Penile intraepithelial neoplasia: Difference between revisions

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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]].


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==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:
*[[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:
DDx:
*[[Squamous cell carcinoma of the penis]].
*[[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)


===Subclassification===
Image: Penile intraepithelial neoplasia - alt -- high mag.jpg | uPeIN - high mag. (WC)
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]]:
Image: Adjacent parakeratosis and reactive changes -- intermed mag.jpg | Parakeratosis & reactive changes - intermed. mag. (WC)
*Conventional PeIN.
</gallery>
*Differentiated PeIN.


==IHC==
==IHC==
*p16 -ve in dPeIN,<ref><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></ref> +ve in cPeIN.
*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==
Retrieved from "https://librepathology.org/wiki/Penile_intraepithelial_neoplasia"