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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,PENILE MALIGNACY,Department of urology,Dr.Matalu Hamis,Dr.Mocha George,A,natomy,Penile parts,Root of the penis(radix),-it is the attached part consisting of the bulb of the penis in the middle and the cruz of penis one on either side of bulb.Lies within the superficial perineal pouch.,Body of the penis(corpus),-has two surfaces;dorsal and ventral.,The glans,sits as a cap on corpora cavernosa but is a part of corpora spongiosa.,Gross anatomy,Vasculature,Arterial supply,Blood supply to the skin of the penis is from the,left,and,right superficial external pudendal,arteries,which arise from,femoral artery.,Supply to deep structures is from continuation of,the internal pudendal artery,which has three branches,bulbourethral artery,carvenosal artery,and,the dorsal artery,.,Venous drainage,Penis is drained by 3 venous systems,the,superficial,intermediate,and,deep,.,S,uperficial veins,coalesce to form single superficial dorsal vein which drains to superficial pudendal vein then to great saphenous vein,Intermediate veins,has circumflex vein which drains to deep dorsal vein.,Deep veins,is via the crura and carvenosal veins which drains to internal pudendal veins.,Lymphatic drainage,Drains to deep,inguinal nodes of the femoral triangle,and some to presymphyseal lymph nodes and lateral lymph nodes of the,external iliac lymphatics.,Penile cancer,Introduction,Is a rare type of cancer that most likely to occurs on the glans of penis,or foreskin.,Mostly are primary.,Among 1,0,most common is scc,.,Others include melanoma,adenocarcinoma from Tysons gland,bcc.,2,0,may also occur and are mostly of urological origin.,Risk factors/,E,tiologies,Uncircumcision.,Chronic balanoposthitis,phimosis.,Sexually transmitted diseases.,Leukoplakia of glans.,Long-standing genital warts.,Pagets disease,of penis(Erythroplasia of Queyrat is persistent rawness of glans penis).,Risk factors cont.,Condyloma acuminata(by human papilloma virus),balanitis xerotica obliterans.,HIV infection,HPV-16.,Age 50yrs.,Smoking cigarette and chewing tobacco,Penile intraepithelial neoplasia,Poor genital hygiene,Natural history of the disease,Penile cancers usually begin as small lesions on the glans or prepuce.,Macroscopically may be exophytic or flat,papillary,or ulcerative.,The growths rates of papillary and ulcerative are similar but of exophytic tend to metastasize to lymph node earlier and are therefore associated with a lower five year rate.,If untreated penile autoamputation can occur,.,Infiltrating,type/exophytic,occurs in a preexisting,leukoplakia.,It,often presents as indurated area.,Papilliferous,type eventually attains a large,size,forming,a fungating foul smelling lesion which,often gets,infected.,Microscopically tumor ranges from well-differentiated keratinizing tumors to solid anaplastic carcinomas with scant keratinization.,Moderated differentiated tumors are highly keratinized,and poorly differentiated carcinomas have variable amounts of spindle cell,giant cell,solid acantholytic,clear cell,small cell,warty,basaloid or glandular components.,Epidemiology,The annual burden of penile cancer has been estimated to be 22000 cases worldwide with incidence rates strongly correlating with those cervical cancer.,Incident rate are higher in less developed than in more developed countries,accounting for up to 10%of male cancers in some part of Africa,South America and Asia.,Is rare.,common affect men aged 50-70 years.,Staging of penile cancer,Jacksons staging of carcinoma,penis-,The commonest method.,Stage I,Tumour,involving,only glans/prepuce/both.90%five year survival,Stage II,Tumour extending into,body,of,penis.70%five year survival.,Stage III,Tumour,having,mobile inguinal nodes.50%,Stage,IV,Tumour spreading to,adjacent,structures/fixed,nodes.5%,TNM,TX,Primary tumour cannot be assessed,TO,No evidence of primary tumour,Tis,Carcinoma,in situ,Ta,Non invasiive carcinoma,T1,Tumour invades sub epithelial tissue,T1a,without lymphovascular invasion and is not,poorly differentiated or undifferentiated,T1b,with either of the above,T2,Tumour invades corpus spongiosum and/or corpora cavernosa,T3,Tumour invades urethra,T4,Tumour invades other adjacent structures,N,Regional lymph nodes,Nx,Regional lymph nodes cannot be assessed,No,No palpable or visibly enlarged inguinal lymph node,N1,Palpable mobile unilateral inguinal lymph node,N2,Palpable mobile multiple unilateral or bilateral inguinal lymph nodes,N3,Fixed inguinal nodal mass or pelvic lymphadenopathy,unilateral or bilateral,M,Distant metastasis,Mo,No distant metastasis,M1,Distant metastasis,Spread of the cancer,Lymphatics,I,t spreads to the horizontal group of inguinal lymph nodes which become nodular and hard.Lymph nodes on both sides can get involved.Later,external iliac group are involved(above and on medial aspect of the inguinal ligament).,Once inguinal lymph nodes are fixed,it causes severe
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