Penile Intraepithelial Neoplasa: Review and Update
Abstract:
Penile intraepithelial neoplasia (PeIN) is a histopathology terminology that is utilized for precancerous penile lesions. PeIN is important in view of the high morbidity and mortality associated with progression to penile squamous cell carcinoma (PSSC). But PeIN is not commonly encountered and it does contribute to a limited evidence-base for the relative efficacy of available options of treatment. PeIN tends to be classified into HPV-associated and HPV-independent (differentiated) (dPeIN). Even though HPV-associated PeIN had been linked to the oncogenic effect of human papillomavirus (HPV), the HPV-independent pathway is stated to be driven by chronic inflammatory conditions. These two biology pathways had been iterated to be are associated with distinct histopathology examination features. The commonest morphology patterns of HPV-associated PeIN include basaloid, warty, and mixed PeIN. DPeIN is the morphological expression of HPV-independent PeIN. A review of therapy options and outcomes for PeIN, had summated the ensuing findings: Topical agents had demonstrated response and recurrence rates of 40% to 100% and 20% for imiquimod, and 48-74% and 11% for 5-fluorouracil, respectively. Discontinuation of topical agents in view of side effects had been noted in 12% of cases. Response rates for laser treatment options were 52 % 100%, with recurrence in 7 % 48% of cases and a change in penile sensitivity in 50%. Circumcision was documented to have cleared preputial PeIN. Recurrence rates pursuant to surgical treatment of glans PeIN were documented to be 25% for wide local excision, 4% for Mohs surgery, 5% for total glans resurfacing, and 10% for glansectomy. Limited data does exist related to the factors that would predict treatment response and to sequencing of treatment options. Many treatment options are available for men who have precancerous lesions of the foreskin or glans penis. Close follow-up is necessary inn view of the fact that PeIN lesions could or progress to invasive penile cancer, a close regular, follow-up assessments are required to establish early any recurrent PeIN lesion or the lesions that had become invasive or malignant. Considering the rarity of PeIN, and the fact that there is no global consensus opinion of the best treatment options of PeINs in various parts of the world it is important for all clinicians to be aware of the clinical manifestations, diagnosis, treatment options that may be available in every locality of the world including the developing countries taking into consideration the availability and non-availability of laser and other treatment agents. It is therefore important for readers to read carefully, summations related to PeINs of the penis in order to establish a quick diagnosis of the PeIN lesion so as to provide a suitable treatment for patients taking into consideration the local availability of treatment options.
