Biomedical subjects

J R Goellner

Publications and source records attributed to J R Goellner.

At least 37 records · Page 2Linked to original sources

PubMed1998

Diagnostic value of albumin gene expression in liver tumors: case report and review of the literature.

Management of a solitary liver mass necessitates reliable distinction between primary hepatocellular carcinoma and metastatic lesions. The histologic differentiation can be difficult even with special stains such as alpha-fetoprotein, cytokeratin, and carcinoembryonic antigen. Albumin is a specific product of hepatocytes, and in situ hybridization to reveal albumin messenger RNA (mRNA) is highly specific and sensitive for the diagnosis of primary hepatocellular carcinoma. This technique can be used on histopathologic specimens and in cytologic diagnosis. Herein we describe a patient with synchronous renal and hepatic masses, in whom the distinction had to be made between metastatic renal cell carcinoma and two separate primary tumors--one in the liver and one in the kidney. In situ hybridization for albumin mRNA proved helpful in making this distinction. In addition, we review the literature on the diagnostic use of albumin gene expression in liver tumors.

Aged↗

PubMed1998

Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma?

BACKGROUND: Controversy continues regarding the optimal extent of primary thyroid resection in most patients with papillary thyroid carcinoma (PTC), who are at minimal risk of cause-specific mortality (CSM). This study was designed to compare CSM and recurrence rates after either unilateral lobectomy (UL) or bilateral lobar resection (BLR) in patients with PTC considered low risk by AMES criteria. METHODS: Outcome was studied in 1685 patients initially treated during 1940 through 1991 and followed for up to 54 postoperative years (mean, 18 years). One thousand six hundred fifty-six patients (98%) had complete primary tumor resection; 634 (38%) had involvement of regional nodes. One hundred ninety-five patients (12%) had UL; BLR accounted for 1468 (near-total 60%; total thyroidectomy 18%). RESULTS: Thirty-year rates for CSM and distant metastasis were 2% and 3%, respectively. Twenty-year rates for local recurrence and nodal metastasis were 4% and 8%, respectively. There were no significant differences in CSM or distant metastasis rates between UL and BLR (P > .2). After UL, 20-year rates for local recurrence and nodal metastasis were 14% and 19%, significantly higher (P = .0001) than the 2% and 6% rates seen after BLR. CONCLUSIONS: UL was not associated with higher CSM rates, but it was associated with a significantly higher risk of locoregional recurrence. Thus BLR probably represents a preferable initial surgical approach to patients with low-risk PTC.

Adult↗

PubMed1997

Insular thyroid carcinoma in adolescents: a potentially lethal endocrine malignancy.

BACKGROUND: Insular thyroid carcinoma is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinomas. METHODS: The authors describe two children with insular thyroid carcinoma who had markedly different outcomes. In the first case, a girl age 15 years, 2 months presented with a large pulsatile mass in the right thyroid lobe. In the second case, a girl age 16 years, 3 months presented after total thyroidectomy was performed elsewhere for confirmed pTNM Stage I insular thyroid carcinoma. RESULTS: In Case 1, total thyroidectomy was performed, and histologic examination revealed insular thyroid carcinoma with lymph node involvement. Six weeks postoperatively, neck masses reappeared. There was significant radioactive iodine uptake in the thyroid bed and in a palpable right supraclavicular lymph node; this was associated with an increased serum thyroglobulin level. Ultrasound-guided biopsy of the lymph node confirmed recurrent insular carcinoma, and neck dissection was performed. Six weeks later, there was 0.35% iodine uptake in the neck, and the patient was treated with 300 mCi of (131)I. She had no signs of recurrence when last seen 22 months postoperatively. In Case 2, the patient was given 29.9 mCi of (131)I for remnant ablation. Four months postoperatively, fine-needle aspiration biopsy of a high jugular lymph node demonstrated recurrence. The patient was given 200 mCi of (131)I but had no significant response. Right modified neck dissection was performed, followed by external beam radiation. Despite aggressive treatment with a further 500 mCi of (131)I, progressive lung and mediastinal metastases developed, followed by brain metastasis. The patient died 31 months after the initial diagnosis. CONCLUSIONS: Insular thyroid carcinoma may occur and behave aggressively in children. Vigorous initial surgical and radioactive iodine treatments are warranted.

Adolescent↗

PubMed1997

Metastasis to the thyroid gland. A report of 43 cases.

BACKGROUND: The incidence of metastasis to the thyroid gland in autopsy series varies from 1.25% to 24%. Metastasis to the thyroid gland is usually considered a terminal event, and the effectiveness of conventional treatment has been questioned. The authors assessed the effects of current methods of diagnosis and treatment on the course of the disease. METHODS: Forty-three patients with metastasis to the thyroid gland were studied retrospectively. Primary tumor origin was identified in all but two cases. Metastasis to the thyroid gland was confirmed by fine-needle aspiration cytology or histology. Data were analyzed for the frequency and types of malignant lesions, the clinical course of disease, and the prognosis after thyroid involvement. RESULTS: The kidney was the most common primary tumor site (33%), followed by lung (16%), breast (16%), esophagus (9%), and uterus (7%). The time from diagnosis of the primary tumor to metastasis to the thyroid gland was considerable for renal cell adenocarcinoma (mean, 106 months) and for adenocarcinomas of the breast (mean, 131 months) and uterus (mean, 132 months). In 12 patients, this interval was more than 120 months. Fine-needle aspiration cytology detected metastatic malignancy in 29 of 30 patients. Treatment involved surgery alone, surgery with adjuvant therapy, or nonsurgical methods. Two patients with uterine adenocarcinoma and one with breast adenocarcinoma had disease regression with no evidence of tumor recurrence. CONCLUSIONS: In any patient with a previous history of malignancy, no matter how remote that history is, a new thyroid mass should be considered recurrent malignancy until proved otherwise. Although detection of metastasis to the thyroid gland often indicates poor prognosis, aggressive surgical and medical therapy may be effective in a small percentage of patients.

Aged↗

PubMed1997

Follicular and Hürthle cell thyroid neoplasms. Is frozen-section evaluation worthwhile?

OBJECTIVES: To determine whether (1) frozen-section (FS) evaluation of follicular and Hürthle cell thyroid neoplasms (FHCNs) is accurate, (2) FS aids in intraoperative decision-making, and (3) FS is cost-effective. DESIGN: Retrospective review of patient histories and FS and paraffin-embedded slides. Permanent histologic sections were considered the standard criterion. Follow-up was achieved in 92% of patients with a mean follow-up of 5.7 years. SETTING: Tertiary care referral center. PATIENTS: All patients undergoing thyroidectomy for a suspected FHCN between January 1, 1985, and December 31, 1994. Patients included were those whose condition was diagnosed as FHCN, either on FS, permanent histologic sections, or both. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FS analysts were determined. Total adjusted hospital charges were compared for those undergoing 1 vs 2 cancer operations. Multivariate analyses were carried out to determine the optimal predictive model for follicular cancer. RESULTS: The study group included 1023 patients (737 women and 286 men), of whom 83 (8.1%) were diagnosed as having a malignant FHCN on permanent section. The diagnosis of malignant neoplasm was correctly established in 65 (78%) of the 83 patients on FS, thereby permitting definitive surgical management at the first operation. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for FS diagnosis of malignant FHCN were 78%, 99%, 90%, 98%, and 98%, respectively. In a multivariate analysis, FS was the most significant variable predictive of malignant neoplasm. Approximately $400,000 was saved in hospital charges by the use of FS as a result of the elimination of many 2-stage operations. CONCLUSION: Frozen-section evaluation of FHCN can be performed with a high degree of accuracy, permitting considerable cost savings.

Adenocarcinoma↗

PubMed1997

Hepatocellular carcinoma: needle biopsy findings in 74 cases.

Needle aspiration specimens from 74 cases of hepatocellular carcinoma (HCC) diagnosed between January 1986 and December 1992 were reviewed and compared with 57 other lesions. The most specific cytologic findings for HCC included capillaries separating tumor cells (34%), bile associated with malignant cells (19%), and endothelial cells lining clusters of neoplastic cells (18%). Less specific findings included polygonal cells with central nuclei resembling normal hepatocytes and intranuclear inclusions. Tissue core fragments available in 53 cases of HCC disclosed that a weak keratin (AE1/AE3) stain (75% of HCC), a canalicular pattern of polyclonal carcinoembryonic antigen (54%), and a positive alpha-fetoprotein stain (58%) are diagnostic of HCC. All HCCs were negative for monoclonal carcinoembryonic antigen. In situ hybridization for albumin mRNA was positive in 27 of 33 cases of HCC. The diagnosis of HCC by needle biopsy should include cytologic findings and the appropriate immunohistochemical profile, along with detection of albumin mRNA by in situ hybridization.

Adult↗

PubMed1997

Factors that predict malignant thyroid lesions when fine-needle aspiration is "suspicious for follicular neoplasm".

OBJECTIVE: To assess clinical factors that may improve the ability to predict the presence of a malignant lesion in thyroid nodules that are found to be "suspicious for follicular neoplasm" by fine-needle aspiration (FNA) cytology. MATERIAL AND METHODS: We undertook a retrospective review of the medical records of all patients at the three Mayo Clinic facilities who underwent a thyroid surgical procedure between January 1992 and December 1994 and had a preoperative FNA report of "suspicious for follicular neoplasm." Patient and nodule characteristics were analyzed statistically for associations with the presence of cancer. RESULTS: The study cohort consisted of 219 patients with a mean age of 54.3 years. Eighty-four percent of resections were done for benign disease. Of the 35 malignant lesions, 9 were incidental papillary cancers separate from the primary nodule; thus, only 26 cancers were found in the index nodule, and only 19 (9% of the total group) were follicular carcinomas. Clinical findings associated with a malignant index nodule were larger diameter, fixation of the mass, and younger age of the patient. CONCLUSION: Clinical characteristics may be used for more accurate assessment of the risk of the presence of a malignant lesion when FNA cytology of a thyroid nodule is reported as "suspicious for follicular neoplasm."

Adenocarcinoma, Follicular↗

PubMed1997

Thyroid carcinoma metastatic to the skin: a cutaneous manifestation of a widely disseminated malignancy.

BACKGROUND: Cutaneous metastases develop in 2% to 9% of patients with an internal malignancy. Thyroid carcinoma metastatic to the skin is a rare clinical entity. OBJECTIVE: Our purpose was to study the clinical and pathologic features and outcome in patients with cutaneous metastasis from thyroid carcinoma. METHODS: The study included a retrospective analysis of six patients with skin metastases from thyroid carcinoma and a review of the English-language literature since 1964. RESULTS: Including our six patients, 43 patients with skin metastases from thyroid carcinoma have been reported. Papillary carcinoma was the most common (41%), followed by follicular (28%), anaplastic (15%), and medullary carcinomas (15%). The scalp was the most common site of metastasis. For our patients, the average length of survival after diagnosis of cutaneous metastasis was 19 months. CONCLUSION: Cutaneous metastasis from thyroid carcinoma is rare and occurs in the setting of disseminated neoplastic disease.

Adult↗

PubMed1997

Extracervical fibrosclerosis causing obstruction of a ventriculo-peritoneal shunt in a patient with hydrocephalus and invasive fibrous thyroiditis (Riedel's struma).

The association of invasive fibrous thyroiditis (IFT) with foci of extracervical fibrosclerosis is well recognized. Affected sites include the retroperitoneum, the mediastinum, the biliary tract, and the orbit. The development of subcutaneous fibrosclerosis, however, is extremely rare. We report a patient with known invasive fibrous thyroiditis and hypoparathyroidism who presented with localized subcutaneous fibrosclerosis of the anterior chest wall resulting in compression of his ventriculoperitoneal shunt. The aetiology of IFT has remained unclear. Several histological and serological features, including the presence of mononuclear cells within the fibrosclerotic process, the occurrence of microscopic vasculitis, and the detection of autoantibodies directed against thyroid-specific antigens in a large proportion of patients with IFT, currently support the notion of autoimmune mechanisms playing a role in the pathogenesis of this rare disease.

Adult↗

PubMed1997

Frequent loss of heterozygosity on chromosomes 3p and 17p without VHL or p53 mutations suggests involvement of unidentified tumor suppressor genes in follicular thyroid carcinoma.

Follicular thyroid carcinoma (FTC) exhibits frequent loss of heterozygosity (LOH) on chromosomes 10q and 3p, suggesting involvement of tumor suppressor genes. We screened 14 FTC (10 Hurthle cell carcinomas and 4 nonoxyphilic FTC), 14 papillary thyroid carcinomas, and 7 follicular adenomas for LOH on chromosome arms 1p, 3p, 3q, 10p, 10q, 11p, 11q, 13q, 17p, and 17q. LOH was more frequent in FTC than in follicular adenoma or papillary thyroid carcinoma. In FTC, rates of LOH on 3p (86%), 17p (72%), and 10q (57%) were higher than the average rate of LOH (33%; P < 0.05). Most frequently involved were 3p21-25 and 17p13.1-13.3, the sites for the VHL (3p25-26) and p53 (17p13.1) tumor suppressors. We, therefore, characterized these genes by dideoxy fingerprinting and DNA sequencing. Two FTC had mutations in p53, but only 1 of these exhibited LOH at 17p. No VHL gene mutations were found. Thus, neither p53 nor VHL genes play a significant role in the pathogenesis of differentiated thyroid cancer. LOH on 17p, but not on 3p or 10q, was correlated with mortality. Accordingly, 3p and 10q LOH may represent early, and 17p LOH late, events in FTC development. The data suggest the presence of novel tumor suppressor genes on chromosomes 3p and 17p that may be important in the pathogenesis of FTC.

Adenocarcinoma, Follicular↗

PubMed1997

Thyroglossal duct carcinoma: report of 12 cases.

OBJECTIVE: To report the relative frequency, natural history, and optimal treatment of thyroglossal duct (TGD) carcinoma. DESIGN: We retrospectively reviewed all cases of TGD carcinoma surgically treated during a 44-year period at a tertiary referral center. MATERIAL AND METHODS: The computerized medical records database at Mayo Clinic Rochester was searched for patients who had the diagnosis of TGD carcinoma or TGD cyst carcinoma from 1950 through 1994. Medical records and pathologic specimens of these patients were reviewed. RESULTS: Twelve patients (six male and six female patients), who were 17 to 60 years old (mean, 40), were identified. The frequency of TGD carcinoma among surgically removed TGD cysts was 0.7%. A midline upper neck mass was the initial symptom in all patients. The diagnosis of cancer was made after the Sistrunk procedure in 11 of 12 cases and preoperatively (by fine-needle aspiration biopsy) in only 1 case. All patients had papillary carcinoma. Thyroid involvement was noted in three cases. Nine patients had subtotal or near-total thyroidectomy, and three received postoperative radioactive iodine. After a mean follow-up of 13 years (range, 1 to 38), no patient had a documented local recurrence or distant metastatic involvement, and no tumor-associated mortality was observed. CONCLUSION: TGD carcinoma is a rare malignant tumor that is usually diagnosed postoperatively. Papillary carcinoma is the most common pathologic finding. The recommended treatment is the Sistrunk procedure followed by near-total or total thyroidectomy by a skilled thyroid surgeon because of the possibility of intrathyroidal foci of cancer. The prognosis is excellent in patients with papillary tumor.

Adolescent↗

PubMed1997

Problems and pitfalls in thyroid cytology.

When performing fine-needle aspiration of the thyroid, the limitations of the technique must be considered and one must keep an open mind when examining the cytologic specimen. It is also important to develop a philosophy for handling the occasional difficult "gray zone" case. Some cases will be at the border of normal and abnormal and a philosophical approach concerning how to handle these problem cases is useful. One approach is to "play it safe" and classify as "suspicious" any lesion that clearly does not fit into a benign category. Sometimes, a discussion with clinicians about the degree of suspicion is appropriate, and minimally suspicious lesions might be followed up unless clinical indications point toward surgery. An intermediate to strong degree of cytologic suspicion usually mandates surgical exploration. Undoubtedly, we will continue to refine our diagnostic abilities in fine-needle aspiration cytology of the thyroid. The above discussion reflects the experience of one institution, represents the state of the art as of 1996 and may have to be revised in the near future.

Adenoma↗

PubMed1996

Management of thyroid nodules in pregnancy.

BACKGROUND: Disorders of the thyroid are common in pregnancy. In particular, a thyroid nodule is frequently discovered before or during pregnancy. OBJECTIVE: To develop guidelines for the management of thyroid nodules during pregnancy. METHODS: We reviewed the cases of 40 pregnant patients with thyroid nodules evaluated during a 10-year period Cytological findings were compared with available histological findings, and concordance rates were determined. The rank sum test was used for statistical analysis. RESULTS: Fine-needle aspirations of thyroid nodules in 62% of patients were benign cytologically (25 patients). Of 8 patients with negative cytological results who had thyroidectomy, all had benign disease histologically (100% concordance rate). Cytological findings of papillary cancer (3 patients) strongly correlated with final histological diagnosis (100% concordance rate), whereas papillary cancer was confirmed histologically in only 2 of 4 patients with cytological findings suspicious for this disease (50% concordance rate). All 3 nodules with cytological findings suspicious for follicular neoplasm were benign adenomas histologically. Of 2 nodules suspicious for Hürthle cell neoplasm, l was Hürthle cell adenoma and the other was Hürthle cell carcinoma (100% concordance rate). Thyroidectomy during the second trimester of pregnancy or the early postpartum period was successful. CONCLUSIONS: The approach to thyroid nodules in pregnancy should be similar to that for nonpregnant patients. Thyroidectomy should be performed (1) during the second trimester for malignant lesions and cytological findings suspicious for papillary cancer and (2) in the postpartum period for cytological findings suspicious for follicular neoplasm.

Adult↗

PubMed1996

Detection of human papillomavirus DNA in primary squamous cell carcinoma of the male urethra.

OBJECTIVES: The prevalence of human papillomavirus deoxyribonucleic acid (DNA) in primary squamous cell carcinoma of the male urethra and corresponding control tissue was studied. METHODS: The technique of polymerase chain reaction DNA amplification was used to detect specific human papillomavirus DNA sequences in archival pathologic and control tissue. We analyzed 16 cases of primary squamous cell carcinoma of the male urethra and 22 specimens of normal male urethra stratified by location within the urethra. RESULTS: Primary squamous cell carcinoma of the pendulous urethra was significantly associated with human papillomavirus type 16 DNA (6 of 6 cases), but the control tissue from the pendulous urethra was not (0 of 12, P < 0.001). Primary squamous cell carcinoma of the bulbous and posterior urethra was not associated with human papillomavirus infection. CONCLUSIONS: Infection of the male urethra with human papillomavirus type 16 may have a role in the pathogenesis of primary squamous cell carcinoma of the pendulous urethra, for which it has a strong predilection, vis-à-vis the bulbous and posterior urethra.

Carcinoma, Squamous Cell↗

PubMed1996

Tissue eosinophilia and eosinophil degranulation in Riedel's invasive fibrous thyroiditis.

The etiology of Riedel's invasive fibrous thyroiditis (IFT) has remained obscure. This rare disorder has been confused in the past with the more common fibrous variant of Hashimoto's disease. The typical histological features of IFT, in particular the presence of an invasive fibrosclerotic process in conjunction with a prominent chronic inflammatory infiltrate, suggest that the release of fibrogenic cytokines and other factors from these cellular infiltrates may play an important role in the pathogenesis of this condition. Our observations in routinely processed tissue sections obtained from patients with documented IFT of striking tissue eosinophilia led us to hypothesize that eosinophils and their products may play a role in the evolution of this disease. Immunofluorescence staining with affinity-purified polyclonal rabbit antibody directed against human eosinophil granule major basic protein revealed marked tissue eosinophilia and abundant extracellular deposition of major basic protein in all specimens from 16 patients with IFT. By contrast, only occasional eosinophils and no extracellular major basic protein were detected in control thyroid tissues obtained from patients with multinodular goiter, Graves' disease, Hashimoto's disease, and normal thyroid tissue. The presence of marked eosinophil infiltration and extracellular major basic protein deposition in IFT and other associated fibrosclerotic conditions suggests a role for eosinophils and their products in propagating the fibrogenesis seen in IFT.

Cell Degranulation↗

PubMed1995

Diagnostic immunohistochemistry of cutaneous metastatic breast carcinoma: a statistical analysis of the utility of gross cystic disease fluid protein-15 and estrogen receptor protein.

BACKGROUND: For accurate classification of cutaneous metastatic carcinoma, reliable tumor-specific immunohistochemical markers would be valuable. OBJECTIVE: Our purpose was to analyze the sensitivity, specificity, and positive predictive value of gross cystic disease fluid protein-15 (GCDFP-15) and estrogen receptor protein (ERP) for diagnosing cutaneous metastatic breast carcinoma. METHODS: Tissue sections from 68 consecutive cases of cutaneous metastatic carcinoma were stained for GCDFP-15 and ERP. Hematoxylin-eosin-stained slides and immunostained slides were reviewed in a blinded fashion before retrospective chart review to ascertain the underlying primary tumor type. RESULTS: Of 42 cases of cutaneous metastatic breast carcinoma, 30 were positive for GCDFP-15. Of 41 cases of metastatic breast carcinoma, 30 were positive for ERP. Calculated sensitivity, specificity, and positive predictive value for GCDFP-15 for diagnosing cutaneous metastatic breast carcinoma were 71%, 91%, and 94%, respectively, and 73%, 100%, and 100% for ERP, respectively. Combined values of these indices for both stains were 83%, 91%, and 95%, respectively. CONCLUSION: GCDFP-15 and ERP are valuable markers for cutaneous metastatic breast carcinoma and should be used in combination.

Apolipoproteins↗

PubMed1995

Distant metastases in papillary thyroid carcinoma: 100 cases observed at one institution during 5 decades.

The present study was designed to define the factors that predict survival in patients with distant metastases (DM) from papillary thyroid carcinoma. We performed a retrospective review of the records of 100 consecutive patients (45 females and 55 males; age range, 8-91 yr) who developed DM after primary treatment at our institution from, 1940-1989. Median follow-up for the 20 survivors was 21 yr (range, 3-38). Cause-specific survival rates at 5, 10, and 15 yr were 40%, 27%, and 24%, respectively, and were not significantly different between the eras 1940-1954, 1955-1969, and 1970-1989 (P = 0.74). By univariate analysis, age at diagnosis of DM was the most important predictor of survival (P < 0.0001), with improved survival occurring in younger patients. Tumor-related factors associated with improved survival included complete resection of the primary tumor (P < 0.005), histological grade 1 (P = 0.006), diploid nuclear DNA (P = 0.03), and lung as first site of DM (P = 0.018). By univariate analysis, use of radioiodine therapy was associated with improved survival (vs. other forms of therapy, P < 0.001). However, by multivariate analysis only age, site of DM, and degree of extrathyroidal invasion of the primary tumor were identified as significant predictors of survival. None of the four treatment variables (external radiation, surgery, chemotherapy, or radioiodine) was a significant predictor of survival in the Cox model. Our retrospective data indicate that 1) outcome has changed little over 5 decades for patients with DM from papillary thyroid carcinoma; and 2) current forms of therapy do not appear to impact on survival.

Adolescent↗

PubMed1995

The detection of human papillomavirus deoxyribonucleic acid in intraepithelial, in situ, verrucous and invasive carcinoma of the penis.

PURPOSE: We study the prevalence of human papillomavirus deoxyribonucleic acid (DNA) in squamous cell carcinoma and control tissue of the penis. MATERIALS AND METHODS: The technique of polymerase chain reaction DNA amplification was used to detect specific human papillomavirus DNA sequences in archival pathological and control tissues. We analyzed 42 cases of invasive squamous cell carcinoma, 13 of carcinoma in situ, 12 of penile intraepithelial neoplasia, 3 of verrucous carcinoma and 25 of balanitis xerotica obliterans, as well as 29 routine neonatal circumcision specimens and 32 adult circumcision specimens. RESULTS: Overall, the detection rates for human papillomavirus DNA in the study and control tissues were 55% (23 of 42 cases) for invasive squamous cell carcinoma, 92% (12 of 13) for carcinoma in situ, 92% (11 of 12) for penile intraepithelial neoplasia, 0% (0 of 3) for verrucous carcinoma, 4% (1 of 25) for balanitis xerotica obliterans, 0% (0 of 29) for neonatal circumcision and 9% (3 of 32) for adult circumcision. In all groups human papillomavirus type 16 was the most common genotype identified. CONCLUSIONS: The prevalence of human papillomavirus DNA is significantly greater in carcinoma of the penis than in control tissue. Moreover, the prevalence is greater in noninvasive lesions (carcinoma in situ and penile intraepithelial neoplasia) than in invasive carcinoma.

Balanitis↗