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Pathology for Urologists

Penile Intraepithelial Neoplasia (PEIN)

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  • Considered precursor in situ lesions of squamous cell carcinoma.
  • Include Erythroplasia of Queyrat (erythematous plaque on the glans and prepuce) and Bowen's Disease (scaly hyperkeratotic plaque, usually on shaft of penis) (image A).
  • Usually in 40's to 60's.
  • Basaloid and warty PEIN is HPV-related (particularly (HPV-16 and 18).
  • Differentiated (simplex) PEIN not related to HPV.
  • More than half associated with invasive squamous cell carcinomas.

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  • Histology:
    • Differentiated PEIN (HPV-unrelated): elongated rete ridges with abnormal maturation (pinker cytoplasm); whorling and keratin earl formation.
    • Warty PEIN: undulating or spiky surface; koilocytic change (irregular raisinoid nuclei) (image B)(image C).
    • Basaloid PEIN: small cells with high nuclear to cytoplasmic ratio (image D).
    • Warty-basaloid PEIN.
  • Exact prognosis of PEIN unknown as most studies were retrospective.


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