Penile Malignancies Research Articles

Construction and validation of a prediction model for inguinal lymph node metastasis of penile malignancy.

Penile squamous cell carcinoma is a relatively rare malignancy among male malignancies, there are more than 30,000 new cases and more than 10,000 deaths of penile cancer annually. In patients with penile malignancy, inguinal lymph node metastasis (ILNM) significantly reduces patient survival. Thus, we identified the risk factors for ILNM in penile malignancies, aiming to develop a precise prediction model. We retrospectively analyzed 112 male patients with penile cancer. All subjects underwent penile surgery and inguinal lymphadenectomy at the same time, and postoperative pathology confirmed ILNM. Fisher's exact test, t-test, and Wilcoxon rank sum test were used to assess differences in demographic information and clinical features between the two groups, followed by logical least absolute shrinkage and selection operator (LASSO) regression analysis to determine risk factors of ILNM. The prediction model was constructed using nomogram. LASSO regression revealed that age [β=-0.005, odds ratio (OR) =0.995], smoking history (β=-0.006, OR =0.994) and interleukin 2 (IL-2) level (β=-0.0112, OR =0.989) were protective against ILNM. However, lymph node diameter (β=0.3117, OR =1.366), T-stage (β=0.1254, OR =1.134), fibrinogen (β=0.0377, OR =1.038), IL-4 level (β=0.004, OR =1.001), and neutrophil-to-lymphocyte ratio (β=0.0355, OR =1.034) were risk factors for developing ILNM. When assessing the risk of metastasis, it is crucial to balance these factors. The aforementioned characteristics were utilized to establish the predictive model, which demonstrated a good predictive ability with an area under the curve (AUC) value of 0.81. Moreover, internal leave-one-way cross-validation was used to construct a nomogram showing consistency, with an AUC of 0.75. The diagnosis of ILNM in penile malignant tumors can be predicted through clinicopathological features, biochemical tests, and prediction models based on tumor markers.

Oncologic control and predictors of urologic reconstruction after Mohs micrographic surgery for low-risk penile malignancy.

Mohs micrographic surgery (MMS) is a low-risk penile cancer management option. However, contemporary patients' short-term oncologic control and preoperative characteristics predicting reconstruction needs are undefined. This study assesses MMS's oncologic efficacy for low-risk penile cancer and identifies baseline predictors of post-resection reconstruction referral. We retrospectively reviewed 73 adult males with 78 penile cutaneous malignancies treated with MMS from 2005 to 2019. Patients underwent MMS with or without surgical reconstruction. Demographic information, MMS operative details, lesion pathology, and short-term outcomes were recorded. Descriptive statistics for all variables were calculated, and logistic regression identified predictive factors for urologic referral for complex reconstruction. Seventy-three men with 78 lesions, all staged ≤ cT1a prior to MMS, were identified. Twenty-one men were found to have invasive SCC. Median follow-up was 2.0years (IQR 0.8-5.2years). MMS was able to clear the disease in 90.4% of cases. One patient had disease related death following progression. Dermatology closed primarily in 68% of patients. Twenty percent of patients had a complication, most commonly poor wound healing. On univariate and multivariate linear regression analysis, lesion size > 3cm and involvement of the glans independently predicted the need for referral to a reconstructive surgeon. MMS for penile cancer appears to provide sound oncologic control in the properly selected patient. Involvement of a reconstructive surgeon may be needed for glandular and large lesions, necessitating early referral to a comprehensive multidisciplinary care team.

Localized Penile Cancer Glans (Squamous Cell Carcinoma of Glans Penis Case Report)

Background: Penile cancer is uncommon. Penile squamous cell carcinoma is the most common penile malignancy, behaves similarly to squamous cell carcinoma in other parts of the skin. Objective: The objective of the study was to study ulcerative eroded skin disease in the glans penis. Patients and Methods: Forty years old farmer Yemeni male patient presented with erosive ulcerative painful skin lesion in all his glans penis. The duration was one year. Skin biopsy was done. Results: The clinical picture and the investigations showed the patient had localized penile cancer or squamous cell carcinomas. No specific laboratory studies or tumor markers are diagnostic for penile cancer. The patient was treated by partial panectomy. There were no regional lymph node enlargements. Conclusion: localized penile cancer was rare in republic of Yemen. This case was first reported.

(239) Postoperative Outcomes and Risk Factors in Patients Receiving Partial vs Total Penectomy for Penile Malignancy

Abstract Introduction Partial penectomies (PP) and total penectomies (TP) are both performed for penile cancer in the United States. Compared to TP, PP is performed more frequently to preserve functional urinary outcomes. To date TP and PP outcomes have not been compared, in this study we compared clinical characteristics and post-operative outcomes between TP and PP conducted between 2006–2016. Objective We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010–2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Methods We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010–2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Results Partial penectomy patients were less likely to be transferred patients (7.3% vs 20.9%, p=0.002), less likely to be suffering from diabetes (25.9% vs 40.3%, p=0.026), and were more likely to have preoperative laboratory values within normal limits. TP was associated with increased preoperative white blood cell count x109, preoperative white blood cell count > 7.5x109 (p<0.001), preoperative hematocrit (p<0.001). PP patients were, in contrast, shown to have higher pre-operative creatinine levels (p=.037) and lower platelet levels than TP patients (p=.045). PP patients had shorter operation times (78.8 vs 145.5 min, p<0.001). PP patients also had decreased levels of inpatient stay length (1.67 vs 4.31, p<0.001), any 30-day post-surgery complication (7% vs 31%, p<0.001), deep incisional surgical site infection (0.5% vs 6% p=0.017), wound disruption (0.5% vs 6.0%p=0.017), intraoperative or postoperative transfusion (1.6% vs 7.5%, p=0.029), and sepsis (0.5% vs 7.5%, p=0.005), when compared to patients who underwent TP. TP patients displayed a significantly greater number of concurrent surgical procedures (p<0.001), when compared to PP patients. There was no information on urinary, sexual, and erectile outcomes in the database. Conclusions PP is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures. Total penectomy is associated with a greater proportion of patients suffering from comorbid conditions, suggesting that TP patients are at higher risk for post-surgical complications and longer hospital stays. There is a gap in reported data pertaining to post-operative sexual function and erectile outcomes for PP at a national level. Disclosure No.

Preferring Lateral Video Endoscopic Inguinal Lymph Node Dissection Over Classic Video Endoscopic Inguinal Lymph Node Dissection in Squamous Cell Carcinoma of Penis: Lessons Learnt from Twenty-One Patients at a Single Center.

Inguinal lymphadenectomy is essential for staging and disease control. Minimally invasive techniques are recently replacing open techniques to reduce complications. We present our experience and lessons learnt from 21 patients who underwent lateral video endoscopic inguinal lymphadenectomy (L-VEIL) for penile malignancy. All patients above 18 years of age with histopathology-confirmed squamous cell carcinoma penis with stages ≥ T1b and T1a with persistent lymphadenopathy who underwent L-VEIL over a period of 2 years (2020-2022) were included. The data were analyzed on the basis of intraoperative and postoperative complications, lymph node yield, hospital stay, and histopathology report. Forty-one lower limbs of 21 patients underwent L-VEIL during the abovementioned period. Median age was 52 years. Mean operative time (on 1 side) was 80 minutes. Median lymph node yield per side was 7.2. Intraoperatively, 1 patient had a vascular injury at the saphenofemoral junction, requiring conversion to open. Postoperative complications were superficial surgical site infection (n=4), lymphedema (n=1), and lymphocoele (n=3), one of which was drained by pigtail catheter. One patient required exploration on the second postoperative day because of vascular injury. Average duration of hospital stay was 3 days. The median time of drain removal was 13 days. Histopathology suggested seminoma in 1 patient and mature teratoma in 1 patient; the rest of the patients' reports were negative for malignancy. The L-VEIL is safe and feasible, and there is a reduction (~30%) in complications; oncological outcomes are also not affected. It has better ergonomics, resulting in ease and comfort for surgeons when compared with classical VEIL.

A population-based analysis of the epidemiology of penile cancer in Newfoundland and Labrador.

Penile cancers are a rare subset of carcinomas accounting for <1% of all diagnosed malignancies. There have been recent reports of increasing incidence globally; however, there is limited Canadian literature pertaining to these neoplasms. The province of Newfoundland and Labrador (NL ) represents an important entity to study, possessing the highest national incidence of cancer, along with a plethora of relevant risk factors for penile cancer. A retrospective chart analysis of all patients with a diagnosis of penile cancer in NL between the years of 2006 and 2018 was conducted. The main outcomes included overall incidence, proportion with metastatic disease, tumor demographics, and overall survival (OS ). Incidence among the male population was calculated using Statistics Canada annual reports. An identified 81 cases satisfied the inclusion criteria, with a median age at diagnosis of 65 (interquartile range 20) years. Crude incidence of penile cancer ranged from 1.20-4.27/100 000 males in 2007 and 2010, respectively, while the average age-standardized incidence was 2.34/100 000 males across the study timeframe. Metastatic disease was noted in 17 (21.0%) patients, with a five-year OS of 74% for all penile malignancies, decreasing to 66% in those with invasive squamous cell carcinoma. The incidence of penile cancer in our population was higher than reported Western jurisdictions and showed frequent rates of metastatic spread. These observations are likely multifactorial, resultant of chronic inflammation paired with high rates of modifiable risk factors and diagnostic delays. An evident need for greater examination and improved reporting of these malignancies in the province was identified.

Malignant Neoplasms of the Penis with Radiologic and Pathologic Correlation.

Penile malignancy is the third most common male-specific genitourinary malignancy, with squamous cell carcinoma representing the most common histologic type. Squamous cell carcinoma is an epithelial malignancy, frequently developing from the mucosal surfaces of the foreskin, glans, and coronal sulcus and manifesting as a distal infiltrative or ulcerated mass. This typically occurs in men from the 6th to 8th decades of life, and risk factors include human papillomavirus, phimosis, presence of foreskin and poor hygiene, chronic inflammatory conditions such as lichen sclerosus, trauma, and smoking. Primary urethral malignancies including urothelial carcinoma and adenocarcinoma can occur but may lack this distal predilection. Sarcoma, melanoma, leukemia or lymphoma, and metastatic disease are less common sources of penile malignancy. Because of the sensitive nature of penile malignancies, there may be delays in seeking care and in subsequent diagnosis. Recently, the staging guidelines for penile cancer have been updated concurrently with a shift toward more penile-preserving therapies, which have led to a larger role of imaging in diagnosis, staging, and treatment planning for penile malignancies. A variety of imaging modalities may play a role in the identification and staging of penile malignancy, including an increased use of MRI for local staging of tumors, CT and PET/CT for identification of nodal and distant disease, and US for image-guided biopsy. The authors discuss an imaging approach to a spectrum of penile malignancies, with an emphasis on radiologic and pathologic correlation and how knowledge of normal tissue types and anatomic structures can aid in the diagnosis and staging of these tumors. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Influence of Race/Ethnicity and Household Median Income on Penile Cancer Mortality.

Penile cancer, while relatively rare in developed nations, presents substantial disparities in outcomes among different demographic groups. Previous research has shown race/ethnicity and socioeconomic status, often proxied by household median income, to be critical determinants of health outcomes across various diseases. This study examines the association of race/ethnicity and household median income with survival among penile cancer patients in the United States. We utilized the Surveillance, Epidemiology, and End Results (SEER) Registry to identify patients with a primary diagnosis of penile malignancies from 2000 to 2019. Our primary outcome of interest was the hazard of death following a diagnosis of penile cancer. We utilized the Cox regression model to explore the association between race/ethnicity and median household income and how this influences survival among these patients. We adjusted for patients' characteristics, disease stage at presentation, and treatment modalities. Of the 6,520 penile cancer patients identified, 5,242 (80.4%) had primary malignancies. The distribution of patients was as follows: 64.1% non-Hispanic Whites, 8.9% non-Hispanic Blacks, 20.8% Hispanics, and 6.2% from other racial/ethnic groups. The median diagnosis age was 66 years (interquartile range: 56-74). Survival rates at 5, 10, and 15 years showed racial disparities: 76.4%, 72.5%, and 69.7% for non-Hispanic Whites; 70.6%, 64.1%, and 61.1% for non-Hispanic Blacks; and 70.5%, 67.4%, and 65.6% for Hispanics. Multivariate Cox regression revealed worst survival for Black (HR=1.40; 95% CI=1.08-1.81, p=0.01) and Hispanic patients (HR=1.24; 95% CI=1.01-1.52, p=0.04). No association was found between median household income and survival. Interaction analysis indicated that the poorest Black men had worse outcomes than the poorest Whites did (HR=2.08; 95% CI=1.27-3.41, p=0.003). Survival rates for non-Hispanic Black and Hispanic patients are significantly lower than those for non-Hispanic Whites. Furthermore, survival is worse for low-income Black patients than their White counterparts in the same income bracket.

Bilateral Lateral Video Endoscopic Inguinal Lymphadenectomy in a Patient with Penile Malignancy

Bilateral Lateral Video Endoscopic Inguinal Lymphadenectomy in a Patient with Penile Malignancy

(388) Primary Penile Squamouse Cell Cancer Related Malignant Priapism In A Cystectomized Patient: A Case Report

Abstract Introduction Priapism is a prolonged (&amp;gt; 4 hours) and unintended erection without sexual stimulation or sexual desire. Priapism due to neoplasms is called malignant priapism, which is a rare condition that tends to occur with corporeal metastasis of other pelvic area malignancies. Priapism due to primary penile malignancies is extremely rare. Objective In this article, we present the case of a patient who underwent total penectomy and bilateral inguinal lymphadenectomy due to malignant priapism related to primary penile squamous cell cancer (SCC), and who also underwent radical cystectomy (RC) and total urethrectomy due to urothelial carcinoma 19 and 2 years prior, respectively. Methods We prepared the patient's information to present. Results An 82-year-old male patient presented to an outpatient clinic with unintended erection and penile pain of about 48 hours’ duration and was on follow-up in our clinic because of urothelial carcinoma history. The patient’s history indicated that he underwent RC and orthotopic neobladder due to muscle-invasive urothelial cancer (UC) in the bladder. No tumor was observed in the final cystectomy pathology; therefore, no adjuvant therapy was given. Seventeen years after the RC operation, he presented with hematuria and a papillary lesion detected in the mid-urethra during cystourethroscopy. Since the biopsy result from this region was compatible with high-grade UC, he underwent total urethrectomy, neobladder resection, and ileal conduit. Urethrectomy pathology results were reported as UC invading the subepithelial stroma and lymphovascular area. Adjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy was administered. On follow-up 2 years after the urethrectomy operation, he presented with prolonged priapism. On examination, a cold and erect penis with a 1 cm diameter ulcerated lesion on the glans penis were observed. Hypoxia and hypercarbia were observed on the cavernosal blood gas examination, which was compatible with ischemic priapism. The hemogram was normal. On the emergent penile duplex Doppler ultrasound showed decreased blood flow and a mass on the proximal part of the penis. Subsequently, pelvic magnetic resonance imaging was performed and a mass was observed that was fully destructive to the cavernosal bodies and had irregularly circumscribed borders (Figure 1). Afterward, the patient underwent a total penectomy and bilateral inguinal lymphadenectomy. The pathology report from the penectomy material suggested that the tumor was compatible with moderately differentiated SCC. No sign of metastasis was observed in the lymph nodes. Extensive sampling of the tumor did not reveal any UC in situ, nor SCC in situ. The penis shaft was fully infiltrated by the tumor, with SCC morphology starting from the surgical margin and damaging all the structures of the penile body (Figure 2). The patient was transferred to the oncology clinic for additional treatment planning. Conclusions Despite being the most common primary malignancy of the penis, to the best of our knowledge priapism due to primary penile SCC has been reported only once in the literature. Although metastatic disease is typically thought to be the cause, when a patient with a history of pelvic malignancy presents with malignant priapism, it should be kept in mind that primary malignancies of the penis may also cause this condition. Disclosure No

Primary Mucosal Melanoma of the Penile Urethra: A Case Report of an Extremely Rare Disease with a Unique Molecular Profile

Primary melanomas of the penis are extremely rare, accounting for 0.18% of all melanomas and less than 2% of all primary penile malignancies. We present a case of primary mucosal melanoma of the penile urethra in an 82-year-old man. His partial penectomy revealed sheets of spindling and epithelioid tumor cells with pale eosinophilic granular cytoplasm and indistinct cell borders, which invaded into the corpus spongiosum. Multi-foci of melanoma in situ were identified at the mucosal surface of the urethra meatus. Both positron emission tomography (PET) and magnetic resonance imaging (MRI) scan one month after the partial penectomy showed no evidence of metastatic disease. Five months later, an F18-fluorodeoxyglucose-PET/computed tomography scan demonstrated mildly increased F18-fluorodeoxyglucose avidity along the ventral penis and a marked avidity of a right inguinal lymph node. Subsequent excision confirmed an ulcerated melanoma and a metastatic melanoma in one inguinal lymph node, respectively. Molecular analysis revealed a unique BRAF c.1780G>A mutation, resulting in the D594N alteration, which is the first report in penile urethral melanoma. The patient was miserable from the first infusion of immunotherapy (Keytruda), and a PET scan showed that the tumor continued to grow, with extensive metastatic pulmonary disease leading to massive pleural effusion. Unfortunately, the patient died of disease 18 months after his first presentation.

A quality assurance review of penile cancer diagnostic delays and stage at presentation during the COVID-19 pandemic.

Penile carcinomas represent a rare malignancy associated with significant psychosocial impacts that deter afflicted individuals from seeking medical attention, thus, worsening prognosis. Following the dramatic shift in healthcare delivery to virtual platforms, it is suspected that prevalent psychosocial impacts have been further compounded by the COVID-19 pandemic, resulting in several late-stage presentations and engendering poorer outcomes. A retrospective chart review of surgically managed cases of penile cancer was conducted from January 2019 to June 2022 to identify patients that may have been unduly impacted by the COVID-19 pandemic. Included cases were analyzed in quantifying diagnostic and treatment delays, along with patient outcomes. Relevant epidemiological and pathological markers were also examined. Ten patients met the inclusion criteria. Average time delay from first complaint of a penile lesion to surgical management was 75 days, with 60% of patients experiencing a time delay of two months or more. The average delay from first complaint to diagnosis was 62 days in 2020 and 18 days in 2021. Advanced-stage disease was present in n=6 (60%) of individuals at presentation, while n=4 (40%) of patients perished during the study period. In cases of concern for penile malignancy, virtual care cannot replace the necessity of physical exams in preventing diagnostic and treatment delays. The present study further highlights the necessity of initial physical examination of penile abnormalities in preventing fatal outcomes for those afflicted. Such consideration warrants urgent examination of referred males with genital abnormalities to prevent further exacerbation of delays.

NEW PERSPECTIVES IN PENILE CANCER MANAGEMENT: HOW TO RETAIN FUNCTIONAL OUTCOMES

Penile cancer is a rare malignancy and a debilitating condition in most industrialized nations that often requires aggressive surgical or multimodal treatment with significant anatomical, functional, and psychosocial impact on patients’ quality of life. Total or partial penile amputation has been considered the standard of treatment according to locoregional clinical staging and risk stratification. However, these surgical options are associated with significant negative functional and psychological outcomes in terms of body image, self-esteem, and manhood resulting in loss of sexual function and inability of upright voiding. Recently, a critical paradigm shift has taken place in the clinical management of penile malignancy, that is, the implementation of alternative, less-invasive surgical strategies to deal with the primary malignancy. These sparing approaches of penile anatomy aim to retain penile and urinary functions and overall quality of life and thus interfering as little as possible with functional anatomy. This paradigm shift has been made possible by advances in surgical and technological developments which have resulted in organ-preserving strategies with gratifying psychosocial and functional outcomes simultaneously without compromising final cancer control. This spectrum of novel surgical strategies includes local excision, glansectomy, and partial penectomy followed by surgical reconstructive procedures consisting of primary closure of the resulting defect, closure with skin flaps or split- thickness skin grafts, penile lengthening and/or enhancing procedures, neophalloplasty, and, more recently, penile transplantation fostered by limitations of conventional reconstruction. This review discusses the complexities of surgical reconstruction following penile cancer treatment including the burgeoning field of penile transplantation.

Immune landscape and immunotherapy for penile cancer.

Penile cancer is a rare malignancy and usually refers to penile squamous cell carcinoma (PSCC), which accounts for more than 95% of all penile malignancies. Although organ-sparing surgery is an effective treatment for early-stage PSCC, surgical intervention alone is often not curative for advanced PSCC with metastases to the inguinal and/or pelvic lymph nodes; thus, systemic therapy is required (usually platinum-based chemotherapy and surgery combined). However, chemotherapy for PSCC has proven to be of limited efficacy and is often accompanied by high toxicity, and patients with advanced PSCC usually have poor prognosis. The limited treatment options and poor prognosis indicate the unmet need for advanced PSCC. Immune-based therapies have been approved for a variety of genitourinary and squamous cell carcinomas but are rarely reported in PSCC. To date, several studies have reported high expression of PDL1 in PSCC, supporting the potential application of immune checkpoint inhibitors in PSCC. In addition, human papillomavirus (HPV) infection is highly prevalent in PSCC and plays a key role in the carcinogenesis of HPV-positive PSCC, suggesting that therapeutic HPV vaccine may also be a potential treatment modality. Moreover, adoptive T cell therapy (ATC) has also shown efficacy in treating advanced penile cancer in some early clinical trials. The development of new therapeutics relies on understanding the underlying biological mechanisms and processes of tumor initiation, progression and metastasis. Therefore, based on the interest, we reviewed the tumor immune microenvironment and the emerging immunotherapy for penile cancer.

PD-L1 expression as predictor of immunotherapy eligibility in penile squamous cell carcinoma patients

Background: Penile cancer is a rare malignancy and potentially lethal disease with an incidence of 0,6-2,1 per 100.000. Squamous cell carcinoma (SqCC) is the most commonly found penile malignancy. PD-L1 is a tumor marker that co-stimulates the receptor PD-1 to suppress T-cell-mediated antitumor immunity. Methods: This study is a retrospective cohort study with a total sampling method. The slides taken from the biopsies of seventy-six male patients from Haji Adam Malik Hospital diagnosed with penile squamous cell carcinoma who have already undergone penile biopsy were re-examined for this study, and PD-L1 levels were measured accordingly. Statistical methods were used to assess the association between PD-L1 levels and with SqCC stage. Results: A total of 76 male patients are the subjects of this study. PD-L1 positivity is identified in 25 patients with +1 intensity in 10 patients (13,2%), +2 in 7 patients (9,2) and +3 intensity in 8 patients (10,5%). There are 36 patients (47,4%) diagnosed with stage T3 SqCC, 35 patients (46,1%) with stage N2 SqCC, and 10 patients (13,2%) with stage M1 SqCC. There is significant correlation between PD-L1 expression and metastasis (p=0,022). However, there is no significant correlation between PD-L1 expression and stage N tumor (p=0,167). Conclusions: PD-L1 highly expressed in advanced stage penile SqCC (32.9%), which is associated with the high-risk clinicopathologic features and poor clinical outcomes. These findings showed a potential usage of immunotherapy in advanced penile SqCC treatment.

Buried Penis Reconstruction in the Management of Localized Penile Cancer

The objective of this article is to describe surgical techniques for the management of localized penile cancer concurrent with adult acquired buried penis. Penile cancer, while rare, invariably impacts quality of life as the primary surgical management ranges from local excision to total penectomy. Penile cancer has recently been linked to adult acquired buried penis (AABP) with the hypothesis that chronic inflammation of the penis contributes to risk of penile malignancy. Buried penis reconstruction is now a well-described procedure involving escutcheonectomy and split thickness skin grafting which has been shown to improve quality of life in individuals with adult acquired buried penis. This report describes a patient with AABP requiring partial penectomy and inguinal node dissection who also underwent adult acquired buried penis repair during his procedure. A review of cases of buried penis cases was carried out and four other cases of penile cancer were identified who were managed with penile preserving procedures. This combination of surgical techniques strives to improve quality of life and facilitate cancer surveillance without compromising oncologic outcomes.

Malignant refractory priapism in case of urothelial cancer. Case report

Background. Malignant priapism is a painful lesion and persistent erection of the penis due to metastatic infiltration by a neoplasm. Secondary penile malignancy, as a consequence of metastatic disease, is a rare event. This indicates the progression of the main disease and an unfavorable outcome. Most cases of metastatic penile cancer are from the urogenital region: the prostate 33%, the urinary bladder 30%, the kidneys 8% and gastrointestinal tract 8%.&#x0D; Aim. To describe the case of malignant refractory priapism in bladder cancer patient.&#x0D; Materials and methods. A 49-year-old patient with pT4aN3M0 stage IIIB low-grade bladder cancer received the complex treatment and was under observation. Combined 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) using GE Healthcare Optima PET/CT 560 scanner was performed.&#x0D; Results. The patient with poorly differentiated bladder cancer underwent transurethral resection followed by 3 cycles of neoadjuvant polychemotherapy using Gemzar plus cisplatin scheme. The surgery concerning cystprostatectomy, pelvic lymphadenectomy, urethrectomy and the Bricker operation was performed after the development of relapse. The histological examination of the bladder tissue showed the presence of poorly differentiated urothelial cancer, invading all the layers with invasion into the seminal vesicles and prostate. The lesion in the root of the penis that were growing and associated with the tensive pain was diagnosed 7 months after the surgical treatment. The intensity of these manifestations was increasing within 2 weeks. During the physical examination the penis was enlarged, solid, rigid and painful on palpation. According to 18F-FDG PET/CT study the metastatic penile cancer complicated with priapism was diagnosed.&#x0D; Conclusion. Malignant priapism is a rare condition. The most often cause of malignant priapism development is urogenital tract tumors, in particular urothelial cancer. Refractory priapism is characterized by the increase of the local manifestations over time. 18F-FDG PET/CT is the method of choice for the diagnosis of malignant priapism.

Penile Mass: When Should Someone Worry and Seek Care?

We present a summary of penile cancer, its epidemiology, risk factors, and possible clinical presentations. We discuss a range of penile lesions that indicate an underlying penile malignancy. We also consider some nonmalignant penile lesions that may be confused with penile cancer. Sources of information include original research articles, review journal articles, and textbooks, which have been referenced in the article. Penile cancer is a rare disease, although geographical variations exist. Due to this rarity, many health care professionals may overlook a diagnosis of penile cancer. Malignant penile lesions may often be confused with benign lesions and vice versa. One needs to have a high index of suspicion to not overlook this important diagnosis. Referral to specialists should be made if malignancy is suspected, if the diagnosis is uncertain, or if the lesion persists despite reasonable treatment with steroids and other creams.

Clinico pathological characteristics and surgical treatment of carcinoma of the penis: a single surgeon experience

IntroductionCarcinoma of the penis is a disease of older men with an increased incidence in 6th decade of life. It is a rare malignancy in men with an annual incidence of one in 100,000 worldwide. Squamous cell carcinoma accounts for more than 95%of the penile malignancies. It has a significant geographical variation worldwide with a high prevalence in African and Asian countries. Usually these patients present late resulting in devastating complications and treatment challenges.sulting in devastating complications and treatment challenges.Methods and materials A retrospective analysis of data collected from 2009 to 2018 in four different provinces in Sri Lanka by the same author. Data were collected prospectively using a pro forma data sheet by the author. This study analyzed the clinico-pathological characteristics of consecutive patients with histopathologically proven penile cancer. Human papilloma virus (HPV) types, HPV-16 and HPV-18 were not assessed.ResultsTwenty eight patients with penile carcinoma were analyzed. The age ranged from 26 years to 86 with a mean age of 61.30.The commonest presentation was a non-healing ulcer on the glans (13/28). None of the patients had undergone circumcision and 10 patients had phimosis at presentation. Majority 67.85% of the patients presented within three months of recognizing the problem. Majority had involvement of the glans penis (24/28= 85.71%) at presentation. Palpable inguinal lymph nodes were found in 10 patients and eight of them had bilateral palpable inguinal lymphadenopathy. Surgical treatment varied from circumcision to total penectomy. Twenty four patients had conventional squamous cell carcinoma (SCC) while one patient had SCC in situ accounting for more than 85.71% of the tumour type to be squamous cell malignancy. Other types of malignancy detected were sarcomatoid SCC, Veruccous SCC and Basal cell carcinoma.ConclusionsThis study revealed that all patients were uncircumcised and 35.71% (10/28) of the subjects had phimosis at presentation which is considered as a risk factor for developing penile carcinoma. 35.71% of the patients were within the age group of 60 to 69 similar to international figures for age at peak incidence of the penile carcinoma. Commonest penile structures involved at presentation were foreskin and glans in keeping with international data. This observational study of penile carcinoma very clearly demonstrates and represents the similarity with the global pattern of this rare disease.

Total Penectomy and Perineal Urethrostomy Management of Penile Squamous Cell Carcinoma with Paraffinoma in Single Center Hospital: A Rare Case Report

BACKGROUND: Penile cancer is a rare condition, affecting less than 1% of the adult male population [1]. The risk of penile cancer increases significantly with age, poor hygiene, and the presence of the prepuce. The most common type encountered is squamous cell carcinoma (SCC). Clinically penile cancer appears as small lesions with induration and erythema or as large infiltrative ulcerative lesions. As the disease progresses, complaints such as itching, bleeding, discharge, foul odor, and pain occurred. CASE REPORT: A 63-year-old man with poor hygiene and has a history of diabetes mellitus had penis ulcers since 5 years ago. On physical examination, an ulcer with the size of 12 × 12 × 10 cm was found growing pus (-). Biopsy had done and confirmed SCC as a result. Pelvic multiple slice CT shows growth covering the entire shaft of the penis down to the base. The patient had a previous history of using silicone injection 35 years ago and causing Sclerofibromatosis. The patient was planned to undergo surgery with clinical diagnosis T4N0M0. Total penectomy was performed with an elliptical incision around the base with a margin of 2 cm. Sclerofibromatosis and the surrounding tissue were excised to the base of the penis followed by perineal urethrostomy. There was no problem postoperatively. The patient went home after staying in the hospital for 96 h. The surgical specimen revealed SCC with free of tumor excision margin. CONCLUSIONS: Injections with silicone to enlarge the penis cannot be justified. The process can trigger a chronic inflammatory reaction associated with penile malignancy. Total penectomy and wide excision with urethral perineostomy could be optimal initial treatment.