Carcinoma de células escamosas (cce) em cão na região prepucial: relato de caso / Squamous cell carcinoma (scc) in dog in the preputial region: case report / Carcinoma de células escamosas (cce) en perro de la región prepucial: reporte de un caso

A expectativa de vida dos animais de companhia vem aumentando devido as mudanças comportamentais e de cuidados dos tutores. Em analogia, com as idades cada vez mais avançadas, é comum o desenvolvimento de doenças associadas, sendo o tumor o mais comum entre elas. Todavia, as neoplasias mais comuns na clínica de pequenos animais estão associadas ao sistema tegumentar. O carcinoma de células escamosas (CCE), ou carcinoma espinocelular, é uma neoplasia de epitélio, maligno, de crescimento lento e de baixo potencial metastático. Sua etiologia ainda não é precisamente conhecida e a causa exógena mais comum e descrita pela literatura é a exposição à luz ultravioleta, gerando consequentes lesões nas estruturas genéticas e imunogênicas na pele. Além disso, essas lesões apresentam-se de forma mais comum em animais de pelagem clara, com grande exposição solar e em área anatômicas hipopigmentadas. O prognóstico varia de acordo com a localização e o estágio clínico, sendo favorável o diagnóstico realizado precocemente, e o tratamento consiste na avaliação clínica seguida do protocolo adequado O presente relato de caso tem como objetivo principal reunir e discutir informações associadas sobre o carcinoma de células escamosas em caninos e felinos, abordando aspectos clínicos e patológicos, a fim de facilitar o raciocínio sobre o CCE, desde sua abordagem inicial, até seu diagnóstico final e estadiamento.(AU)

The life expectancy of companion animals has been increasing due to behavioral and care changes of the guardians. In analogy, with the increasingly advanced ages, the development of associated diseases is common, the tumor being the most common among them. However, the most common neoplasms in the small animal clinic are associated with the integumentary system. Squamous cell carcinoma (SCC), or squamous cell carcinoma, is a malignant, slow-growing, low-potential metastatic epithelial neoplasm. Its etiology is not yet precisely known and the most common exogenous cause described by the literature is exposure to ultraviolet light, generating consequent lesions on the genetic and immunogenic structures in the skin. In addition, these lesions are more common in light-haired animals, with high exposure to the sun, and in hypopigmented anatomical areas. The prognosis varies according to the location and clinical stage, being favorable to the early diagnosis, and the treatment consists in the clinical evaluation followed by the appropriate protocol. The present case report has as its main objective to gather and discuss associated information about squamous cell carcinoma in canines and cats, addressing clinical and pathological aspects, in order to facilitate the reasoning about the CCE, from its initial approach, to its final diagnosis and staging.(AU)

La esperanza de vida de los animales de compañía ha ido en aumento debido a los cambios de comportamiento y cuidado de los guardianes. Por analogía, con las edades cada vez más avanzadas, el desarrollo de enfermedades asociadas es común, siendo el tumor el más común entre ellos. Sin embargo, las neoplasias más comunes en la clínica de animales pequeños se asocian con el sistema tegumentario. El carcinoma epidermoide (CCE), o carcinoma epidermoide, es una neoplasia epitelial metastásica maligna de crecimiento lento y bajo potencial. Su etiología aún no se conoce con precisión y la causa exógena más común descrita por la literatura es la exposición a la luz ultravioleta, generando lesiones consecuentes en las estructuras genéticas e inmunogénicas de la piel. Además, estas lesiones son más comunes en animales de pelo claro, con alta exposición al sol, y en áreas anatómicas hipopigmentadas. El pronóstico varía según la localización y el estadio clínico, siendo favorable al diagnóstico precoz, y el tratamiento consiste en la evaluación clínica seguida del protocolo adecuado. El presente reporte de caso tiene como objetivo principal reunir y discutir información asociada sobre el carcinoma epidermoide en caninos y gatos, abordando aspectos clínicos y patológicos, con el fin de facilitar el razonamiento sobre el CCE, desde su abordaje inicial, hasta su diagnóstico final y estadificación.(AU)

A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa.

OBJECTIVE: Medical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa. METHODS: This was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities. FINDINGS: During the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8-13 year olds. Median age was 15 years (IQR: 12-23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8-13, 14-18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8-13 years (OR = 5.9; 95% CI = 4.8-7.1) and 14-18 years (OR = 1.9; 95% CI = 1.5-2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4-2.7). CONCLUSION: The high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries.

Adult prepuceplasty: comparison of outcomes of standard prepuceplasty and foreskin Z-plasty.

OBJECTIVE: To compare the clinical and patient-reported outcomes from standard prepuceplasty and foreskin Z-plasty. METHODS: Consecutive standard prepuceplasty (n = 22) and Z-plasty (n = 12) procedures performed from September 2005 to December 2010 were analyzed. The patient and operative data were collated, together with the results of a patient questionnaire inquiring about the postoperative complications, postoperative pain, remaining foreskin tightness in the flaccid or erect penis, cosmetic appearance after surgery, and the need for later circumcision. RESULTS: The median follow-up period was 26 months for standard prepuceplasty and 16 months for Z-plasty. Of the 22 patients in the standard prepuceplasty group and 12 patients in the Z-plasty group, 5 (22.7%) and 1 (9.1%) requested circumcision (P = .33), respectively. One man in each group underwent revision standard prepuceplasty. Patients undergoing the 2 procedures reported no significant differences for the questions relating to postoperative pain and foreskin tightness in the flaccid or erect penis. However, the cosmetic appearance after Z-plasty, assessed using a Likert scale question, were "good" or "very good" compared with "acceptable" for the standard group (P = .005). CONCLUSION: Prepuceplasty can be used successfully in well-selected patients. In the present series, 82% of men avoided circumcision. Z-plasty resulted in fewer circumcisions and a significantly better cosmetic appearance than standard prepuceplasty.

Skin phototype and local trauma in the onset of balanitis xerotica obliterans (BXO) in circumcised patients.

The association between balanitis xerotica obliterans (BXO) and skin disorders is long established, however, the role of skin phototype and local trauma in its onset has never been investigated in detail. Medical records of all Caucasian children circumcised over a 6-year period were reviewed. The excised skin underwent histological examination for BXO. Children with histological diagnosis of BXO were classified as group A, whereas children without histological diagnosis of BXO were classified as group B. The Fitzpatrick phototype (FT) was obtained in all children performing a personal or family interview with regards to their sunburn and suntan experience. According to their FT, both group A and B patients were divided into two subgroups: FT 1-2, with a higher tendency to sunburn due to their low skin melanin content; and FT 3-4 with a higher tendency to tan due to their higher skin melanin content. Maneuvers of mechanical reduction of the foreskin (MRF) performed at least 5-10 times per month during the year preceding circumcision was also considered. Statistical analysis was performed using univariate and multivariate analysis. A total of 297 patients met the inclusion criteria of our study: 78 patients were classified as group A and 219 as group B. The risk of developing BXO was significantly greater in FT 1-2 patients (n=76) (odd ratio=0.232, 95% confidence interval=0.124-0.435, p<0.0001). Furthermore, those undergoing MRF (n=131) had a significantly higher risk of developing BXO (odds ratio= 5.344, 95% confidence interval=2.860-9.987, p<0.0001). Although the foreskin is not directly exposed to sunlight, this study emphasizes the role of skin phototype on the onset of BXO in circumcised individuals. Moreover, the data produced suggest should the advantages of repeated MRF be weighed against the increased risk of developing BXO, which in turn may increase complication rate of circumcision surgery.

Pathologic and physiologic phimosis: approach to the phimotic foreskin.

OBJECTIVE: To review the differences between physiologic and pathologic phimosis, review proper foreskin care, and discuss when it is appropriate to seek consultation regarding a phimotic foreskin. SOURCES OF INFORMATION: This paper is based on selected findings from a MEDLINE search for literature on phimosis and circumcision referrals and on our experience at the Children's Hospital of Eastern Ontario Urology Clinic. MeSH headings used in our MEDLINE search included "phimosis," "referral and consultation," and "circumcision." Most of the available articles about phimosis and foreskin referrals were retrospective reviews and cohort studies (levels II and III evidence). MAIN MESSAGE: Phimosis is defined as the inability to retract the foreskin. Differentiating between physiologic and pathologic phimosis is important, as the former is managed conservatively and the latter requires surgical intervention. Great anxiety exists among patients and parents regarding non-retractile foreskins. Most phimosis referrals seen in pediatric urology clinics are normal physiologically phimotic foreskins. Referrals of patients with physiologic phimosis to urology clinics can create anxiety about the need for surgery among patients and parents, while unnecessarily expanding the waiting list for specialty assessment. Uncircumcised penises require no special care. With normal washing, using soap and water, and gentle retraction during urination and bathing, most foreskins will become retractile over time. CONCLUSION: Physiologic phimosis is often seen by family physicians. These patients and their parents require reassurance of normalcy and reinforcement of proper preputial hygiene. Consultation should be sought when evidence of pathologic phimosis is present, as this requires surgical management.

Phimosis and topical steroids: new clinical findings.

Phimosis has been defined as unretractable foreskin without adherences and/or a circular band of tight prepuce preventing full retraction. The aim of this study is to evaluate the efficacy (response rate) of topical steroids for the treatment of tight phimosis at different age stages. After using the same medication with different dosage schemes, a retrospective analysis was carried out to assess the efficacy of topical steroids in the treatment of tight phimosis. Patients were divided into three groups: group A (betamethasone scheme A), group B (betamethasone scheme B) and group C (control group). Remission of phimosis, with a complete exposure and without a narrowing behind the glans, was considered a complete response to treatment. The outcomes were then related to dosage scheme and patient's age. The dosage for group A was more effective than the dosage for groups B and C (control group). Phimosis resolved in 90% (group A), 72% (group B) and 56% (group C) of cases. A successful treatment was closely related to the age of patients at the beginning of steroid application. The results showed that treatment with topical steroids, which in general gives good results, proved to be much more successful in patients aged between 4 and 8 years, suggesting the efficacy of an early beginning of the treatment.