|Year : 2017 | Volume
| Issue : 1 | Page : 15-17
Pattern of penile cancers in Kano
Abubakar Abdulkadir1, Sule Alfa Alhaji2, Haruna Muhammad Sanusi3
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 Publication||7-Apr-2017|
Sule Alfa Alhaji
Department of Pathology, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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., 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).,,, 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. 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.
There are few reported reviews on the pattern of penile cancers from the parts of Nigeria., 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|| |
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|| |
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|
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|Figure 1: Bar chart showing age distribution of patients with penile cancers in Kano.|
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|Figure 2: Well-differentiated squamous cell carcinoma of the penis (H and E, ×40).|
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|Figure 3: Poorly differentiated squamous cell carcinoma of the penis (H and E, ×40).|
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| Discussion|| |
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., 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., This could be due to the common practice of male circumcision in the study population which was cited as protective against penile cancer. 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%).,,,,
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.,, Penile cancers occur ordinarily around the glans and prepuce, and less commonly in the coronal sulcus and shaft.
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.
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. 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.
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.,
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. 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%).,
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|| |
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.
We are grateful to the Chief Laboratory Scientist of Aminu Kano Teaching Hospital Mr. Sani Abubakar for technical work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]