Indian Journal of Urology Users online:2271  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents 
CASE REPORT
Year : 2018  |  Volume : 34  |  Issue : 2  |  Page : 155-157
 

A neglected reddish penile patch: A wolf in sheep's clothing


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

Date of Web Publication2-Apr-2018

Correspondence Address:
Sudheer K Devana
Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_251_17

Rights and Permissions

 
   Abstract 

Microinvasive squamous cell carcinoma (SCC) is a known premalignant lesion of carcinoma cervix. It is also reported from other sites such as the oral cavity, larynx, and vulva. Microinvasive SCC is very rarely reported from the penis. We report the occurrence of microinvasive SCC in a long-standing erythematous lesion of glans penis in a patient, with extensive metastasis. We emphasize the need for awareness among patients and urologists about the premalignant lesions of penis and prompt treatment of such lesions to prevent possible spread of the disease.



How to cite this article:
Murugavaithianathan P, Devana SK, Vaiphei K, Mavuduru R, Bora GS. A neglected reddish penile patch: A wolf in sheep's clothing. Indian J Urol 2018;34:155-7

How to cite this URL:
Murugavaithianathan P, Devana SK, Vaiphei K, Mavuduru R, Bora GS. A neglected reddish penile patch: A wolf in sheep's clothing. Indian J Urol [serial online] 2018 [cited 2019 Jun 20];34:155-7. Available from: http://www.indianjurol.com/text.asp?2018/34/2/155/229036



   Introduction Top


Microinvasive squamous cell carcinoma (SCC) is reported commonly as a premalignant lesion of cervix. However, it is reported very rarely from the penis. We report a patient with neglected erythematous penile patch who was diagnosed to have microinvasive SCC with concurrent extensive metastasis that has not been previously reported.


   Case Report Top


A 45-year-old male presented with the complaints of a small swelling on his right groin which had rapidly increased in size over the preceding 3 months. He had been prescribed some medication by a local physician after which he developed painful bullous lesions over upper part of his right thigh and left inguinal region. He came to our institute and was initially evaluated by dermatologists. A thorough examination revealed bilateral, hard, multiple, mobile, inguinal lymph nodes, and multiple small nodular lesions over the left half of glans penis. On further enquiry, the patient revealed that he had an erythematous patch over glans without the nodular lesions for the past 4 years. A skin biopsy from the groin was suggestive of bullous pemphigoid, and fine needle aspiration cytology of bilateral inguinal lymph nodes revealed metastatic SCC. He was subsequently referred to us for the suspicious lesion on the glans penis [Figure 1]. A wedge biopsy of the largest nodule on glans was performed which showed features of a microinvasive SCC where there was invasion of the superficial dermis and vascular tumor embolization [Figure 2]a and [Figure 2]b. There was dominant mononuclear inflammatory cell infiltration along the deeper aspect of the tumor. The tumor cells in the superficial portion were dis-cohesive resulting in cleft formation. Following the biopsy report, contrast-enhanced computed tomography scan of chest and abdomen revealed multiple enlarged necrotic lymph nodes in bilateral external and internal iliac, obturator, and inguinal locations, the largest being in the right hemipelvis measuring 2.5 cm. Two ill-defined subpleural nodules were seen in the anterior basal segment of the right lower lobe and another in lateral basal segment of the left lower lobe. Fluorodeoxyglucose (FDG) positron emission tomography scan showed FDG avid left supraclavicular, abdominal, retroperitoneal, pelvic, inguinal nodes, and also multiple lytic skeletal lesions [Figure 3]a,[Figure 3]b,[Figure 3]c,[Figure 3]d. A final diagnosis of microinvasive SCC penis with extensive lymph nodal and skeletal metastasis was made. He was subsequently planned for TIP (paclitaxel, ifosphamide, cisplatin)-based chemotherapy in view of extensive metastasis. He received 6 cycles of chemotherapy and is presently undergoing radiotherapy.
Figure 1: Erythematous lesion over glans penis with multiple nodules

Click here to view
Figure 2: (a) Low-power photomicrograph of the biopsy showing a thickened mitotically active epidermis exhibiting anisonucleosis, dyskeratosis, dis-cohesive cells with cleft formation (solid arrow), and superficial dermal infiltration (black arrows, hematoxylin and eosin, ×150). (b) Medium-power photomicrograph showing the tumor embolus (solid arrow) and infiltrating tumor front (white arrow; H and E, ×300)

Click here to view
Figure 3: (a and b) Positron emission tomography scan showing lytic skeletal lesion with intense fluorodeoxyglucose uptake in the left pelvic bone (maximum standardized uptake value - 23.8, solid arrow). (c and d) Fluorodeoxyglucose positron emission tomography scan showing necrotic right external iliac lymph nodes (4.5 cm × 2.9 cm, maximum standardized uptake value - 12.9; arrow)

Click here to view



   Discussion Top


Carcinoma in situ of penis is called erythroplasia of Queyrat if it involves glans/prepuce and as Bowen's disease if it involves the penile shaft/rest of the genitalia/perineal region. Erythroplasia of Queyrat presents as red, velvety, well-marginated lesion over glans. Our patient had an erythematous lesion over the glans for approximately 4 years which was ignored and it progressed to microinvasive SCC with extensive metastases.

Microinvasive SCC is a known disease of the cervix. It is considered a premalignant lesion for SCC of the cervix. Microinvasive variant of SCC has also been reported to arise from the oral cavity, larynx, and vulva.[1] It is biologically capable of gaining access to lymphatic or vascular channels in the lamina propria and may result in metastatic disease.[2] Hence, early excision in the form of conization in lesions of cervix is recommended.[3]

There is only one reported case in the literature documenting localized microinvasive SCC arising in the penis in a premalignant lichen sclerosis lesion which was cured with CO2 laser ablation.[4] However, our patient had microinvasive SCC of glans arising in an erythematous red-colored patch over the glans with lymphatic and hematogenous metastasis. In spite of the penile lesion being very small, he had extensive metastasis suggesting the aggressiveness of this variant. It can be postulated that the location of the lesion on the glans may be a poor prognostic factor since the lesion has easy access to the vascular sinuses of glans leading to early hematogenous spread unlike conventional SCC of penis which predominantly has lymphatic spread.


   Conclusion Top


Our case highlights the need for creating awareness among patients and urologists about premalignant lesions of penis. Any suspicious lesion over the glans penis should not be ignored and needs proper evaluation and treatment to prevent progression of the disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Barnes L, editor. Diseases of the larynx, hypopharynx and esophagus. In: Surgical Pathology of the Head and Neck. 2nd ed. Vol. I. New York: Dekker; 2001. p. 127-237.  Back to cited text no. 1
    
2.
Wenig BM. Squamous cell carcinoma of the upper aerodigestive tract: Precursors and problematic variants. Mod Pathol 2002;15:229-54.  Back to cited text no. 2
[PUBMED]    
3.
He Y, Wu YM, Zhao Q, Wang T, Wang Y, Kong WM, et al. Clinical value of cold knife conization as conservative management in patients with microinvasive cervical squamous cell cancer (stage IA1). Int J Gynecol Cancer 2014;24:1306-11.  Back to cited text no. 3
[PUBMED]    
4.
Nasca MR, Panetta C, Micali G, Innocenzi D. Microinvasive squamous cell carcinoma arising on lichen sclerosus of the penis. J Eur Acad Dermatol Venereol 2003;17:337-9.  Back to cited text no. 4
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 

    

 
   Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,018 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed1182    
    Printed24    
    Emailed0    
    PDF Downloaded64    
    Comments [Add]    

Recommend this journal

HEALTHWARE INDIA