A 59-year-old smoker presented with a progressive bulging lesion on his
penis, causing difficulty in urination, differential diagnosis?
A 59-year-old male presented with complaints of a bulging
lesion on his penile glans for the past 3 months. The patient had a 20-years
history of smoking. The patient didn’t have multiple sexual partners, nor was
there a history of any sexually transmitted infections, including HPV, HIV. The
patient was circumcised. He reported that the lesion had increased in size
since the time he had first noticed the lesion. The patient belonged to a lower
socioeconomic status; therefore, he consulted when the lesion grew enough to
cause micturition.
On examination, the glans of the penis was fully occupied by
the lesion and its invasion was detected in the urethral meatus.
A sample of the lesion was taken for histopathological
evaluation, and the urethral meatus was opened.
The histopathological evaluation confirmed the diagnosis of squamous cell carcinoma, the most common cancer of the penis. The most common site of penile SCC is glans, as seen in this patient.
A computed tomography scan and positron emission tomography (PET) scan were performed for staging. The inguinal lymph nodes showed metastasis. The cancer was of stage T3cN1M0.
Penile SCC most commonly metastasizes to the inguinal lymph nodes initially, then the lymphatic spread may involve the pelvic lymph nodes, and then periaortic nodes. Distant metastases are rare (1-10%) and seen later in the course of the disease.
The patient was counseled for surgical management, i.e.,
radical surgery, which would mean a total penectomy with bilateral pelvic lymph
node dissection. The patient refused; therefore, an alternate management plan
was offered to the patient.
Considering the metastasis and the deep localization of the
tumor, topical treatment was not recommended. Instead, he was offered chemotherapy.
Urethral meatus was surgically opened, and he underwent
palliative chemotherapy. The treatment of the patient continues. العب واربح المال الحقيقي
Treatment options:
For localized disease, glans-sparing partial penectomy, brachytherapy, and reconstructive surgery are the options. For metastatic disease in lymph nodes, a curative neoadjuvant multidisciplinary approach is feasible, but, overall, the metastatic disease has poor outcomes. Unfortunately, fewer clinical trials are available owing to the rarity of the disease. 888
However, prevention and early detection may improve clinical outcomes. كازينو كبار الشخصيات For example, neonatal circumcision, smoking cessation, and HPV vaccination may substantially reduce the incidence of penile cancer.
More researches and studies are required to answer the
unanswered questions regarding the management of penile cancer.
Source: Solakhan M, Bulut E (2018) Penile Cancer: Case Report. Int Arch Urol Complic 4:045. doi.org/10.23937/2469-5742/1510045
