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CASE REPORT
Year : 2003  |  Volume : 19  |  Issue : 2  |  Page : 164-165
 

Second primary tumour following partial penectomy


1 Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
A K Mandal
Department of Urology, PGIMER, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Penectomy, metastases.


How to cite this article:
Niranjan J, Mandal A K, Sharma PB, Vaiphei K. Second primary tumour following partial penectomy. Indian J Urol 2003;19:164-5

How to cite this URL:
Niranjan J, Mandal A K, Sharma PB, Vaiphei K. Second primary tumour following partial penectomy. Indian J Urol [serial online] 2003 [cited 2019 Jul 16];19:164-5. Available from: http://www.indianjurol.com/text.asp?2003/19/2/164/37154



   Case Report Top


A 46-year-old man with squamous cell carcinoma of glans penis underwent partial penectomy in May 1992. He had an ulceroproliferative growth of about 3 cms in size confined to glans penis. There were multiple firm mobile inguinal lymph nodes of about 1 cm in diameter bilaterally. Fine needle aspiration cytology (FNAC) from these lymph nodes showed reactive hyperplasia. Histopa­thology of partial penectomy specimen showed keratiniz­ing squamous cell carcinoma [Figure - 1] and resection margins were free of tumour. He remained disease free till July 2000. In June 2001, he presented with a cauliflower growth over the penile stump measuring about 3x3 cm with indurated distal penile stump. Proximal part of penis was normal on palpation [Figure - 2]. There were multiple, mobile, firm about 1 cm inguinal lymph nodes, FNAC of which did not reveal any evidence of malignancy. Biopsy from the lesion was suggestive of malignancy.

Patient underwent total penectomy with perineal ure­throstomy. Histopathology of the specimen showed a ver­rucous carcinoma [Figure - 3]. Resection margins were free of tumor. At 9 months' follow-up he is well and disease-free.


   Comments Top


Carcinoma of the penis accounts for 0.4 to 0.6 percent of all malignancies among males in United States and Eu­rope.

The gold standard of therapy for penile carcinoma is partial or total penectomy. The low incidence of distant metastasis, the significant morbidity that can result from untreated local disease and successful long-term pallia­tion and survival even with advanced disease support ag­gressive local therapy. [1] Generally local recurrence rate after amputation ranges from 0-19%, small tumours having bet­ter outcome. Most local recurrences occur within 2 years of surgery. Late recurrences in the penile stump several years after successful treatment of primary up to 10 years has been reported . [2] It is not always possible to distinguish a local recurrence from a second primary tumour.

Verrucous carcinoma is a rare slow growing tumour, grossly difficult to differentiate from squamous cell carci­noma. It is considered as a less aggressive variant of sq­uamous cell carcinoma. It accounts for only about 5% of all penile cancers. Because of its papillary appearance, a benign-looking cytology and indolent behaviour, it has been considered as a benign condyloma accuminatum. It is important to distinguish these tumours from a benign growth due to their ability to invade and destroy adjacent tissue. [3]

The rarity of lymph node metastasis from a verrucous carcinoma negates the need for either prophylactic groin dissection or a routine sentinel node biopsy. But any sus­picious node warrants careful clinical assessment and sur­gical intervention. [4]

Verrucous carcinoma arising in the stump following partial amputation of the penis for a squamous cell carci­noma is extremely rare. Our case had the second tumour 9 years after partial penectomy.

 
   References Top

1.Donald F Lynch Jr, Paul F Schellhammer. Tumours of the penis. In : Walsh PC. Retik AB. Vaughan DE. Wein AJ (eds.). Campbell's Urology. 7th edition, WB Saunder's 1998; 2453-85.  Back to cited text no. 1    
2.Horenblas S. Van Tinteren H. Delemarre JKM. Boon TA. Moonen LMF. Lustig V. Squamous cell carcinoma of the penis. J Urol 1992; 147: 1533-1538.  Back to cited text no. 2    
3.Mc Kee PH, Owe K, Haigh RJ. Penile verrucous carcinoma. Histo­path 1983: 7: 897-906.  Back to cited text no. 3    
4.Johnson DE. Lo RK. Srigley J. Ayala AG. Verrucous carcinoma of penis. J Urol 1985: 133: 216-218.  Back to cited text no. 4    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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