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|Year : 2020 | Volume
| Issue : 1 | Page : 55-56
Penile carcinoma with isolated expansile skull metastasis
S Rajaian1, M Pragatheeswarane1, P Boopesh2, D Jain3
1 Department of Urology, MIOT International, Chennai, Tamil Nadu, India
2 Department of Neurosurgery, MIOT International, Chennai, Tamil Nadu, India
3 Department of Pathology, MIOT International, Chennai, Tamil Nadu, India
|Date of Submission||15-May-2019|
|Date of Acceptance||31-Aug-2019|
|Date of Web Publication||13-Jan-2020|
Department of Urology, MIOT International, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rajaian S, Pragatheeswarane M, Boopesh P, Jain D. Penile carcinoma with isolated expansile skull metastasis. J Postgrad Med 2020;66:55-6
In general, penile cancer metastasizes in a step-wise fashion affecting predominantly the locoregional lymph nodes before systemic spread. Lungs, liver, and pelvic bones are the predominant sites of systemic deposits. However, even early-stage penile carcinoma can exhibit systemic spread., We report a case of penile cancer in which cranial metastases have occurred even in the clinically organ-confined stage. A 46-year-old male presented with 6 × 4 cm ulceroproliferative growth of 3 months duration in distal penis. Edge wedge biopsy of the lesion was done which revealed moderately differentiated squamous cell carcinoma. He underwent MRI chest and abdomen with pelvis during evaluation. There was no evidence of metastasis [[Figure 1], Panel A]. He underwent partial penectomy with 1-cm margin [[Figure 1], Panel B]. Histopathology of the specimen revealed that the excised margins were free of tumor but with urethral and corpora cavernosa involvement (T3). He was lost to follow up and after 4 months presented to the neurosurgery department with expanding right scalp lesion. On examination, 10 × 10 cm right temporoparietal hard swelling was noted. Penile stump was healthy and he was voiding well. Contrast-enhanced computerized tomography (CECT) of the brain was done which revealed a right parietooccipital swelling with bony destruction and a midline shift to left hemicranium [[Figure 1], Panel C, D]. He underwent PET CT whole body for evaluation of systemic metastasis which did not show any evidence of metastasis of the other organs. He underwent right temporoparietal craniectomy [[Figure 2], Panel A] and whole brain irradiation comprising 30 Gy in 10 fractions under steroid cover. Postoperative CECT brain showed residual skull defect with regression of mass effect [[Figure 2], Panel B]. Histopathology revealed moderately differentiated squamous cell carcinoma with necrosis and keratin pearls invading into the bony tissue [[Figure 2], Panel C, D]. At 3-months follow up, he was voiding well with no evidence of new lesions.
|Figure 1: Panel A: Sagittal section of T2-weighted MRI of pelvis showing growth replacing the distal part of the shaft of penis (hollow arrow heads). Panel B: Postpartial penectomy status with normal neoexternal urethral meatus. Panel C: Skiagram of the contrast-enhanced CT of the brain showed loss of cranial continuity with large soft tissue swelling. Panel D: Axial section of contrast enhanced CT of the brain revealed heterogeneously enhancing lesion on the right parietooccipital region (black and white hollow arrows) with midline shift (solid black arrow)|
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|Figure 2: Panel A: Excised specimen of tumor along with infiltrated cranial bones. Panel B: Axial section of the contrast-enhanced CT of the brain showing reconstructed cranium (hollow white arrows) and regression of mass effect. Panel C: Histopathological examination slide (H and E, 40x) showing infiltration of nests of moderately differentiated squamous cell carcinoma with necrosis and keratin pearls (Hollow black arrows) into bony tissue (black asterisk). Panel D: Nest of moderately differentiated squamous cell carcinoma (Black asterisk) with central keratin pearl formation|
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Sparing few autopsy case reports, only two cases of cranial metastasis have been reported till date., The incidence of brain metastases may be underreported as cranial imaging is not performed routinely. If there is local recurrence along with systemic spread it may be easy to label as metastasis otherwise metachronous and solitary lesions from rare primary can cause diagnostic dilemma. Excision of large solitary intracranial or symptomatic metastases should relieve raised intracranial pressure and can relieve neurological deficits, besides prolonging survival. Role of palliative chemotherapy in advanced cases is selected on a case basis. As the cranial metastasis is extremely rare in case of penile carcinoma, it has to be managed on individual case basis with a multidisciplinary approach.
Declaration of patient consent
The authors certify that appropriate patient consent was obtained.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]