Difference between revisions of "Penile intraepithelial neoplasia"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Penile intraepithelial neoplasia -- intermed mag.jpg
| Width      =
| Caption    = Penile intraepithelial neoplasia (undifferentiated subtype). [[H&E stain]].
| Synonyms  =
| Micro      =
| Subtypes  = differentiated PeIN, undifferentiated PeIN
| LMDDx      = [[squamous cell carcinoma of the penis]], [[squamous hyperplasia]]
| Stains    =
| IHC        = p16 +ve (uPeIN) -ve (dPeIN), p53 -ve (uPeIN) +ve (dPeIN)
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[penectomy grossing]]
| Assdx      = [[HPV]] infection (undifferentiated PeIN), [[lichen sclerosus]] or [[BXO]] (differentiated PeIN)
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good
| Other      =
| ClinDDx    = [[squamous cell carcinoma of the penis]], [[lichen sclerosis]], [[phimosis]]
| Tx        =
}}
'''Penile intraepithelial neoplasia''', abbreviated '''PeIN''', is the precursor of [[squamous cell carcinoma of the penis]].
'''Penile intraepithelial neoplasia''', abbreviated '''PeIN''', is the precursor of [[squamous cell carcinoma of the penis]].


It is subclassified based on the role of [[HPV]],<ref>{{Cite journal  | last1 = Velazquez | first1 = EF. | last2 = Chaux | first2 = A. | last3 = Cubilla | first3 = AL. | title = Histologic classification of penile intraepithelial neoplasia. | journal = Semin Diagn Pathol | volume = 29 | issue = 2 | pages = 96-102 | month = May | year = 2012 | doi =  | PMID = 22641959 }}</ref> as in [[vulvar intraepithelial neoplasia]].
It may be abbreviated '''PIN''';<ref name=pmid12452865>{{Cite journal  | last1 = Porter | first1 = WM. | last2 = Francis | first2 = N. | last3 = Hawkins | first3 = D. | last4 = Dinneen | first4 = M. | last5 = Bunker | first5 = CB. | title = Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases. | journal = Br J Dermatol | volume = 147 | issue = 6 | pages = 1159-65 | month = Dec | year = 2002 | doi =  | PMID = 12452865 }}</ref> however, this can cause confusion with the [[prostatic intraepithelial neoplasia]] (the presursor of [[prostate carcinoma]]).  
 
It may be abbreviated '''PIN''';<ref name=pmid12452865>{{Cite journal  | last1 = Porter | first1 = WM. | last2 = Francis | first2 = N. | last3 = Hawkins | first3 = D. | last4 = Dinneen | first4 = M. | last5 = Bunker | first5 = CB. | title = Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases. | journal = Br J Dermatol | volume = 147 | issue = 6 | pages = 1159-65 | month = Dec | year = 2002 | doi =  | PMID = 12452865 }}</ref> however, this can cause confusion with the presursor of prostate carcinoma ([[prostatic intraepithelial neoplasia]]).  


==General==
==General==
*Not very common.
*Not very common overall.
*Typically seen adjacent to [[squamous cell carcinoma of the penis]].


==Microscopic==
==Microscopic==
See ''[[vulvar intraepithelial neoplasia]]''.
Subclassified as:<ref name=pmid22641959>{{Cite journal  | last1 = Velazquez | first1 = EF. | last2 = Chaux | first2 = A. | last3 = Cubilla | first3 = AL. | title = Histologic classification of penile intraepithelial neoplasia. | journal = Semin Diagn Pathol | volume = 29 | issue = 2 | pages = 96-102 | month = May | year = 2012 | doi =  | PMID = 22641959 }}</ref>
*Undifferentiated PeIN (uPeIN).
*Differentiated PeIN (dPeIN).
 
Note:
*Subclassification similar to one for [[vulvar intraepithelial neoplasia]], that is based on the role of [[HPV]] in the pathogenesis.
 
===Undifferentiated penile intraepithelial neoplasia===
Features:
*Increased [[NC ratio]].
*Multinucleation.
*Lack of maturation to surface - not that useful.
**May have "vertical streaming" - the long axis of the cells are perpendicular to the free surface & basement membrane.
*Apical mitoses.


DDx:
DDx:
*[[Squamous cell carcinoma of the penis]].
*[[Squamous cell carcinoma of the penis]].
===Differentiated penile intraepithelial neoplasia===
Features:
*Thickening of the stratum spinosum ([[acanthosis]]).
*Elongation of rete ridges with bridging/anastomoses between rete ridges.
*[[Nuclear atypia]] - esp. of the basal layer.
*Nuclei in stratum corneum ([[parakeratosis]]).
*+/-Atypical mitoses.
DDx:
*[[Squamous cell carcinoma of the penis]].
*[[Squamous hyperplasia]].
*[[Lichen sclerosus]].
===Images===
<gallery>
Image: Penile intraepithelial neoplasia -- low mag.jpg | uPeIN - low mag. (WC)
Image: Penile intraepithelial neoplasia  - alt -- low mag.jpg | uPeIN - low mag. (WC)
Image: Penile intraepithelial neoplasia -- intermed mag.jpg | uPeIN - intermed. mag. (WC)
Image: Penile intraepithelial neoplasia  - alt -- intermed mag.jpg | uPeIN - intermed. mag. (WC)
Image: Penile intraepithelial neoplasia -- high mag.jpg | uPeIN - high mag. (WC)
Image: Penile intraepithelial neoplasia  - alt -- high mag.jpg | uPeIN - high mag. (WC)
Image: Adjacent parakeratosis and reactive changes -- intermed mag.jpg | Parakeratosis & reactive changes - intermed. mag. (WC)
</gallery>
==IHC==
*p16 -ve in dPeIN,<ref>{{Cite journal  | last1 = Oertell | first1 = J. | last2 = Caballero | first2 = C. | last3 = Iglesias | first3 = M. | last4 = Chaux | first4 = A. | last5 = Amat | first5 = L. | last6 = Ayala | first6 = E. | last7 = Rodríguez | first7 = I. | last8 = Velázquez | first8 = EF. | last9 = Barreto | first9 = JE. | title = Differentiated precursor lesions and low-grade variants of squamous cell carcinomas are frequent findings in foreskins of patients from a region of high penile cancer incidence. | journal = Histopathology | volume = 58 | issue = 6 | pages = 925-33 | month = May | year = 2011 | doi = 10.1111/j.1365-2559.2011.03816.x | PMID = 21585428 }}</ref> +ve in uPeIN.
==Sign out==
<pre>
Skin, Penile Lesion, Excision:
    - High-grade penile intraepithelial neoplasia (PeIN), undifferentiated type.
    -- Margin POSITIVE for PeIN.
</pre>


==See also==
==See also==
*[[Penis]].
*[[Penis]].
*[[Squamous dysplasia]].


==References==
==References==

Latest revision as of 17:02, 4 October 2018

Penile intraepithelial neoplasia
Diagnosis in short

Penile intraepithelial neoplasia (undifferentiated subtype). H&E stain.
Subtypes differentiated PeIN, undifferentiated PeIN
LM DDx squamous cell carcinoma of the penis, squamous hyperplasia
IHC p16 +ve (uPeIN) -ve (dPeIN), p53 -ve (uPeIN) +ve (dPeIN)
Site penectomy grossing
Associated Dx HPV infection (undifferentiated PeIN), lichen sclerosus or BXO (differentiated PeIN)
Prevalence uncommon
Prognosis good
Clin. DDx squamous cell carcinoma of the penis, lichen sclerosis, phimosis

Penile intraepithelial neoplasia, abbreviated PeIN, is the precursor of squamous cell carcinoma of the penis.

It may be abbreviated PIN;[1] however, this can cause confusion with the prostatic intraepithelial neoplasia (the presursor of prostate carcinoma).

General

Microscopic

Subclassified as:[2]

  • Undifferentiated PeIN (uPeIN).
  • Differentiated PeIN (dPeIN).

Note:

Undifferentiated penile intraepithelial neoplasia

Features:

  • Increased NC ratio.
  • Multinucleation.
  • Lack of maturation to surface - not that useful.
    • May have "vertical streaming" - the long axis of the cells are perpendicular to the free surface & basement membrane.
  • Apical mitoses.

DDx:

Differentiated penile intraepithelial neoplasia

Features:

  • Thickening of the stratum spinosum (acanthosis).
  • Elongation of rete ridges with bridging/anastomoses between rete ridges.
  • Nuclear atypia - esp. of the basal layer.
  • Nuclei in stratum corneum (parakeratosis).
  • +/-Atypical mitoses.

DDx:

Images

  • uPeIN - low mag. (WC)

  • uPeIN - low mag. (WC)

  • uPeIN - intermed. mag. (WC)

  • uPeIN - intermed. mag. (WC)

  • uPeIN - high mag. (WC)

  • uPeIN - high mag. (WC)

  • Parakeratosis & reactive changes - intermed. mag. (WC)

IHC

  • p16 -ve in dPeIN,[3] +ve in uPeIN.

Sign out

Skin, Penile Lesion, Excision: 
     - High-grade penile intraepithelial neoplasia (PeIN), undifferentiated type.
     -- Margin POSITIVE for PeIN.

See also

References

  1. ↑ Porter, WM.; Francis, N.; Hawkins, D.; Dinneen, M.; Bunker, CB. (Dec 2002). "Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases.". Br J Dermatol 147 (6): 1159-65. PMID 12452865.
  2. ↑ Velazquez, EF.; Chaux, A.; Cubilla, AL. (May 2012). "Histologic classification of penile intraepithelial neoplasia.". Semin Diagn Pathol 29 (2): 96-102. PMID 22641959.
  3. ↑ Oertell, J.; Caballero, C.; Iglesias, M.; Chaux, A.; Amat, L.; Ayala, E.; Rodríguez, I.; Velázquez, EF. et al. (May 2011). "Differentiated precursor lesions and low-grade variants of squamous cell carcinomas are frequent findings in foreskins of patients from a region of high penile cancer incidence.". Histopathology 58 (6): 925-33. doi:10.1111/j.1365-2559.2011.03816.x. PMID 21585428.
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