Penile intraepithelial neoplasia: histopathological evaluation, HPV typing, clinical presentation and treatment

Abstract

Genital human papillomavirus (HPV) infection in male patients can cause great variety of lesions, most of which are benign, but some are categorised as penile intraepithelial neoplasia (PIN). The aims of the present work were to: (i) perform HPV testing and correlate to histopathology from genital HPV-induced lesions in men; and (ii) determine the clinical presentation and treatment of PIN. Men attending the venereological clinic at Karolinska Hospital for surgical treatment of genital HPV infection were included. Two biopsies were taken from each patient, one for histopathology and one for HPV typing using PCR. Patients exhibiting PIN were selected for further analysis. Lesions were described, and treatment and follow-up data were recorded. Forty-seven of 303 (16%) male HPV patients exhibited PIN lesions. Nineteen were afflicted with lesions denominated as PIN I, 13 had PIN II lesions and 15 had PIN III lesions. Macular lesions were most common (n = 27). Ninety-three percent of the analysed PIN lesions were HPV-positive. Three of twelve (25%) HPV-positive PIN III lesions contained only low-risk HPV types compared to 13 of 19 (68%) PIN I lesions. In addition, 9 of 12 (75%) HPV-positive PIN III lesions contained high-risk HPV types compared to 6 of 19 (32%) PIN I lesions (P = 0.029). HPV 6 and HPV 16 were the most prevalent genotypes. A mean of four surgical treatment sessions was performed during a treatment period of mean 27 months. PIN is highly HPV-positive, can show differing clinical pictures and is difficult to treat.