HUMAN PAPILLOMAVIRUS INFECTION AND INTRAEPITHELIAL, IN-SITU, AND INVASIVE-CARCINOMA OF PENIS

The role of human papillomavirus (HPV) infection and other reported co factors in the genesis, evolution, and clinical manifestations of prec ancerous and cancerous squamous cell lesions of the penis were studied in 34 men. Clinically, all lesions demonstrated aceto-whitening. Hist ologic changes of HPV infection formed a field-of-change that involved the components of the preputial cavity in all patients. These changes were associated with minor grades of penile intraepithelial neoplasia (PIN I and II) in 19 patients, major grades of PIN/carcinoma in situ (PIN III/Tis) in 7, and invasive squamous cell carcinoma (SCCa, Stages T2 and T3) in 8. Most of the patients (79.4%) were heavy smokers; 52. 9 percent had a history of HPV infection, PIN, or invasive penile SCCa ; and 60 percent of 30 patients had female sexual partners who had HPV -related genital neoplasia. A pilot virologic study of specimens obtai ned from 20 representative patients utilizing polymerase chain reactio n amplification detected HPV DNA in 80 percent. Laser therapy was aime d at the entire field-of-change in 30 patients; recurrent minor-grade PIN or SCCa developed in 2 of 23 patients (8.7%) followed for up to th ree years. Of the 4 remaining patients treated with local excision or partial penectomy, 3 (75%) had development of recurrent minor-grade PI N when followed for up to four years. The combination of the host of c arcinogenic factors and currently rampant immunologic disorders will l ikely lead to an increase in the historically low incidence of SCCa of the penis in the United States.