Foreskin examination (PG059)

Pathomorphological examination of the foreskin — is a histological analysis of tissues obtained after circumcision surgery. Although this operation is often performed for religious or hygienic reasons, in medical practice it is usually due to phimosis, inflammatory processes, or suspected neoplasm. Code PG059 involves studying the structure of the skin and mucous membrane to exclude pathological conditions.

Research objective: The main task is to verify the causes of pathological changes (e.g., scarring in phimosis) and exclude precancerous diseases or cancer in the early stages. Particular attention is paid to patients of the older age group, since chronic inflammation of the foreskin is a risk factor for the development of squamous cell carcinoma.

What does the pathologist evaluate:

• Presence of inflammation: diagnosis of balanoposthitis (specific or nonspecific).

• Sclerotic changes: detection of signs of scleroatrophic lichen (Balanitis xerotica obliterans) - a chronic condition that leads to severe scarring and narrowing of the foreskin.

• Dysplastic changes: looking for signs of intraepithelial neoplasia (PeIN), which is a precancerous condition.

• HPV-associated lesions: identification of morphological signs of human papillomavirus (koilocytosis, condylomas).

• Exclusion of malignancy: checking for the presence of foci of invasive squamous cell carcinoma.

Clinical significance: The conclusion with the code PG059 allows the urologist to determine further tactics. If lichen sclerosus is detected, the patient requires long-term observation, since this condition has an increased risk of malignancy in the future. If dysplasia or cancer is detected, the patient is referred for an in-depth oncological examination.

When is it prescribed:

• after circumcision surgery for cicatricial phimosis;

• if there are suspicious ulcers, spots or growths on the foreskin;

• recurrent balanoposthitis that does not respond to conservative treatment;

• with clinical signs of scleroatrophic lichen;

• removal of large warts along with the foreskin area.