-
Urologie (Heidelberg, Germany) May 2024Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin disease. It is frequently diagnosed following circumcision. Diabetes mellitus (DM) is a known risk...
BACKGROUND
Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin disease. It is frequently diagnosed following circumcision. Diabetes mellitus (DM) is a known risk factor in men. Malignant pathology is more common in patients with LSA. Data on LSA in men are very limited.
OBJECTIVE
This study investigated the incidence of LSA in men who had undergone circumcision. Risk factors and likelihood of malignancy were captured.
MATERIALS AND METHODS
Data of 215 patients were retrospectively analyzed. As potential risk factors, age, body mass index (BMI), DM, coronary heart disease (CHD) and arterial hypertension were identified. Data were analyzed and displayed graphically as spike histograms. Logistic regression was applied. Age and BMI were transformed using cubic spline function.
RESULTS
Mean age of patients was 37 years (± 22 years). Mean BMI was 26.4. In all, 24% of the patients had a BMI > 30. Of the patients, 11% had DM, 5.1% had CHD, and 19% had arterial hypertension. Pathology revealed LSA in 47% of patients. Malignant disease was apparent in 3.3% of patients (2.7% without concomitant LSA, 4% with concomitant LSA). Age (55 vs 20 years, odds ratio [OR]: 3.210 [1.421, 7.251]) was a significant risk factor for LSA. BMI (30 vs 22 kg/m, OR 1.059 [0.614, 1.828]) and DM (OR: 0.42 [0.148, 1.192]) elevated the risk for LSA.
CONCLUSION
We saw high rates of LSA in patients had undergone circumcision. Higher age represents a significant risk factor. In 3.3%, final pathology revealed squamous cell carcinoma of the penis. Therefore, pathologic work-up of circumcision specimen is mandatory.
Topics: Humans; Male; Lichen Sclerosus et Atrophicus; Risk Factors; Penile Neoplasms; Phimosis; Adult; Incidence; Carcinoma, Squamous Cell; Middle Aged; Circumcision, Male; Retrospective Studies; Young Adult; Aged; Comorbidity; Adolescent
PubMed: 38180522
DOI: 10.1007/s00120-023-02271-6 -
Annals of Dermatology Nov 2023
PubMed: 38061748
DOI: 10.5021/ad.21.133 -
Urology Case Reports Sep 2023Fournier's gangrene is a fast progressive necrotizing fasciitis of the perineum and external genitals, It is secondary to polymicrobial infection by aerobic and...
Fournier's gangrene is a fast progressive necrotizing fasciitis of the perineum and external genitals, It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with synergistic action. The origin of the infection is either cutaneous, urogenital or colorectal. There are age, diabetes and immunosuppression, are frequently present in affected patients. Fluid and electrolyte management, combined with broad-spectrum antibiotic therapy followed rapidly by surgical debridement, is the standard of treatment. we report in this article a very rare case of cancer of the penis manifested by fournier's gangrene.
PubMed: 37529202
DOI: 10.1016/j.eucr.2023.102503 -
Plastic and Reconstructive Surgery.... Sep 2023In phalloplasty, the radial forearm free flap is the most commonly used flap, followed by the anterolateral thigh flap. Superficial circumflex iliac artery perforator...
In phalloplasty, the radial forearm free flap is the most commonly used flap, followed by the anterolateral thigh flap. Superficial circumflex iliac artery perforator (SCIP) flaps have been used in phalloplasty, but bulkiness and unstable perfusion have precluded their common use. In this report, we present a case in which tube-in-tube phalloplasty was performed using bilateral SCIP flaps assisted by preoperative high-resolution ultrasonography. A 67-year-old man underwent resection of his penis for treatment of carcinoma. A year later, phalloplasty using bilateral SCIP flaps was planned. After mapping out the superficial circumflex iliac artery and the superficial circumflex iliac vein to their terminal portions using preoperative high-resolution ultrasonography, a 12 cm × 8 cm rectangular flap was designed on the right groin for reconstruction of the phallus, and a 10 cm × 4 cm rectangular flap was designed on the left groin for reconstruction of the urethra. Both flaps were harvested above the superficial fascia, and the thickness of both flaps was 4 mm. The Foley catheter was removed three weeks after the operation, and the patient began urinating in the standing position. No fistula or urethral stenosis had occurred as of 12 months after the reconstruction, and the patient was satisfied with the cosmesis. The use of preoperative high-resolution ultrasonography played a decisive role in ensuring the perfusion of the flap, resulting in prevention of postoperative complications such as fistula and/or urethral stenosis caused by malperfusion of the flap.
PubMed: 37744775
DOI: 10.1097/GOX.0000000000005280 -
The Journal of Urology Jan 2024Penile cancer is rare, with significant morbidity and limited literature assessing utility of peripheral and deep en face margin assessment (PDEMA) vs traditional margin...
PURPOSE
Penile cancer is rare, with significant morbidity and limited literature assessing utility of peripheral and deep en face margin assessment (PDEMA) vs traditional margin assessment (vertical sections) on treatment outcomes.
MATERIALS AND METHODS
This was a 32-year retrospective multicenter cohort study at 3 academic tertiary care centers. The cohort consisted of 189 patients with histologic diagnosis of in situ or T1a cutaneous squamous cell carcinoma of the penis at Brigham and Women's, Massachusetts General Hospital (1988-2020), and Memorial Sloan Kettering Cancer Center (1995-2020) treated with PDEMA surgical excision, excision/circumcision, or penectomy/glansectomy. Local recurrence, metastasis, and disease-specific death were assessed via multivariable Cox proportional hazard models.
RESULTS
The cohort consisted of 189 patients. Median age at diagnosis was 62 years. Median tumor diameter was 1.3 cm. The following outcomes of interest occurred: 30 local recurrences, 13 metastases, and 5 disease-specific deaths. Primary tumors were excised with PDEMA (N = 30), excision/circumcision (N = 110), or penectomy/glansectomy (N = 49). Of patients treated with traditional margin assessment (non-PDEMA), 12% had narrow or positive margins. Five-year proportions were as follows with respect to local recurrence-free survival, metastasis-free survival, and disease-specific survival/progression-free survival, respectively: 100%, 100%, and 100% following PDEMA; 82%, 96%, and 99% following excision/circumcision; 83%, 91%, and 95% following penectomy/glansectomy. A limitation is that this multi-institutional cohort study was not externally validated.
CONCLUSIONS
Initial results are encouraging that PDEMA surgical management effectively controls early-stage penile squamous cell carcinoma.
Topics: Male; Humans; Female; Middle Aged; Penile Neoplasms; Carcinoma, Squamous Cell; Cohort Studies; Organ Sparing Treatments; Neoplasm Recurrence, Local; Skin Neoplasms; Retrospective Studies
PubMed: 37788015
DOI: 10.1097/JU.0000000000003736 -
Pathology, Research and Practice Apr 2024Mucinous adenocarcinoma of the urethra is rare. Here we performed a contemporary clinicopathologic analysis of this entity in both male and female patients. All cases...
Mucinous adenocarcinoma of the urethra is rare. Here we performed a contemporary clinicopathologic analysis of this entity in both male and female patients. All cases with secondary tumors involving the urethra were excluded. Clinicopathologic parameters and follow up was obtained. Seventeen patients were included in the study, 9/17 (53 %) male and 8/17 (47 %) female. The mean patient age was 68 years (range: 53-88 years). The majority (11/17, 65 %) of patients were African American, with an even greater incidence (7/8, 87 %) in female patients. In male patients, prostatic urethra was the most common part of the urethra (6/9, 67 %) where the tumor arose from. Immunohistochemical stains were performed in 11/17 (65 %) tumors and were positive for CK20 (11/11, 100 %), CDX2 (11/12, 92 %), CK7 (8/9, 88 %), GATA3 (3/8, 37 %) and negative for NKX3.1, PSA, p63, PAX8, and Beta-Catenin. In resection specimens, tumors were categorized as pT2 (3/11, 27 %), pT3 (1/11, 9 %), and pT4 (7/11, 64 %). Lymph node status was categorized as pN0 (6/9, 67 %), pN1 (1/9, 11 %), and pN2 (2/9, 22 %). Available follow up data showed 7/13 (54 %) patients developed recurrence after surgical resection and chemotherapy, of which 3/7 (43 %) died of widespread metastatic disease. It is critical for pathologists and urologic oncologists to be aware of this entity in both male and female patients in view of potential diagnostic pitfalls, prognosis, and therapeutic implications.
Topics: Humans; Male; Female; Middle Aged; Aged; Aged, 80 and over; Urethra; Adenocarcinoma, Mucinous; Transcription Factors; Prognosis; Prostate; Biomarkers, Tumor
PubMed: 38565023
DOI: 10.1016/j.prp.2024.155273 -
Clinical Nuclear Medicine Jun 2024Prostate carcinoma (PC) is the second most common malignant tumor in males globally. The metastatic spread of PC usually involves the pelvic and abdominal lymph nodes...
Cutaneous, Subcutaneous, and Bilateral Adrenal Gland Metastases in Progressive Prostate Carcinoma: Theranostic Potential of 68 Ga-PSMA-11 PET/CT Imaging and 177 Lu-PSMA-617 Therapy.
Prostate carcinoma (PC) is the second most common malignant tumor in males globally. The metastatic spread of PC usually involves the pelvic and abdominal lymph nodes and the skeletal system. Cutaneous metastases are exceedingly uncommon and typically manifest themselves late in the disease course, considered as ominous sign with limited treatment options and a poor prognosis. We describe a patient wherein 68 Ga-PSMA-11 PET/CT detected multiple uncommon metastatic sites in the cutaneous region of the scrotum, penis, and thigh, as well as in the subcutaneous region of anterior abdominal wall, and in bilateral adrenal glands. These findings served as a theranostic tool for selecting 177 Lu-PSMA-617 treatment for these extremely rare metastatic sites.
Topics: Humans; Male; Prostatic Neoplasms; Positron Emission Tomography Computed Tomography; Gallium Isotopes; Gallium Radioisotopes; Adrenal Gland Neoplasms; Lutetium; Skin Neoplasms; Heterocyclic Compounds, 1-Ring; Edetic Acid; Disease Progression; Radioisotopes; Dipeptides; Aged; Oligopeptides; Subcutaneous Tissue; Precision Medicine
PubMed: 38557426
DOI: 10.1097/RLU.0000000000005186 -
Annals of Dermatology Nov 2023Extramammary Paget disease (EMPD) is a rare adenocarcinoma that usually occurs in areas of the body that are rich in apocrine sweat glands. Great depth of tumor invasion...
Extramammary Paget disease (EMPD) is a rare adenocarcinoma that usually occurs in areas of the body that are rich in apocrine sweat glands. Great depth of tumor invasion is a well-known risk factor for worse prognosis. Paget cells usually are limited to the epidermis, whereas invasive EMPD, which infiltrates the dermis, is relatively rare. It is even rarer for the tumor to spread beyond the dermis. Only 3.1% of patients with EMPD of the penis and scrotum have exhibited infiltration of the subcutaneous fat layer. We report a case of a 62-year-old male with EMPD that invaded the subcutaneous fat layer. He presented with a several-year history of a slowly expanding erythematous plaque with the hypopigmented area on the left penoscrotum. One month before presentation, the patient had undergone punch biopsy at another hospital and diagnosed with EMPD. He had no personal history of urogenital cancers. The patient was treated with Mohs micrographic surgery, and negative margins were achieved after four stages. The histopathologic findings revealed Paget cells scattered throughout the epidermis. At the hypopigmented area, Paget cells extended to the subcutaneous fat layer with lymphovascular invasion. There was no evidence of recurrence at seven months postoperatively. Herein, we describe a case of hypopigmented EMPD that infiltrated the subcutaneous layer, which rarely has been reported in Korea.
PubMed: 38061710
DOI: 10.5021/ad.21.055 -
World Journal of Surgical Oncology Feb 2024Penile squamous cell carcinoma (PSCC) is a highly aggressive malignancy with a poor prognosis. BRCA1/2 mutations are associated with impaired DNA double-strand break...
BACKGROUND
Penile squamous cell carcinoma (PSCC) is a highly aggressive malignancy with a poor prognosis. BRCA1/2 mutations are associated with impaired DNA double-strand break repair and are among the common mutations in penile cancer, potentially paving the way for poly ADP-ribose polymerase inhibitor therapy.
CASE PRESENTATION
We report a 65-year-old male with PSCC who progressed to thigh metastasis at 10 months after partial penectomy. Next-generation sequencing showed that the penis primary lesion and metastatic thigh lesion harboured a BRCA2 mutation. Chemotherapy plus immunotherapy was used for treatment, and the thigh metastasis was found to involve no tumour. Progression-free survival (PFS) lasted for 8 months until the appearance of lung metastasis. Afterwards, the patient benefited from second-line therapy of olaparib with pembrolizumab and anlotinib, and his disease was stable for 9 months. The same BRCA2 was identified in the lung biopsy. Given the tumour mutation burden (TMB, 13.97 mutation/Mb), the patient received third-line therapy with nivolumab plus ipilimumab, but PFS only lasted for 3 months, with the appearance of right frontal brain metastasis. Then, the patient was treated with radiation sequential fluzoparib therapy as fourth-line treatment, and the treatment efficacy was evaluated as PR. Currently, this patient is still alive.
CONCLUSIONS
This is the first report of penile cancer with BRCA2 mutation, receiving a combination treatment with olaparib and experiencing a benefit for 9 months. This case underscores the pivotal role of BRCA2 in influencing treatment response in PSCC, providing valuable insights into the application of targeted therapies in managing recurrent PSCC with BRCA2 alterations. This elucidation establishes a crucial foundation for further research and clinical considerations in similar cases.
Topics: Male; Humans; Aged; BRCA1 Protein; Penile Neoplasms; BRCA2 Protein; Neoplasm Recurrence, Local; Carcinoma, Squamous Cell; Mutation
PubMed: 38336701
DOI: 10.1186/s12957-024-03305-9 -
BMC Urology Jun 2024Carcinoma in situ of the bladder is a high-grade cancer that originates in the superficial layer of the bladder. It has the potential to invade nearby organs, and it can...
BACKGROUND
Carcinoma in situ of the bladder is a high-grade cancer that originates in the superficial layer of the bladder. It has the potential to invade nearby organs, and it can spread through blood and lymphatic circulation to distant parts of the body.
CASE PRESENTATION
A 58-year-old non-smoker male presented with gross and microscopic hematuria. His family history included his father's recent bladder cancer. Initial investigations showed hematuria, inflammation, negative urine culture, digital rectal examination revealed an enlarged right lobe of the prostate, and an elevated Prostate-Specific Antigen level. Histopathological examination of samples taken from the bladder mucosa and the prostate confirmed urothelial carcinoma in situ in the bladder and prostate. Further evaluation revealed no other metastasis. The tumor was classified as T4aN0M0. The patient underwent radical cystoprostatectomy and histopathological examination showed that the tumor invading the muscularis propria of the bladder as well as the prostatic glands, but no malignancy was found in prostatic urethra and other areas. The patient was discharged three weeks post-operation and completed on adjuvant chemotherapy consisting of Gemcitabine, and Cisplatin to prevent of relapse. The patient is currently in a good healthy.
CONCLUSION
The occurrence of bladder cancer metastasizing to the prostate without involving the prostatic urethra is uncommon and requires precise diagnostic techniques for accurate tumor classification. Early management is advised to enhance the prognosis for the patient.
Topics: Humans; Male; Middle Aged; Urinary Bladder Neoplasms; Prostatic Neoplasms; Carcinoma in Situ; Urethra
PubMed: 38879527
DOI: 10.1186/s12894-024-01516-6