Penis - Medium Biopsy 1-3 cm

Biopsy

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Biopsy of penile lesion.

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Penis - Medium Biopsy 1-3 cm

Why is it done?
- Test measures or detects: A penile biopsy involves the removal and microscopic examination of tissue from the penis (1-3 cm lesion) to identify histopathological abnormalities, malignancies, or infectious processes affecting penile tissue.
- Primary indications: Diagnosis of penile lesions including suspected squamous cell carcinoma, basal cell carcinoma, melanoma, Paget's disease, lichen sclerosus, penile intraepithelial neoplasia (PeIN), or suspicious erythematous/ulcerated lesions unresponsive to conservative treatment.
- Typical timing: Performed when a patient presents with a visible penile lesion (1-3 cm), persistent skin changes, abnormal appearance, or mass that requires definitive histological diagnosis; typically after clinical examination and imaging if indicated.
- Clinical circumstances: Lesions that have been present for more than 2-4 weeks, show signs of malignant features (irregular borders, ulceration, bleeding), do not respond to topical therapy, or cause patient concern regarding malignancy.
Normal Range
- Normal/reference ranges: Histopathology results are primarily qualitative (not quantitative); normal findings include benign tissue with intact epidermis and dermis, absence of malignant cells, inflammatory infiltrates, infectious organisms, or dysplastic changes.
- Result interpretation: NEGATIVE (Normal) - Benign tissue architecture with no evidence of malignancy, dysplasia, or significant pathology; POSITIVE (Abnormal) - Presence of malignant cells, carcinoma in situ, dysplasia, or infectious/inflammatory process.
- Units of measurement: Histological grading (differentiation levels - well/moderate/poorly differentiated); TNM staging may be applied for malignant lesions; Breslow thickness recorded for melanomas (in millimeters).
- What normal versus abnormal means: Normal indicates the lesion is benign and does not require oncological treatment; Abnormal indicates need for further management including surgical excision, radiation therapy, chemotherapy, or close surveillance depending on diagnosis severity and stage.
Interpretation
- Squamous cell carcinoma (most common): Well-differentiated (low grade) shows organized nests of cells with minimal nuclear pleomorphism and better prognosis; poorly-differentiated (high grade) shows irregular infiltrative growth, high mitotic activity, and worse prognosis requiring aggressive treatment.
- Basal cell carcinoma: Shows nests of basaloid cells with peripheral palisading; typically lower malignant potential than squamous cell carcinoma; may require Mohs micrographic surgery for optimal margin control.
- Penile intraepithelial neoplasia (PeIN): Dysplasia confined to epidermis without invasion; represents precancerous lesion; risk of progression to invasive carcinoma; requires close surveillance and consideration of topical or laser therapy.
- Lichen sclerosus: Characteristic appearance with hyperkeratosis, thin epidermis, and homogeneous hyalinization of upper dermis; benign but associated with increased risk of squamous cell carcinoma; requires long-term follow-up.
- Infectious processes: May show viral inclusions (HPV, HSV), fungal organisms, or bacterial invasion; treatment directed at underlying infection.
- Factors affecting interpretation: Tissue sampling site, adequacy of specimen, presence of crush artifact, degree of inflammation, background HPV status, immunosuppression status, and previous treatments.
- Clinical significance: Biopsy findings determine extent of surgical resection needed, necessity for adjuvant therapy, prognosis determination, surveillance recommendations, and impact on sexual function and cosmesis decisions.
Associated Organs
- Primary organ system: Integumentary system (skin) with involvement of external male genitalia; urogenital system implications given anatomical proximity to urethra and erectile tissue.
- Lymphatic system: Penile carcinomas can metastasize to inguinal lymph nodes; biopsy findings determine need for inguinal lymphadenectomy; assessment may require imaging (ultrasound, CT, or PET) and sentinel lymph node biopsy.
- Diseases diagnosed: Squamous cell carcinoma of penis, basal cell carcinoma, melanoma, Paget's disease of penis, lichen sclerosus with dysplasia, genital warts (HPV-related), penile sarcoma, and other rare malignancies.
- Potential complications from abnormal results: Partial or total penectomy may be required for advanced malignancies; erectile dysfunction from surgical treatment; urinary dysfunction; psychological impact from sexual organ malignancy; distant metastases if lymph node or systemic involvement present.
- Associated conditions: HPV infection (particularly HPV-16, HPV-18), phimosis (retained foreskin), poor hygiene, smoking history, chronic inflammation, immunosuppression, and previous penile trauma or disease.
Follow-up Tests
- Imaging studies: Ultrasound of inguinal lymph nodes for staging; CT chest/abdomen/pelvis or PET-CT for advanced cases to assess for metastatic disease; MRI penis for local extent determination in selected cases.
- Surgical evaluation: Sentinel lymph node biopsy (SLNB) for tumors >4 mm or intermediate/high-grade histology; consideration of inguinal lymphadenectomy based on nodal status; planning for wide local excision or partial penectomy.
- HPV testing: HPV genotyping may be performed on biopsy tissue to identify high-risk strains (HPV-16, HPV-18); useful for prognosis and determining management approach.
- Immunohistochemistry: p53, Ki-67, p16 staining to assess cellular proliferation and tumor aggressiveness; helps determine prognosis and treatment intensity.
- Surveillance schedule: Clinical examination every 3 months for first 2 years; annually thereafter; close monitoring for recurrence or new lesions; long-term follow-up for at least 5 years recommended for malignancies.
- Complementary tests: Serum tumor markers (SCC antigen, CEA) in advanced disease; complete blood count and metabolic panel prior to systemic chemotherapy; assessment for distant metastases as clinically indicated.
- Repeat biopsy: If initial biopsy shows only inflammation or inconclusive findings, rebiopsy may be needed; also considered if new lesions develop during surveillance.
Fasting Required?
- Fasting requirement: NO - Fasting is not required for a penile tissue biopsy as this is a local procedure performed with topical/local anesthesia under office or surgical conditions.
- Pre-procedure preparation: Patient should clean the genital area with soap and water the morning of procedure; no special pre-biopsy fasting or dietary restrictions needed; normal meals and fluids allowed.
- Medications: Continue all regular medications unless otherwise directed; aspirin and anticoagulants should be discussed with the provider and may need to be held 3-5 days before procedure if heavy bleeding risk; topical anesthetics (lidocaine cream) may be applied 15-20 minutes prior.
- Additional instructions: Arrange for transportation if sedation used; wear loose, comfortable clothing; avoid tight undergarments for 24-48 hours post-procedure; keep area dry for first 24 hours; take prescribed antibiotics if provided; avoid sexual activity for 1-2 weeks post-biopsy.
- Post-procedure care: Minor bleeding and discomfort expected; apply pressure with sterile gauze if bleeding occurs; use ice packs intermittently for first 24 hours; over-the-counter pain relievers acceptable; report excessive bleeding, signs of infection, or severe pain to provider.
- Specimen handling: Tissue immediately placed in formalin preservative; labeled with patient identification; transported to pathology lab within appropriate timeframe; histological examination typically completed within 3-7 business days.

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