Clinical features and histological grades of penile carcinoma in patients seen at Mulago Hospital

Abstract

Background: Globally the incidence of penile carcinoma is relatively low and that of Uganda has been noted to be highest at 4.4/100,000 men, involving both the young and the elderly in Mulago. This has been associated with high morbidity and mortality. Despite the marked improvement in hygiene status, increased circumcision practice among Ugandan men, better socioeconomic status, penile cancer incidences have kept on raising, making it a challenging health problem in this country. Since the HIV pandemic the spectrum of malignancies has changed in the afflicted areas. The HIV prevalence in Uganda is 6.4% as well, yet the only literature available was done 45 years ago, by Kyalwazi. Therefore the need for carrying out a study to provide current information about this debilitating condition, by following the standards of proper clinical diagnosis to pick up the lesion, biopsy and histological diagnosis which can be done at most levels.

Study objective: To establish the present clinical presentation of penile carcinoma and their histological grades in HIV seropositive and seronegative patients seen at Mulago Hospital.

Methods: A descriptive ambispective case patients series study involving 42 patients who presented with a penile lesion and histological confirmation of penile carcinoma and in the prospective arm, patients were consecutively recruited; clinically assessed, 5mls of whole blood for HIV serology was drawn and penile incisional biopsy taken for histopathological studies. Analysis of their sociodemographic and already known risk factors was done. Frequency tables, pie charts, bar graphs were used to display results whereas the associations between study variables were done using the Pearson Chi- Square tests and results expressed as P- values of less than 5%..

Results: The overall mean age was 55.45 years range 29 – 92 years and the age category 41 -50 years was the most affected by both SCC of penis and HIV. The objectively assessed clinical presentations identified included; nodular swelling (induration), ulceration, fungating growth and auto amputation and atleast more than 60% of the study population were G1, well differentiated Squamous cell carcinoma in both HIV seropositive and seronegative patients. Thus in relation to Jackson’s classification, nearly all patients belonged to Clinical Stage I and II. HIV impacts much on the histological grade of penile carcinoma.

Conclusion: This study showed that penile carcinoma now occurs in a younger age group, with the highest peak stretching from the third to fifth decades, comprising 66.67% of the study population below 60 years of age compared to previous studies which revealed that it was more in the elderly. HIV shortens the course of symptoms of SCC and leads to poor histological differentiation, grade III, the more aggressive form of the cancer of penis. From this study, the commonest clinical staging was I as per Jackson’s classification with 52.38%. The commonest histological type being Squamous cell carcinoma with 73.81% contributing well differentiated grade I thus a low grade tumour, amenable to surgical intervention, with good prognosis and a longer duration of survival.