Penile tumors

Pavlica PB (1998) Ultrasound of penile tumors and trauma. Ultrasound Q 14 95-109... 

Penile Tumors Classification, Clinics and Current Therapeutic Approach... 

Mohs FE, Snow SN, Larson PO (1992) Mohs micrographic surgery for penile tumors. Urol Clin North Am 19 291-304 Narayana AS, Olney LE, Loening SA et al (1982) Carcinoma of the penis analysis of 219 cases. Cancer 49 2185-2191 Ornellas AA, Seixas AL, Marota A et al (1994) Surgical treatment of invasive squamous cell carcinoma of the penis retrospective analysis of 350 cases. J Urol 151 1244-1249 Pascual A, Pariente M, Godinez JM et al (2007) High prevalence of human papillomavirus 16 in penile carcinoma. Histol Histopathol 22 177-183... 

Penile tumor is uncommon in developed countries. As illustrated in Chapter 13, however, in some developing countries it accounts for as many as 10% to 20% of all malignancies in men (Algaba et al. 2002 Pow-Sang et al. 2002). 

Most penile tumors are squamous cell carcinomas. Non-squamous cell primary tumors are very uncommon and include benign lesions, such as hemangiomas (Kim et al. 1991), neurilemmomas (Kousseff and Hoover 1999 Jung et al. 2006) and leiomyomas (Stehr et al. 2000 Bartoletti et al. 2002 Liu et al. 2007), and malignant lesions such as epithelioid sarcoma (Sirikci et al. 1999), Kaposi s sarcoma (Hermida Gutierrez et al. 1995), lymphoma (El-Sharkawi and Murphy 1996 Lo et al. 2003 Wei et al. 2006) and melanoma (Sanchez-Ortiz et al. 2005). Other penile tumors are extremely rare. 

Ultrasound appearance of benign and malignant penile tumors different from squamous cell carcinoma is usually non specific. Diagnosis is based on history, clinics and biopsy. Echographic characteristics, however, can help in characterization of some tumors and, as occurs for squamous cell carcinomas, imaging may be required for staging purpose. 

Most penile metastases originate from the genital apparatus or from the lower urinary tract (Belville and Cohen 1992). In the past, bladder tumor was considered the major source responsible for penile metastases, but a relatively recent revision of the literature pointed out that most secondary penile tumors originate from prostate cancer (Perez et al. 1992). Tumors from different organs, however, can be involved, such as renal, testicle, bowel and rectum, lung, skin and bone malignancies. The reason why penile metastases are rare despite rich penile vascularization remains unexplained. 

This technique has been used in the past for evaluation of penile tumors that appear as filling defects within the erectile bodies (Escribano et al. 1987 Haddad 1989). It is an invasive procedure, however, that may cause severe complications and currently is not indicated. 

This technique has a limited role in local staging of patients with penile tumors. In fact, while CT and magnetic resonance imaging are equally effective to identify pathological nodes, the relationships of the tumor with adjacent structures are better evaluated with magnetic resonance imaging because of higher contrast resolution. In advanced penile cancers TC has a role in identification of distant metastatic deposits. CT is also indicated in patients with lymphoma apparently localized to the penis to check for the presence of other localizations of the disease. 

Different examination techniques should be used to image penile vasculature with microbubble contrast agents. While patients with penile malformations, primary penile tumors, and Peyronie s disease are evaluated after cavernosal injection of vasoactive drugs to obtain erection, patients with trauma, ischemic priapism, and penile metastases are examined in hasal condition. 

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