Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma

Abstract

Purpose: The incidence of penile cancer is four times higher in Paraguay than in the United States or Europe. There are no adequate scientific explanations for this geographical variation. The goal of this study was to evaluate the interplay among risk factors, morphology of the primary tumor, and HPV status.

Methods: Information on socioeconomic status, education level, habits, and sexual history was obtained in 103 Paraguayan patients with penile cancer. All patients were then treated by surgery, and specimens were evaluated histopathologically.

Results: Patients usually dwelled in rural/suburban areas (82%), lived in poverty (75%), had a low education level (91%), and were heavy smokers (76%). Phimosis (57%), moderate/poor hygienic habits (90%), and history of sexually transmitted diseases (74%) were frequently found. Patients with >10 lifetime female partners had an odds ratio of 3.8 (95% CI 1.1, 12.6; P-trend = .03) for presenting HPV-positive tumors when compared to patients with <6 partners. However, this trend was not significant when the number of sexual partners was adjusted for age of first coitus and antecedents of sexually transmitted diseases. HPV-related tumors (found in 36% of the samples) were characterized by a warty and/or basaloid morphology and high histological grade in most cases.

Conclusions: In our series, patients with penile cancer presented a distinctive epidemiologic and pathologic profile. These data might help explaining the geographical differences in incidence and aid in the design of strategies for cancer control in Paraguay.

Figure 1. Morphological features of HPV-related penile tumors

HPV positive basaloid carcinoma (upper left, H&E) showing invasive tumors nests; neoplastic cells are strongly positive for p16^INK4a expression (upper right). Warty carcinoma (lower left, H&E) depicting papillae with prominent parakeratosis and conspicuous koilocytosis; p16^INK4a overexpression is observed in tumor cells but not in the parakeratotic layer (lower right).