling, oedematous with severe pain and tenderness.
  • Glans will undergo necrosis or gangrenous change.

TREATMENT-

  • Sedation
  • Injection hyluronidase (250 units in 10- 15 ml of saline injected into constricting ring reduces oedema and paraphimosis also gets reduced)
  • Dorsal slit is given for reduction which is followed by circumcision later.
Don’t Forget to Solve all the previous Year Question asked on PARAPHIMOSIS

Module Below Start Quiz

Paraphimosis

Paraphimosis

Q. 1 Not true about paraphimosis is –

 A

Iatrogenic

 B

Seen in Diabetes mellitus

 C

Gangrene of glans

 D

Circumcision is the t/t

Q. 1

Not true about paraphimosis is –

 A

Iatrogenic

 B

Seen in Diabetes mellitus

 C

Gangrene of glans

 D

Circumcision is the t/t

Ans. B

Explanation:

Ans is ‘b’ ie Seen in Diabetes mellitns 

  • Diabetes mellitus has no role in paraphimosis.

Paraphimosis

  • Etiology: When a prepuce is forcibly retracted over the glans penis, it may get stuck behind the glans. This condition is k/a paraphimosis.
  • Pathology –>

This constricting band of phimotic prepuce causes obstruction to the venous flow, which lead to edema and congestion of the glans.

The glans swells leading to more difficulty in retracting back the prepuce.

In neglected cases gangrene may result.

  • Treatment —>
  • Ice bags, gentle manual compression and injection of a solution of hyaluronidase in normal saline may help to reduce the swelling.
  • If conservative method fails then the pt. can be t/t by circumcision*.

A dorsal slit of the prepuce under local anaesthetic may be enough in an emergency

  • It is uncommon for the urethra to be compressed, so the micturition is normally not affected.

Q. 2 About Paraphimosis true is :

 A

Catheter induced

 B

Circumcision is treatment

 C

Hyaluronidase inj

 D

All of the above

Q. 2

About Paraphimosis true is :

 A

Catheter induced

 B

Circumcision is treatment

 C

Hyaluronidase inj

 D

All of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e. All of the above 
Paraphimosis may be produced when during catheterization the prepuce is forcibly retracted over gland penis. 

Quiz In Between



Peyronie’s Disease

PEYRONIE’S DISEASE


PEYRONIE’S DISEASE (PENILE FIBROMATOSIS/ INDURATION- PENIS PLASTICA)

  • It is a development of fibrous tissue plaque on the covering of corpus cavernosum involving tunica albuginea which may later calcify or ossify.
  • Palmar fibromatosis + plantar fibromatosis + penile fibromatosis = superficial fibromatosis

ETIOLOGY

  • Associated with-

a) Dupuytren’s contracture (plamar fibromatosis)

b) Retroperitoneal fibrosis

c) Plantar facitis

  • Trauma
  • Venereal disease

CLINICAL FEATURES-

  • Painful erection, curvature of penis and poor erection distal to involved area
  • Palpable induration or mass present on dorsolateral aspect of the penis
  • Later erectile dysfunction, penile shortening
  • Indurated plaque in the penis
  • Spontaneous regression occurs in 50% of the cases.

 

TREATMENT-

  1. Drugs- steroids, Vitamin E, tsmoxifen, terfenadine and fexafenadine (not very effective)
  2. Intralesional injection- verapamil
  3. Surgery-

a) Excision and placation to opposite side- fitzpatric

b) Multiple incisions over fibrous plaque and temporal fascia bridging- Gelhard’s operation

Exam Important

ETIOLOGY

  • Associated with-

a) Dupuytren’s contracture (plamar fibromatosis)

b) Retroperitoneal fibrosis

c) Plantar facitis

  • Trauma
  • Venereal disease

CLINICAL FEATURES-

  • Painful erection, curvature of penis and poor erection distal to involved area
  • Palpable induration or mass present on dorsolateral aspect of the penis
  • Later erectile dysfunction, penile shortening
  • Indurated plaque in the penis
  • Spontaneous regression occurs in 50% of the cases.

TREATMENT-

  1. Drugs- steroids, Vitamin E, tsmoxifen, terfenadine and fexafenadine (not very effective)
  2. Intralesional injection- verapamil
  3. Surgery-

a) Excision and placation to opposite side- fitzpatric

b) Multiple incisions over fibrous plaque and temporal fascia bridging- Gelhard’s operation

Don’t Forget to Solve all the previous Year Question asked on PEYRONIE’S DISEASE

Module Below Start Quiz

Peyronie’s Disease

Peyronie disease

Q. 1

The following statements are true about Peyronie’s disease except –

 A Pt. presents with complaints of painful erection

 B

Condition affects adolescent males

 C

The condition can be associated with Dupuytren’s contracture of the tendon of the hand.

 D

Spontaneous regression occurs in 50% of the cases.

Q. 1

The following statements are true about Peyronie’s disease except –

 A

Pt. presents with complaints of painful erection

 B

Condition affects adolescent males

 C

The condition can be associated with Dupuytren’s contracture of the tendon of the hand.

 D

Spontaneous regression occurs in 50% of the cases.

Ans. B

Explanation:

Ans is (b) i.e. Condition affects adolescent males

  • Peyronie’s disease is usually seen over 40 years of age
  • Important points about Peyronie’s disease
  • It is also k/a penile fibromatosis
  • It is due to fibrous plaques in one or both corpus cavernosum.They may later calcify or ossify.
  • Fibrous plaques lead to pain and curvature of the penis on erection
  • Palpable induration or mass appears usually on the dorsolateral aspect of the penis.
  • Palmar fibromatosis (Dupuytren’s contracture), plantar fibromatosis and penile fibromatosis (Peyronie’s ds.) are components of the same pathological process called superficial fibromatosis.
  • The aetilogy is uncertain, but it may be a result of past trauma.
  • Treatment is difficult but some cases may show spontaneous regression. Medical treatments are often ineffective.
  • If the penile deformity is distressing, Nesbitt’s operation can be performed to straighten the penis

Q. 2

All are true about Peyronie’s disease except ‑

 A Self limiting

 B

Medical treatment is effective

 C

Association with Dupytren’s contracture

 D

Calcified plaques

Q. 2

All are true about Peyronie’s disease except ‑

 A

Self limiting

 B

Medical treatment is effective

 C

Association with Dupytren’s contracture

 D

Calcified plaques

Ans. B

Explanation:

Ans. is `b’ i.e., Medical treatment is effective 


Q. 3

Peyronie’s disease affects the –

 A

Breast

 B

Vagina

 C

Scrotum

 D

Penis

Q. 3

Peyronie’s disease affects the –

 A

Breast

 B

Vagina

 C

Scrotum

 D

Penis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Penis 

Quiz In Between



Circumcision

CIRCUMCISION


CIRCUMCISION

INDICATIONS-

  • Religious (jews and muslims)
  • Phimosis
  • Paraphimosis
  • Balanitis & balanoposthitis
  • Early carcinoma of prepuce or glans penis
  • STD
  • Recurrent UTI

PROCEDURE-

  • In children, it is done under GA
  • In adults, it is done under LA.

COMPLICATIONS-

  • Reactionary haemorrhage
  • Infection
  • Stricture urethra near external meatus in children
  • Chordee

Exam Important

INDICATIONS-

  • Religious (jews and muslims)
  • Phimosis
  • Paraphimosis
  • Balanitis & balanoposthitis
  • Early carcinoma of prepuce or glans penis
  • STD
  • Recurrent UTI

PROCEDURE-

  • In children, it is done under GA
  • In adults, it is done under LA.

COMPLICATIONS-

  • Reactionary haemorrhage
  • Infection
  • Stricture urethra near external meatus in children
  • Chordee
Don’t Forget to Solve all the previous Year Question asked on CIRCUMCISION

Module Below Start Quiz

Circumcision

Circumcision

Q. 1 Which of the following is/are TRUE about hypospadias?

1. Defect is seen in the ventral part
2. Always associated with chordee
3. Associated with hooded prepuce
4. Circumcision should be avoided

 A

1,2 & 3

 B

2,3 & 4

 C

1,3 & 4

 D

All are true

Q. 1

Which of the following is/are TRUE about hypospadias?

1. Defect is seen in the ventral part
2. Always associated with chordee
3. Associated with hooded prepuce
4. Circumcision should be avoided

 A

1,2 & 3

 B

2,3 & 4

 C

1,3 & 4

 D

All are true

Ans. C

Explanation:

About option 1
Hypospadias results from failure of fusion of the urethral folds on the undersurface of the genital tubercle so defect is seen on the ventral part
.

About option 2
“In the penile variety (not other type- so not always present) the urethra and corpus spongiosum distal to the ectopic opening are absent.

These structures are represented by a fibrous cord. Due to contracture of this fibrous cord, the penis is curved ventrally, which is known as chordee”.
 
About option 3
“In all cases the inferior aspect of the prepuce is poorly developed. As the superior aspect of the prepuce is almost normally developed whereas the inferior aspect is poorly developed, the prepuce takes the form of a hood and is called “hooded prepuce”.
About option 4
“Circumcision should not be done in these patients, as prepuce can be used later in surgical repair (85% of patients)”
Ref: L & B 25/e, Page 1362-63 ; CSDT 11/e, Page 1028 ; Textbook Of Surgery By S. Das 5/e, Page 1322-23

Q. 2 Regarding neonatal circumcision, which one of the following is true:

 A

It should be done without anaesthesia, as it is hazardous to give anaesthesia.

 B

It should be done without anesthesia, as neonates do not perceive pain as adults

 C

It should be done under local anaesthesia only.

 D

General anaesthesia should be given to neonate for circumcision as they also feel pain as adults.

Q. 2

Regarding neonatal circumcision, which one of the following is true:

 A

It should be done without anaesthesia, as it is hazardous to give anaesthesia.

 B

It should be done without anesthesia, as neonates do not perceive pain as adults

 C

It should be done under local anaesthesia only.

 D

General anaesthesia should be given to neonate for circumcision as they also feel pain as adults.

Ans. D

Explanation:

D i.e. G.A. Should be given to neonate for circumcision as they also feel pain as adults


Q. 3

Circumcision cannot be used in management of 

 A

Phimosis

 B

Severe balanitis xerotica

 C

Paraphimosis

 D

Penile Cancer

Q. 3

Circumcision cannot be used in management of 

 A

Phimosis

 B

Severe balanitis xerotica

 C

Paraphimosis

 D

Penile Cancer

Ans. D

Explanation:

Answer- D. Penile Cancer

  • Phimosis
  • Balanitis 
  • Posthitis
  • Paraphimosis
  • Severe UTIs

Q. 4 Indication of circumcision includes:

 A

Hypospadias

 B

Epispadias

 C

Phimosis

 D

Balanitis

Q. 4

Indication of circumcision includes:

 A

Hypospadias

 B

Epispadias

 C

Phimosis

 D

Balanitis

Ans. C:D:E

Explanation:

Answer- C,Phimosis D,Balanitis E, Balanoposthitis
Indication- religious & phimosis
Medical indications for circumcision in boys include-

  1. recurrent attacks of balanoposthitis
  2. recurrent urinary tract infections
  3. In adults, inability to retract for intercourse, abnormally tight frenulum, balanitis

Quiz In Between



Carcinoma Of Penis

CARCINOMA OF PENIS


CARCINOMA OF PENIS

  • MC type – SCC

ETIOLOGY-

  1. Premalignant lesions-
  • Genital warts- Bushke- Lowenstein tumour is a giant penile condyloma (verrucous carcinoma of penis)
  • Erythroplasia of Queyrat or Paget’s disease of penis- precancerous lesion
  • Leukoplakia of glans
  • Bowen’s disease- small eczematous plaque
  • Chronic balanoposthitis, phimosis (50%), Balanitis xerotica obliterans
  • Condyloma auminata (HPV)
  • Most important carcinogens- HPV (16, 18, 31, 33)
  • Poor hygiene

PATHOLOGY-

  1. Infiltrating type- pre-existing leukoplakia
  2. Papilliferous type
  3. Ulcerative type- glans penis MC site. 80% are low grade tumours

SPREAD-

  1. Lymphatics-
  • Spreads to horizontal group of inguinal lymph nodes and are nodular, hard, fixed which suggests metstasis.
  • Carcinoma from shaft of penis spreads to external iliac LN
  • Initernal and paraaortic LN get enlarged

2. Blood spread is rare

3. Death may occur due to erosions of femoral vessels by iguinal LN.

CLINICAL FEATURES-

  • Occurs in 6th decade
  • Neonatal circumcision helps in immunity against carcinoma penis, HIV or STD.
  • MC orginates from glans > sulcus > prepuce > shaft
  • Foul smelling discharge is common
  • In adults, recent onset of phimosis
  • Haematuria, pain while passing urine- advanced tumours
  • On examination, fungation and induration, everted edge
  • Pain, oedema, tenderness, redness present on infection
  • Urethra is rarely involved as it is protected by tough Buck’s fascia

 

INVESTIGATIONS-

  • Incisional biopsy for grade and depth of invasion and wedge biopsy for SCC
  • Senitel LN biopsy (Cabana sentinel LN)
  • USG- assessment of depth
  • MRI- IOC for staging in CA penis

STAGING-

  1. Stage 1- Confined to glans or prepuce
  2. Stage 2- involving penile shaft or copora cavernosa
  3. Stage 3- Operable inguinal LN metastasis
  4. Stage 4- inoperable inguinal LN metastasis Or advanced spread

TNM STAGING 

TREATMENT-

  • Surgery is the TOC
  • Ca in situ- topical 5- FU cream, Nd- YAG laser, radiotherapy + follow up
  • Ca in situ
  • Young’s operation- for glans involvement without extending into proximal part of shaft
  • Total amputation with perineal urethrostomy- if shaft is involved
  • Piersey Gold operation- total amputation + total scrotectomy + total orchidectomy
  • Laser ablation- stage T1 tumour
  • Enlarged inguinal node- block dissection

Exam Important

  • MC type – SCC

ETIOLOGY-

  1. Premalignant lesions-
  • Genital warts- Bushke- Lowenstein tumour is a giant penile condyloma (verrucous carcinoma of penis)
  • Erythroplasia of Queyrat or Paget’s disease of penis- precancerous lesion
  • Leukoplakia of glans
  • Bowen’s disease- small eczematous plaque
  • Chronic balanoposthitis, phimosis (50%), Balanitis xerotica obliterans
  • Condyloma auminata (HPV)
  • Most important carcinogens- HPV (16, 18, 31, 33)
  • Poor hygiene

SPREAD-

1. Lymphatics-

  • Spreads to horizontal group of inguinal lymph nodes and are nodular, hard, fixed which suggests metstasis.
  • Carcinoma from shaft of penis spreads to external iliac LN
  • Initernal and paraaortic LN get enlarged

2. Blood spread is rare

3. Death may occur due to erosions of femoral vessels by iguinal LN. 

CLINICAL FEATURES-

  • Occurs in 6th decade
  • Neonatal circumcision helps in immunity against carcinoma penis, HIV or STD.
  • MC orginates from glans > sulcus > prepuce > shaft
  • Foul smelling discharge is common
  • In adults, recent onset of phimosis
  • Haematuria, pain while passing urine- advanced tumours
  • On examination, fungation and induration, everted edge
  • Pain, oedema, tenderness, redness present on infection
  • Urethra is rarely involved as it is protected by tough Buck’s fascia

TREATMENT-

  • Surgery is the TOC
  • Ca in situ- topical 5- FU cream, Nd- YAG laser, radiotherapy + follow up
  • Ca in situ
  • Young’s operation- for glans involvement without extending into proximal part of shaft
  • Total amputation with perineal urethrostomy- if shaft is involved
  • Piersey Gold operation- total amputation + total scrotectomy + total orchidectomy
  • Laser ablation- stage T1 tumour
  • Enlarged inguinal node- block dissection
Don’t Forget to Solve all the previous Year Question asked on CARCINOMA OF PENIS

Module Below Start Quiz

Carcinoma Of Penis

Carcinoma Penis

Q. 1 Carcinoma penis is rarest among –

 A

Americans

 B

Indians

 C

Swedes

 D

Jews

Q. 1

Carcinoma penis is rarest among –

 A

Americans

 B

Indians

 C

Swedes

 D

Jews

Ans. D

Explanation:

Ans. is `d’ i.e., Jews

Carcinoma of penis

  • Penile cancer is a malignant growth found on the skin or in the tissue of penis.
  • Circumcision confers protection hence, this cancer is extremely rare among jews and moslems and is correspondingly more common in populations in which circumcision is not routinely practiced. Predisposing factors : – 

 Smoking    

  • Infection with HPV16 and HPV- 18
  • Presence of pre-cancerous lesion —> Bowen disease.

Q. 2 Not true about carcinoma penis is –

 A

Erythroplasia of Queret is a precancerous condition

 B

40% of pts are under 40 year of age

 C

Circumcision if done any time before puberty provides 100% protection against carcinoma penis

 D

More than 50% pt. have inguinal 1.n enlargement when they present

Q. 2

Not true about carcinoma penis is –

 A

Erythroplasia of Queret is a precancerous condition

 B

40% of pts are under 40 year of age

 C

Circumcision if done any time before puberty provides 100% protection against carcinoma penis

 D

More than 50% pt. have inguinal 1.n enlargement when they present

Ans. C

Explanation:

Ans. ie ‘c’ ie Circumcision if done any time before puberty provides 100% protection 

  • The circumcision that is done soon after birth in infancy gives almost complete immunity against Ca penis; but that done later in life does not have the same effect, so Muslims circumcised between the ages of 4 and 9 years are still liable to the disease.
  • About Ca Penis

Most common histological type is –> sq. cell Ca (98%)

Erythroplasia of Queret is precancerous condition. It’s the in-situ form of Ca Penis.

[Carcinoma in situ of the penis is called Erythroplasia of Queyrat if it involves the glans penis, prepuce or penile shaft, and is called Bowen’s disease if it involves the remainder of the genitalia or perinea! region” – Cambell’s Urology 8/e, p 2950]

  • Premalignant lesions of Ca Penis

a.          Penile cutaneous horn
b.          Balanitis xerotica obliterans
c.          Leukoplakia
d.          Viral (Human papilloma virus) related Dermatologic lesion

– Condyloma acuminata (also k/a genital warts)

– Bowenoid papulori

  • The one etiological factor most commonly associated with penile carcinoma is poor hygine.
  • Clinical features
  • Age – Penile Ca occurs most commonly in the sixth decade of life, but its presentation in younger age group is not uncommon (“40% of pts are under 40 years of age” – Bailey)
  • Most common complaint at presentation is the lesion itself. Pain is rare.
  • Most common site of involvement (% from Cambell’s Urology 8/e, p 2953)

Glans

—>

-48%

Prepuce

—>

-21%

Both Glans & Prepuce

-4

9%

Coronal sulcus

 

-6%

Shaft

—>

-2%

  • Lymph node involvement

More than 50% of patients present with enlarged inguinal lymph nodes (but half of these are reactive enlargement d/t sepsis).

–  The presence and the extent of metastasis to the inguinal region is the most important prognostic factor for survival in patients with Ca Penis.

  • Distant metastasis is infrequent
  • Diagnosis is made by biopsy of lesion.
  • Treatment is discussed ahead.

Q. 3

Cause of death in Carcinoma penis is usually –

 A Metastasis to lung

 B

Metastasis to liver

 C

Erosion of Femoral blood vessels

 D

Urinary obstruction

Q. 3

Cause of death in Carcinoma penis is usually –

 A

Metastasis to lung

 B

Metastasis to liver

 C

Erosion of Femoral blood vessels

 D

Urinary obstruction

Ans. C

Explanation:

Ans. is ‘c’ i.e., Erosion of femoral blood vessels 

Inguinal lymph nodes erode the skin of the groin and the death of the patient may be due to involvement of the femoral or external iliac artery with torrential haemorrhage.

Quiz In Between


Q. 4 What is true about carcinoma penis – 

 A

Metastasis is rare

 B

Occurs more commonly in circumcised male

 C

Arises from corona of glans

 D

Pain is frequent

Q. 4

What is true about carcinoma penis – 

 A

Metastasis is rare

 B

Occurs more commonly in circumcised male

 C

Arises from corona of glans

 D

Pain is frequent

Ans. C

Explanation:

Ans. is ‘c’ i.e., Arises from corona of glans 

  • As already mentioned persons circumcised at birth or soon after are immune to Ca Penis.
  • Metastasis to lymph nodes is quite common. Distant metastasis occurs in less than 10% of pts.
  • MC site is glans penis
  • Pain is infrequent
  • Bailey writes – “There is little or no pain”

Q. 5

Features of carcinoma penis are all EXCEPT:

March 2013

 A

Circumcision soon after birth provides total immunity

 B

Pagets disease is not a premalignant disease

 C

Metastasis to inguinal nodes

 D

Surgery is treatment of choice

Q. 5

Features of carcinoma penis are all EXCEPT:
March 2013

 A

Circumcision soon after birth provides total immunity

 B

Pagets disease is not a premalignant disease

 C

Metastasis to inguinal nodes

 D

Surgery is treatment of choice

Ans. B

Explanation:

Ans. B i.e. Pagets disease is not a premalignant disease

Quiz In Between


Q. 6

Features of carcinoma penis include all except:
March 2007

 A

Metastasize to inguinal lymph nodes

 B

Surgery is the treatment of choice

 C

Hypospadias is a premalignant lesion

 D

Circumcision provides protection

Q. 6

Features of carcinoma penis include all except:
March 2007

 A

Metastasize to inguinal lymph nodes

 B

Surgery is the treatment of choice

 C

Hypospadias is a premalignant lesion

 D

Circumcision provides protection

Ans. C

Explanation:

Ans. C: Hypospadias is a premalignant lesion

Following as risk factors for penile cancer:

Human papillomavirus (HPV) infection, smoking, smegma, phimosis, treatment of psoriasis, age, and AIDS. The other etiologic factor most commonly associated with penile carcinoma is poor hygiene. Lichen sclerosus (also known as balanitis xerotica obliterans) may also be a risk factor.

Symptoms

Redness, irritation and a sore or a lump on the penis.

Pathology

  • Precancerous Dermatologic Lesions
  • Carcinoma in Situ (Bowen Disease, Erythroplasia of Queyrat)
  • Invasive Carcinoma of the Penis

A Squamous cell carcinoma usually originating in the glans or foreskin is by far the most common type, occurring in 9 out of 10 cases.

Staging

The stages are assessed as follows:

  • Stage I – Cancer has only affected the glans and/or foreskin.
  • Stage II – Cancer has spread to the shaft of the penis.
  • Stage III – Cancer has affected the penis and surrounding lymph nodes.
  • Stage IV – Cancer has moved beyond the groin area to other parts of the body.
  • Recurrent – Cancer that has returned after treatment.

The most common treatment is one of five types of surgery:

  • Wide local excision – The tumor and some surrounding healthy tissue are removed
  • Microsurgery – Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible
  • Laser surgery – laser light is used to burn or cut away cancerous cells
  • Circumcision – cancerous foreskin is removed
  • Amputation (penectomy) – a partial or total removal of the penis, and possibly the associated lymph nodes. This is the most common and effective treatment.

Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence.

With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy.


Q. 7 All of the following are features of carcinoma penis Except:        
March 2005

 A

Surgery is the treatment of choice

 B

Balanoposthitis may be a predisposing factor

 C

Metastaizes to inguinal nodes

 D

Histologically a transitional cell carcinoma

Q. 7

All of the following are features of carcinoma penis Except:        
March 2005

 A

Surgery is the treatment of choice

 B

Balanoposthitis may be a predisposing factor

 C

Metastaizes to inguinal nodes

 D

Histologically a transitional cell carcinoma

Ans. D

Explanation:

Ans. D: Histologically a transitional cell carcinoma

Penile squamous cell carcinoma, the most common penile malignancy, behaves similarly to squamous cell carcinoma in other parts of the skin.

Chronic balanoposthitis is known to be a contributory factor for penile carcinoma.

Metastasis, which is possible with this type of carcinoma, is often lethal.

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