Home Ahead of print Instructions
About us Current issue Subscribe
Editorial board Archives Contact us
Search Submit article Login 
Print this page Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 15-17

Pattern of penile cancers in Kano


1 Department of Surgery, Urology Unit, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Pathology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Morbid Anatomy and Forensic Medicine, Usmanu Danfodiyo University, Sokoto/Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication7-Apr-2017

Correspondence Address:
Sule Alfa Alhaji
Department of Pathology, Bayero University, Kano
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-8540.204078

Rights and Permissions
  Abstract 

Background: The prevalence of penile cancer differs from region to region across the globe. The highest prevalence was reported in some parts of the developing countries in South America and Africa. However, its epidemiology in our population is unknown. Our study, therefore, aimed to describe the frequency, the age of presentation, and the histological spectrum of penile cancers seen in Kano, Northern Nigeria. Materials and Methods: This study was an 18-year retrospective appraisal from 1998 to 2015 of all the histological diagnosed penile cancers recorded at the Aminu Kano Teaching Hospital, Kano, Nigeria. Where necessary, a new slide was reprocessed from tissue block for re-evaluation. Results: Six penile cancers were diagnosed during the study period. Patient's age ranged from 50 to 75 years (mean 59.70 years). Three patients (50%) were in the 50–59 years age group. All the six cases were squamous cell carcinomas, five (83.3%) were well differentiated and one (16.7%) was poorly differentiated. Conclusion: This review affirmed the low prevalence of penile cancer in our population which may not be detached from the common tradition of circumcision in our populace.

Keywords: Cancers, penile, squamous cell carcinoma


How to cite this article:
Abdulkadir A, Alhaji SA, Sanusi HM. Pattern of penile cancers in Kano. Niger J Basic Clin Sci 2017;14:15-7

How to cite this URL:
Abdulkadir A, Alhaji SA, Sanusi HM. Pattern of penile cancers in Kano. Niger J Basic Clin Sci [serial online] 2017 [cited 2017 Oct 21];14:15-7. Available from: http://www.njbcs.net/text.asp?2017/14/1/15/204078


  Introduction Top


Studies have shown the global geographic variance in the prevalence of penile cancer. This seemingly concurs with the differences in socioeconomic status, cultural, and religious rites.[1],[2] Higher rates were reported in Uganda (2.8/100,000), Zimbabwe (1.6/100,000), Brazil (1.5–3.7/100,000), and Swaziland (3.2/100,000).[3],[4],[5],[6] The lowest rates were amidst Israeli Jews that practice neonatal circumcision (0.1/100,000) and it is seldom seen among Muslims, whose circumcision ranges from neonatal age through to the ages of 3–13.[7] Penile cancer is commonly the disease of middle-to-older age; typically it affects those between 50 and 70 years. It is rarely reported in the younger age groups.[8]

There are few reported reviews on the pattern of penile cancers from the parts of Nigeria.[9],[10] However, to our knowledge, there was none from our institution in spite being among the major facilities with considerable urologic and pathological capacity in Nigeria. This study reviews the frequency, age at presentation, the anatomical site of the lesion, and the histological spectrums of penile cancers seen at the Aminu Kano Teaching Hospital, Kano, over the 18-year period.


  Materials and Methods Top


This was an 18-year retrospective review of the entire histologically diagnosed penile cancer at the Aminu Kano Teaching Hospital, Kano, Nigeria, from January 2, 1998, to December 31, 2015. The biodata of all the cases was retrieved from records. The slides prepared from the specimens fixed in 10% formal saline and submitted to the Pathology Department were reviewed by the authors. The fixed specimens were at presentation processed for paraffin embedding, then microtome sectioned at 5 μm and stained with hematoxylin and eosin. Fresh sections from these archival paraffin blocks were obtained when the original slides could not be retrieved. Three cases were from our center, two were from the state urology center, and a case from a peripheral hospital in Kano. Collated results were presented in the form of a table, bar chart, and photomicrographs.


  Results Top


Only six cases of penile cancers were histologically diagnosed in our institution during the 18-year study period. The age of the patients ranged from 50 to 75 years, with mean 59.70 years. The peak prevalence was in the 50–59 years age group with three cases (50%) and two (33.4%) cases were 70–75 years. One patient was in the 60–69 years age group (16.7%). The youngest was a 50-year-old patient. Each of the patients had a circumcision.

The tumors were mostly sited on the glans (50%), followed by the glans and prepuce (33.3%), and then the shaft (16.7%). The histological analysis shows all patients had squamous cell carcinoma. Most (83.3%) were well differentiated with one (16.7%) poorly differentiated.

[Table 1] depicts the relative frequency and age distribution of different histological subtypes [Figure 1]. While [Figure 2] and [Figure 3] are the photomicrographs of well-differentiated and poorly differentiated squamous cell carcinoma of the penis, respectively.
Table 1: Histological Types and Age Distribution of Penile Cancers in Kano

Click here to view
Figure 1: Bar chart showing age distribution of patients with penile cancers in Kano.

Click here to view
Figure 2: Well-differentiated squamous cell carcinoma of the penis (H and E, ×40).

Click here to view
Figure 3: Poorly differentiated squamous cell carcinoma of the penis (H and E, ×40).

Click here to view



  Discussion Top


Penile cancer is an uncommon lesion in our population with an average frequency of 1 in 3 years in this study. This rate is similar to other reviews from the parts of Nigeria.[9],[10] Earlier studies also documented penile cancer as the least common of the genitourinary malignancies in Northern Nigeria; only 1% and 1.7% of all urological malignancies in Jos and Gombe, respectively.[11],[12] This could be due to the common practice of male circumcision in the study population which was cited as protective against penile cancer.[13] Likewise, in Western Europe and the United States, penile cancer accounts for only 0.4–0.6% of all malignancies, in contrast, it accounts for a relatively higher proportion of cancers in Swaziland (4.4%), Rwanda (2.9%), Kenya (1.9%), and Uganda (1.7%).[1],[2],[3],[4],[6]

Our review revealed the youngest patient as 50-year-old, while the oldest was 75 years of age, which conforms with the reports across the globe. Similarly, the mean age of 59.7 years in this study agrees with other reports from many centers.[10],[14],[15] Penile cancers occur ordinarily around the glans and prepuce, and less commonly in the coronal sulcus and shaft.[16]

Penile cancers are thought to arise from a complex process of genetic imbalance that may be spontaneous or an offshoot from activities of the environmental agents. The risk factors included genital human papillomavirus infections, smoking, penile tears, phimosis, and poor genital hygiene.[17]

The classical clinical characteristics consist of an ulcerated lump that may be itchy, painful, and tender with contact bleeding. The ulcer is often further complicated by a secondary infection. There may be associated inguinal lymphadenopathy and lower urinary symptoms. The cancer is a disastrous disorder when the presentation is delayed with a terrible impact on the quality of life.[18] About 95% of penile cancers are squamous cell carcinoma, while 5% are metastases from tumors of the other organs. Very fewer cases of sarcomas, melanomas, and lymphomas are reported.[19]

Penile cancers in our series showed a striking predilection for the glans penis (50%), followed by the glans and prepuce (33.3%), and then the shaft (16.7%). This preponderance concurs with other studies.[20],[21]

The overwhelming majority of squamous cell carcinomas in this study were well-differentiated squamous cell carcinomas (83.3%), which is also consistent with some published studies. In a review reported by Ajekigbe in Lagos, well-differentiated squamous cell carcinomas comprised 100% of penile cancer.[9] Our result was in contrast to that of Chandra's study in India that showed moderately differentiated squamous cell carcinomas as the most frequent histological subtype (52.8%); Chandra's study rhymed with the review by Koifman in Brazil that also indicated the preponderance of moderately differentiated squamous cell carcinomas (56.9%).[15],[22]

There is the need for further studies in our set up on other factors that may influence the epidemiology. Further prospective studies may determine the appropriate predictor variables for penile cancer in our populace.


  Conclusion Top


Penile cancer is a rare urologic malignancy in Kano. An early circumcision and genetic factors appear to be a major component that determined its very low prevalence in our populace. The most common histological pattern in our setting is the well-differentiated squamous cell carcinoma.

Acknowledgment

We are grateful to the Chief Laboratory Scientist of Aminu Kano Teaching Hospital Mr. Sani Abubakar for technical work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ. Penile cancer: Epidemiology, pathogenesis and prevention. World J Urol 2009;27:141-50.  Back to cited text no. 1
    
2.
Chaux A, Cubilla AL. Advances in the pathology of penile carcinomas. Hum Pathol 2012;43:771-89.  Back to cited text no. 2
    
3.
Parkin DM, Nambooze S, Wabwire-Mangen F, Wabinga HR. Changing cancer incidence in Kampala, Uganda, 1991-2006. Int J Cancer 2010;126:1187-95.  Back to cited text no. 3
    
4.
Parkin DM, Ferlay J, Hamdi-Cherif M, Sitas F, Thomas JO, Wabinga H, et al. Cancer Incidence in Africa. Lyon: International Agency for Research on Cancer; 2003.  Back to cited text no. 4
    
5.
Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR. Surgical treatment of invasive squamous cell carcinoma of the penis: Retrospective analysis of 350 cases. J Urol 1994;151:1244-9.  Back to cited text no. 5
    
6.
Parkin DM. Cancer Incidence in Five Continents. Lyon: International Agency for Research on Cancer; 2002.  Back to cited text no. 6
    
7.
Curado MP, Edwards B, Shin HR, editors. Cancer Incidence in Five Continents. No. 160. Vol. IX. Lyon: IARC Scientific Publications; 2007.  Back to cited text no. 7
    
8.
Persson B, Sjödin JG, Holmberg L, Windahl T; Steering Committee of the National Penile Cancer Register in Sweden. The National Penile Cancer Register in Sweden 2000-2003. Scand J Urol Nephrol 2007;41:278-82.  Back to cited text no. 8
    
9.
Ajekigbe AT, Anunobi CC, Tijani KH, Banjo AA, Nweke IG. Carcinoma of the penis: Experience from the Lagos University Teaching Hospital Lagos, Nigeria. Nig Q J Hosp Med 2011;21:25-8.  Back to cited text no. 9
    
10.
Ajuluchukwu EU, Khalil MI. Penile cancer in North-Eastern Nigeria. Mary Slessor J Med 2003;3:39-46.  Back to cited text no. 10
    
11.
Mandong BM, Iya D, Obekpa PO, Orkar S. Urological tumours in Jos University Teaching Hospital, Jos, Nigeria. Niger J Surg Res 2000;2:108-13.  Back to cited text no. 11
    
12.
Dauda MA, Misauno MA, Ojo EO, Nnadozie UU. Pattern of urological malignancies seen at Federal Medical Centre Gombe North Eastern Nigeria. Niger J Med 2012;21:237-40.  Back to cited text no. 12
    
13.
Schoen EJ, Oehrli M, Colby Cd, Machin G. The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 2000;105:E36.  Back to cited text no. 13
    
14.
Slaoui A, Jabbour Y, El Ghazoui A, Karmouni T, Elkhader K, Koutani A, et al. Penile cancer: About ten cases at the University Hospital of Rabat, review of the literature. Pan Afr Med J 2015;22:53.  Back to cited text no. 14
    
15.
Koifman L, Vides AJ, Koifman N, Carvalho JP, Ornellas AA. Epidemiological aspects of penile cancer in Rio de Janeiro: Evaluation of 230 cases. Int Braz J Urol 2011;37:231-40.  Back to cited text no. 15
    
16.
Gerbaulet A. Cancers de la verge. In: Steg A, Eschwege F, editors. Cancers Uro-Genitaux. Paris: Flammarion Medecine Science; 1991. p. 406-24.  Back to cited text no. 16
    
17.
Chaux A, Netto GJ, Rodríguez IM, Barreto JE, Oertell J, Ocampos S, et al. Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma. World J Urol 2013;31:861-7.  Back to cited text no. 17
    
18.
Burgers JK, Badalament RA, Drago JR. Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am 1992;19:247-56.  Back to cited text no. 18
    
19.
Cubilla AL, Reuter V, Velazquez E, Piris A, Saito S, Young RH. Histologic classification of penile carcinoma and its relation to outcome in 61 patients with primary resection. Int J Surg Pathol 2001;9:111-20.  Back to cited text no. 19
    
20.
Pow-Sang MR, Benavente V, Pow-Sang JE, Morante C, Meza L, Baker M, et al. Cancer of the penis. Cancer Control 2002;9:305-14.  Back to cited text no. 20
    
21.
Derakhshani P, Neubauer S, Braun M, Bargmann H, Heidenreich A, Engelmann U. Results and 10-year follow-up in patients with squamous cell carcinoma of the penis. Urol Int 1999;62:238-44.  Back to cited text no. 21
    
22.
Chandra S, Chandra H, Gaur DS. Male Genitourinary tumours: 14 years experience in Garwal Region of India. Indian Med Gaz 2014;7:1-5.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1337    
    Printed12    
    Emailed0    
    PDF Downloaded86    
    Comments [Add]    

Recommend this journal