Associate Professor ExResident Lecturer Department of - PDF document

Associate Professor, Ex-Resident,Lecturer; Department of Pathology, Government Medical College, Nagpur. Maharashtra. : 20.07.2007; : 19.09.2007; : 15.10.2007 Introductionbeen recognized since 1842, when Rigoni Sterncelibate women. The geographic clustering of cervicaland penile cancer and elevated rate of cervical cancer scrotum, anus and perineum were examined using For conveniencecytologic smear was obtained from the urethra usingmoistened with normal saline and advanced in thedistal urethra 2 to 3 cm deep. It was then rotatedpencil. Two wet slides were immediately fixed (withinfor Papanicolaou stain. Two slides were air dried andstored for Giemsa stain. After collecting the smear,5% acetic acid was applied to whole of the externalgenitalia with the help of gauze pieces. After 3 minutesaceto-white lesion, if any, was noted (Fig 1).The cytologic features followed in the present studythat are indicative of HPV infection were according toinfection and cervical intraepithelial neoplasm (CIN)of these 38 cases, all of whom were asymptomatic,(Table 1). These lesions in the urethra were diagnosedIn the present study, none of the males had anyabnormality. Krebs and Schneider observed that 7%papules, but intraurethral condylomas were usuallyIn the present study the anatomic distribution ofHPV lesions in the male genitalia (Table 1), in majorityconducted by Krebs and Schneider, most of the HPVand almost half of these were at or near the frenulum, 42% of theThe observation by other workers that clinicaldetection of HPV cases was confirmed in the presentFig. 1 :Acetowhite areas on glans penis and meatus at 7O’clock Table 1 : Anatomic distribution of HPV lesions in male Distribution Urethra*3Urethral meatus1Glans penis4Corona1Frenulum0Prepuce1Shaft0 Total10 *These cases were diagnosed by cytology alone. Urethral Cytology, Penioscopy for HPVstudy as none showed any evidence of HPV infectionon clinical examination. While, 13.16% cases werepositive after penioscopy alone, 7.90% cases werepositive by cytology alone, and 5.26% cases werepositive by a combination of these two methods (Tableinfection by penioscopy reported in other studies to a high of 100%.cervical biopsies in women and the results of thedetected by cytology and penioscopy. 6 (26%) of theseacetic acid test and two by cytology. One (50%) maleconsort of the females with CIN II/HPV infection hadacetic acid test. No HPV infection was detected in theHPV infection (Table 3). Barrasso et alreported that(positive in 42.5%) was taken into consideration ain the same study. helped toCIN II and CIN III respectively, while Krebs and detected HPV infection by histology in 66,CIN I, CIN II and CIN III respectively. A comparison ofthat thekoilocytosis, dyskeratosis, hyperkeratosis, parakeratosisonly indicative but not specific of HPV infection (exceptkoilocytosis). Combinations of two or more cytologicKoilocytosis alone and in combination with otherfeatures were seen in 2 cases, while dyskeratosis in2 cases. Parakeratosis and hyperkeratosis inHyperkeratosis alone that was observed in one caseworkers too are of the opinion that althoughkoilocytosis is pathognomonic, the other non-classiccriteria may help predict HPV infection. Cecchini reported that these non-classic criteria mightinfection. Boon et al observed hyperkeratosis in allthe twenty cases they studied while koilocytosis andparakeratosis was observed in one case and three casesrespectively. The reason for absence of koilocytes wasthought to be due to a thick layer of keratinised cellscovering the koilocytes.Whereas Levine et al attributed the rare presence of koilocytosis in urethralTable 2 : Detection of HPV infection by clinical examination, No.% No evidence of HPV infection by any method28Evidence of HPV infection10Clinical examination0-Penioscopy with acetic acid application05Cytology03oClinical examination and penioscopy0-oClinical examination and cytology0-oPenioscopy and cytology02oClinical examination, penioscopy0- Table 3 : Histopathological diagnosis of cervical biopsies in women, and results of different tests in their male consorts Diagnosis in femalesTotal no. of femalesacid)CytologyT CIN I/HPV 23Nil426CIN II/HPV 2Nil1NilNilCIN III/HPV 1NilNilNil1 Total 26Nil527 usually not result in the production of characteristickoilocytes. Other reasons that could account for thefrequent absence of koilocytes in the cytologic smearsthe superficial layer of the lesion in which there areno koilocytes, and the frequency of koilocytes in thedeep layer is much less than that in the cervix.condylomata to be clinically inapparent explains whythis association was not recognized until recently. Thismakes it imperative to screen all male consorts ofscreening technique. Methods like urine cytology andtest for the detection of HPV infection.1.Cartwright RA and Sinson JD. Carcinoma of penis and cervix. 1980; 1: 97.2.Li JY, Li FP, Blot WJ, et al. Co-relation between cancers of J Natl Cancer Inst 3.MacGregor JE and Innes G. Carcinoma of penis and cervix. 1980; 1: 1246-7.4.Grahm S, Priore R, Grahm M, et al. Genital cancer in wives of 1979; 44: 1870-4.5.Martinez I. Relationship of squamous cell carcinoma of the 1969; 24: 777-80.6.Smith PG, Kinlen LJ, White GC, et al. Mortality of wives of men7.Levine RU, Crum CP, Herman E, Silvers D, Ferenczy A, RichartRM. Cervical papilloma virus infection and intraepithelial8.Sedlacek TV, Cunane M, Carpiniello V. Colposcopy in the 1986;9.Krebs HB and Schneider V. Human papillomavirus - Associatedlesions of the penis: colposcopy, cytology and histology. Obstet 1987; 70: 299 - 304.10.Boon ME, Schneider A, Hogewoning CJA, Kwast H, Bolhuis P,Kok LP. Penile studies and heterosexual partners: penioscopy,cytology, histology and immunocytochemistry. 1988;11.Krebs HB. Genital HPV infections in men. 12.Gupta J, Gupta P, Shah K. Detection of human papilloma virusimmunocytochemistry and cytopathology. Acta Cytol 1987;13. Crum CP. Papilloma- related changes and premalignant andPB and Young RH, editors. Contemporary issues in surgicalpathology. Tumor and tumor-like lesions of the uterine corpusand cervix. 1st ed. New York: Churchill Livingstone; 1993. p.51-14.Rosenberg SK, Greenberg MD, Reid R. Sexually transmittedPapilloma viral infection in men. 1987; 14: 495 - 512.15.Cecchini S, Cipparrone I, Confortini M, et al. Urethral cytology16.Brinton LA, William CR, Maria MB, et al. The male factor in the 1989; 44: 199-203.17.Barrasso R, DeBrux J, Odile C and Orth G. High prevalence of