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Circumcision - Medium Biopsy 1-3 cm
Biopsy
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Medium foreskin biopsy.
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Circumcision - Medium Biopsy 1-3 cm
- Why is it done?
- Histopathological examination of foreskin tissue removed during circumcision procedure to detect malignancy, dysplasia, or other pathological conditions
- To identify suspected squamous cell carcinoma, penile intraepithelial neoplasia (PeIN), or malignant transformation of the foreskin
- To evaluate persistent dermatological conditions such as lichen sclerosus, balanitis xerotica obliterans, or chronic inflammatory lesions
- To determine presence of HPV infection or other infectious pathology in foreskin tissue
- Performed when clinical examination reveals abnormal tissue, lesions, discoloration, or other suspicious findings on the foreskin
- Part of staging and diagnosis when penile malignancy is suspected or confirmed
- Normal Range
- Normal finding: Intact stratified squamous epithelium with normal keratinization; absence of dysplasia, malignancy, or inflammatory infiltration
- Benign findings may include: Normal cutaneous tissue, mild chronic inflammation, hyperkeratosis, or benign skin lesions
- Negative for malignancy: No evidence of cancer cells, dysplastic changes, or HPV-related neoplasia
- Clear surgical margins: Specimen demonstrates adequate distance from abnormal tissue to tissue edge (if lesion present)
- Units: Qualitative pathology report with histological classification; specimen size typically 1-3 cm as specified
- Interpretation
- Benign/Normal Results: Indicates no malignancy or dysplasia; patient may be reassured; routine follow-up as clinically indicated
- Squamous Cell Carcinoma (SCC): Presence of malignant squamous epithelial cells; requires staging, possible further surgery, radiation, or chemotherapy; grade and differentiation level reported
- Penile Intraepithelial Neoplasia (PeIN)/Dysplasia: Precancerous changes with risk of progression to invasive carcinoma; close clinical follow-up, repeat biopsies, or extended local treatment recommended
- Lichen Sclerosus or Balanitis Xerotica Obliterans: Chronic inflammatory conditions; associated with increased malignancy risk; long-term surveillance recommended
- HPV-Related Findings: Detection of human papillomavirus (high-risk vs low-risk types); influences prognosis and treatment decisions
- Positive Margins: Abnormal tissue extends to edge of specimen; suggests incomplete removal; additional surgery may be necessary
- Specimen Adequacy: 1-3 cm size allows adequate tissue sampling; larger lesions may require additional biopsies or wider excision
- Associated Organs
- Primary Organ: Prepuce (foreskin) - part of external male genitalia; stratified squamous epithelium-lined tissue
- Penile Squamous Cell Carcinoma: Rare malignancy; may spread to regional lymph nodes (inguinal), require node dissection, and potentially involve distant sites
- Associated Conditions: Phimosis (tight foreskin), chronic inflammation, HPV infection, immunosuppression, smoking, poor hygiene
- Disease Risk Factors: Age (typically >50 years), uncircumcised status, HPV exposure, lichen sclerosus, ultraviolet exposure (if exposed),history of penile injury or inflammation
- Potential Complications: If malignancy confirmed: surgical complications from wider excision or penectomy, lymph node dissection morbidity, sexual dysfunction, metastatic disease, reduced quality of life
- System Impact: Genitourinary system; psychological impact of diagnosis affects urinary and sexual function; systemic effects if metastatic disease develops
- Follow-up Tests
- If Malignancy Confirmed: CT imaging of pelvis and abdomen to stage disease; MRI for local staging; chest imaging to exclude pulmonary metastases; consider PET-CT for advanced disease
- Sentinel Lymph Node Biopsy: If stage 1-2 SCC to assess inguinal lymph node involvement; determines need for lymphadenectomy
- Inguinal Lymph Node Imaging: Ultrasound or CT of inguinal region to detect nodal metastases; palpation under anesthesia may be performed
- Repeat Biopsy: If margins positive or dysplasia present; may be recommended 6-12 weeks after initial procedure to assess for recurrence
- HPV Genotyping: If HPV detected, identify high-risk vs low-risk types; influences prognosis and treatment planning
- Immunohistochemistry/Molecular Testing: p16 staining if HPV association suspected; other markers may assess prognosis or guide therapy selection
- Clinical Surveillance: Regular physical examination every 3-6 months initially; monthly self-examination of genital area for any recurrent lesions or changes
- Baseline Laboratory Studies: CBC, metabolic panel, and tumor markers (if advanced disease) prior to chemotherapy or radiation therapy
- Fasting Required?
- Fasting: NO - Fasting is not required for tissue biopsy collection
- Pre-Procedure Preparations: Routine circumcision procedure performed under local anesthesia (lidocaine with epinephrine) or general anesthesia depending on clinical setting
- Genital Preparation: Surgical site scrubbed and prepped with antiseptic solution (chlorhexidine or povidone-iodine); sterile draping applied
- Medication Considerations: Discontinue anticoagulants (warfarin, novel anticoagulants) per surgeon protocol; hold NSAIDs 5-7 days prior if possible; continue essential cardiac/hypertensive medications with small sip of water
- If General Anesthesia: NPO (nothing by mouth) typically 6-8 hours prior to procedure; follow anesthesia-specific guidelines provided by hospital
- Post-Procedure Care: Tissue preserved in formalin fixative (10% neutral buffered formalin standard); specimen transported to pathology laboratory immediately for processing
- Specimen Labeling: Specimen must be properly identified with patient identifiers, source location (foreskin), procedure type, and date/time of collection per pathology protocol
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