PurposeTo investigate and compare the trends in incidence and mortality of penile cancer between Australia, England and Wales, and the US, and provide hypotheses for these trends.MethodsCancer registry data from 1982 to 2005 inclusive were obtained from Australia, England and Wales, and the United States. From these data, age-specific, -standardised and mortality:incidence ratios were calculated, and compared.ResultsThe overall incidence of penile cancer in England and Wales (1.44 per 100,000 man-years) was higher than in Australia (0.80 per 100,000), and the US (0.66 per 100,000). Incidence of penile cancer in all three countries has remained relatively stable over time. Similarly, although the mortality rates were also higher in England and Wales (0.37 per 100,000 man-years) compared to Australia (0.18 per 100,000) and the US (0.15 per 100,000), the mortality/incidence ratios were similar for all three countries.ConclusionsPenile cancer incidence is low, affecting mainly older men. Rates differ between the three countries, being twice as common in England and Wales as in the other studied regions. Circumcision rates have a potential influence on these rates but are not the sole explanation for the variation.

We describe a patient with a 3-year history of recurrent deep vein thromboses (DVT) of the lower limbs, who developed adrenal insufficiency following withdrawal of warfarin therapy. Multiple splinter haemorrhages of the nail beds were evident, simultaneous with the development of adrenal infarction in the absence of infective endocarditis. CT scans of the adrenal glands were consistent with bilateral adrenal infarctions. The patient had persistently high titres of IgG anticardiolipin antibodies (aCL) over the previous 4 years in the absence of antinuclear antibodies (ANA), antibodies to double stranded deoxyribonucleic acid (dsDNA) or extractable nuclear antigens (ENA). Thrombocytopenia and an intermittently positive Coombs' test had been noted. Previous episodes of DVT were associated with inadequate warfarin control and a period of warfarin resistance. He conforms to a diagnosis of a 'primary' antiphospholipid syndrome.

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We present a 21-year-old HIV-negative Somalian male who was diagnosed with an immunohistochemically proven human herpes virus 8 (HHV8)-positive primary penile Karposi's Sarcoma (KS). He was treated with local surgery and remained in complete clinical remission for 18 months. This is the first case of a heterosexual teenage and young adult (TYA) patient diagnosed with a primary penile KS without a history of sexual intercourse. This case provides clinical evidence that KS may be transmitted through routes other than sexual transmission. KeywordsPenile Karposi's Sarcoma, HIV, HHV-8, local surgery, TYA cancers Compliance with Ethics Guidelines: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in this case study. We present a 21-year-old Somalian male, who grew up in the UK, who presented initially to the urology department at a London university hospital with a 4-month history of two penile lesions. These lesions were located in the glans penis and had gradually enlarged, with concomitant bleeding and purulent discharge. In addition, the patient mentioned a 1-year history of intermittent night sweats. His past medical history included a circumcision at birth and hay fever. He denied any previous sexual activity. The family history was negative in terms of other malignancies. On examination there was a 1 cm diameter polypoid nodule on the right hand side of his urethral meatus and a 5 mm subcutaneous nodule on the left hand side of his glans penis. These lesions were non-tender and there was no palpable lymphadenopathy. KS is a neoplastic vascular lesion first described in 1872 by Moritz Kaposi. Primary Penile Kaposi Sarcoma in an HIV-negative 21-year-old MaleLesions can be subdivided into four distinct forms: classic, endemic, iatrogenic and AIDS-associated.