|Year : 2003 | Volume
| Issue : 2 | Page : 164-165
Second primary tumour following partial penectomy
J Niranjan1, AK Mandal1, Pooja Bakshi Sharma2, Kim Vaiphei2
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
A K Mandal
Department of Urology, PGIMER, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
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
| Case Report|| |
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|| |
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.  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 .  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. 
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. 
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|| |
|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. |
|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. |
|3.||Mc Kee PH, Owe K, Haigh RJ. Penile verrucous carcinoma. Histopath 1983: 7: 897-906. |
|4.||Johnson DE. Lo RK. Srigley J. Ayala AG. Verrucous carcinoma of penis. J Urol 1985: 133: 216-218. |
[Figure - 1], [Figure - 2], [Figure - 3]