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IDCases 2019Syphilitic gumma involving the penis is a rare manifestation of tertiary syphilis. Only seventeen cases have been reported in the literature. It can mimic other...
Syphilitic gumma involving the penis is a rare manifestation of tertiary syphilis. Only seventeen cases have been reported in the literature. It can mimic other diagnoses such as penile carcinoma. We report a case of a 56 year old male that had been sexually abstinent for over 10 years and presenting with a 4 cm painful penile lesion with clinically palpable bilateral inguinal nodes with no prior history of sexually transmitted diseases (STDs). A positron emission tomography-computed tomography scan identified the penile mass as being hypermetabolic and suspicious for penile carcinoma. Several inguinal and pelvic lymph nodes were also found to be suspicious for penile carcinoma. A penile biopsy was proposed and declined by the patient as he opted for a partial penectomy. The surgery was performed for diagnostic and palliative purposes. Histopathological studies revealed the presence of polymorphous, granulomatous, epitheloid inflammatory infiltrate with giant cells. Additional microbiologic testing confirmed the diagnosis of tertiary syphilis, presenting as gummatous syphillis associated with neurosyphilis. The patient was treated with intravenous penicillin and had adequate clinical clinical and serologic 12 months following treatment. Gummatous syphillis is a rare entity, but should be considered in the differential diagnosis of a penile lesion. To rule out this possibility, a biopsy should always be performed prior to invasive penis surgery.
PubMed: 31406680
DOI: 10.1016/j.idcr.2019.e00589 -
Annales de Dermatologie Et de... Jun 2021Paget's disease (PD) denotes an initially intra-epidermal adenocarcinoma that can later invade the dermis and metastasise. Among the extramammary forms of PD (EMPD),... (Review)
Review
Paget's disease (PD) denotes an initially intra-epidermal adenocarcinoma that can later invade the dermis and metastasise. Among the extramammary forms of PD (EMPD), penoscrotal presentations are rarer than the vulvar and perianal forms. Once diagnosis has been confirmed by histopathological examination, a search for associated neoplasia must be conducted, although penoscrotal EMPD is less frequently associated with underlying neoplasia than mammary PD (MPD). The associated cancer most often involves a neighbouring organ, with prostate cancer being the most common, or in some cases consists of underlying cutaneous adnexal tumours. First-line therapy consists of surgical excision. Alternatives to surgery (imiquimod, CO laser vaporisation, dynamic phototherapy) may be considered in certain cases.
Topics: Adenocarcinoma; Breast Neoplasms; Humans; Male; Paget Disease, Extramammary; Paget's Disease, Mammary; Scrotum
PubMed: 33461789
DOI: 10.1016/j.annder.2020.08.051 -
Frontiers in Oncology 2022
PubMed: 36249073
DOI: 10.3389/fonc.2022.1027852 -
Journal of Clinical Medicine Mar 2022Diffusion weighted imaging (DWI) constitutes a major functional parameter performed in Magnetic Resonance Imaging (MRI). The DW sequence is performed by acquiring a set... (Review)
Review
Diffusion weighted imaging (DWI) constitutes a major functional parameter performed in Magnetic Resonance Imaging (MRI). The DW sequence is performed by acquiring a set of native images described by their b-values, each b-value representing the strength of the diffusion MR gradients specific to that sequence. By fitting the data with models describing the motion of water in tissue, an apparent diffusion coefficient (ADC) map is built and allows the assessment of water mobility inside the tissue. The high cellularity of tumors restricts the water diffusion and decreases the value of ADC within tumors, which makes them appear hypointense on ADC maps. The role of this sequence now largely exceeds its first clinical apparitions in neuroimaging, whereby the method helped diagnose the early phases of cerebral ischemic stroke. The applications extend to whole-body imaging for both neoplastic and non-neoplastic diseases. This review emphasizes the integration of DWI in the genitourinary system imaging by outlining the sequence's usage in female pelvis, prostate, bladder, penis, testis and kidney MRI. In gynecologic imaging, DWI is an essential sequence for the characterization of cervix tumors and endometrial carcinomas, as well as to differentiate between leiomyosarcoma and benign leiomyoma of the uterus. In ovarian epithelial neoplasms, DWI provides key information for the characterization of solid components in heterogeneous complex ovarian masses. In prostate imaging, DWI became an essential part of multi-parametric Magnetic Resonance Imaging (mpMRI) to detect prostate cancer. The Prostate Imaging-Reporting and Data System (PI-RADS) scoring the probability of significant prostate tumors has significantly contributed to this success. Its contribution has established mpMRI as a mandatory examination for the planning of prostate biopsies and radical prostatectomy. Following a similar approach, DWI was included in multiparametric protocols for the bladder and the testis. In renal imaging, DWI is not able to robustly differentiate between malignant and benign renal tumors but may be helpful to characterize tumor subtypes, including clear-cell and non-clear-cell renal carcinomas or low-fat angiomyolipomas. One of the most promising developments of renal DWI is the estimation of renal fibrosis in chronic kidney disease (CKD) patients. In conclusion, DWI constitutes a major advancement in genitourinary imaging with a central role in decision algorithms in the female pelvis and prostate cancer, now allowing promising applications in renal imaging or in the bladder and testicular mpMRI.
PubMed: 35407528
DOI: 10.3390/jcm11071921 -
International Journal of Urology :... Jul 2022Boron neutron capture therapy is based on a nuclear reaction between the nonradioactive isotope boron-10 and either low-energy thermal neutrons or high-energy epithermal... (Review)
Review
Boron neutron capture therapy is based on a nuclear reaction between the nonradioactive isotope boron-10 and either low-energy thermal neutrons or high-energy epithermal neutrons, which generate high linear energy transfer α particles and a recoiled lithium nucleus ( Li) that selectively destroys the DNA helix in tumor cells. Boron neutron capture therapy is an emerging procedure aimed at improving the therapeutic ratio for the traditional treatment of various malignancies, which has been studied clinically in a variety of diseases, including glioblastoma, head and neck cancer, cutaneous melanoma, hepatocellular carcinoma, lung cancer, and extramammary Paget's disease. However, boron neutron capture therapy has not been clinically performed for urological cancers, excluding genital extramammary Paget's disease that appeared at the scrotum to penis area. In this review, we aimed to provide an updated summary of the current clinical literature of patients treated with boron neutron capture therapy and to focus on the future prospects of boron neutron capture therapy for urological cancers.
Topics: Boron Neutron Capture Therapy; Brain Neoplasms; Humans; Male; Melanoma; Paget Disease, Extramammary; Skin Neoplasms; Urologic Neoplasms
PubMed: 35240726
DOI: 10.1111/iju.14855 -
Current Oncology (Toronto, Ont.) Apr 2023Carcinoma penis is a rare neoplasm, and the literature is scarce on long-term survival and its predictors. The aim of the study was to determine the clinical profile and...
BACKGROUND
Carcinoma penis is a rare neoplasm, and the literature is scarce on long-term survival and its predictors. The aim of the study was to determine the clinical profile and management patterns, identify predictors of survival, and the impact of education and rural/urban dwelling on survival.
METHODS
Patients with a histological diagnosis of carcinoma penis from January 2015 to December 2019 were included in the study. Demographics, clinical profile, education status, primary residence address, and outcomes were obtained from the case records. Distance from the treatment centre was obtained from the postal code. The primary objectives were to assess relapse-free survival (RFS) and overall survival (OS). The secondary objectives were to identify the predictors of RFS and OS and to determine the clinical profile and treatment patterns in patients with carcinoma penis in India. Time-to-event was calculated by Kaplan-Meir analysis and survival was compared by the log-rank test. Univariate and multivariable Cox regression analyses were used to find independent predictors of relapse and mortality. Logistic regression analyses to examine the associations of rural residence, education status, and distance from the treatment centre with the relapse adjusting for measured confounding variables.
RESULTS
Case records of 102 patients treated during the above period were retrieved. The median age was 55.5 (interquartile range [IQR] 42-65 years). Ulcero-proliferative growth (65%), pain (57%), and dysuria (36%) were the most common presenting features. Clinical examination or imaging revealed inguinal lymphadenopathy in 70.6% of patients, however, only 42% of these lesions were pathologically involved. A total of 58.8% of patients were from rural areas, 46.9% had no formal education, and 50.9% had a primary residence ≥100 km from the hospital. Patients with lower education and rural households had higher TNM stages and nodal involvement. Median RFS and OS were 57.6 months (15.8 months to not reached) and 83.9 months (32.5 months to not reached), respectively. On univariate analysis tumor stage, involvement of lymph nodes, T stage, performance status, and albumin was predictive for relapse and survival. However, on multivariate analysis, the stage remained the only predictor of RFS and nodal involvement, and metastatic disease was a predictor of OS. Education status, rural habitation, and distance from the treatment centre were not predictors for relapse or survival.
CONCLUSIONS
Patients with carcinoma have locally advanced disease at presentation. Rural dwellings and lower education were associated with the advanced stage but did not have a significant bearing on the survival outcomes. The stage at diagnosis and nodal involvement is the most important predictor of RFS and OS.
Topics: Male; Humans; Adult; Middle Aged; Aged; Prognosis; Neoplasm Recurrence, Local; Lymph Nodes; Carcinoma; Penis
PubMed: 37232803
DOI: 10.3390/curroncol30050345 -
Skin Health and Disease Apr 2023Lichen sclerosus (LSc) is a chronic, inflammatory, destructive skin disease with a predilection for the genitalia (GLSc). An association with vulval (Vu) and penile (Pe)... (Review)
Review
BACKGROUND
Lichen sclerosus (LSc) is a chronic, inflammatory, destructive skin disease with a predilection for the genitalia (GLSc). An association with vulval (Vu) and penile (Pe) squamous carcinoma (SCC) is now well established but melanoma (MM) has only rarely been reported complicating GLSc.
METHODS
We have performed a systematic literature review of GLSc in patients with genital melanoma (GMM). Only articles that mentioned both GMM and LSc affecting either the penis or vulva were included.
RESULTS
Twelve studies with a total of 20 patients were included. Our review shows that an association of GLSc with GMM has been more frequently reported in women and female children than men viz, 17 cases compared with three. It is notable that five of the cases (27.8%) concerned female children aged under twelve.
DISCUSSION
These data suggest a rare association between GLSc and GMM. If proven, there arise intriguing questions about pathogenesis and consequences for counselling of patients and follow-up.
PubMed: 37013116
DOI: 10.1002/ski2.198 -
Annales de Pathologie Jan 2022Penile carcinogenesis can be superposed on vulvar carcinogenesis, with two pathways : with or without a link to HPV. Penile squamous cell carcinomas arise from...
Penile carcinogenesis can be superposed on vulvar carcinogenesis, with two pathways : with or without a link to HPV. Penile squamous cell carcinomas arise from precursor lesions: penile intraepithelial neoplasia (PeIN) defined by the presence of intraepithelial atypia, which can progress to invasive squamous cell carcinoma. Differentiated PeINs not linked to HPV, affect elderly men with inflammatory lesions, most often lichen sclerosus. PeINs linked to HPV, basaloid, condylomatous or condylomatous-basaloid growth affect younger men. Although clinically similar, their distinction is important, because the treatment differs with a greater risk of invasion for forms unrelated to HPV.
Topics: Aged; Carcinoma in Situ; Carcinoma, Squamous Cell; Female; Humans; Lichen Sclerosus et Atrophicus; Male; Papillomavirus Infections; Penile Neoplasms; Precancerous Conditions; Vulvar Neoplasms
PubMed: 34865881
DOI: 10.1016/j.annpat.2021.04.005 -
Urology Nov 2019Lesions of the skin and soft tissues of the penis and scrotum may be confusing in urological practice, since rare differential diagnoses can be challenging to providers...
Lesions of the skin and soft tissues of the penis and scrotum may be confusing in urological practice, since rare differential diagnoses can be challenging to providers with limited dermatological experience. Hidradenocarcinoma is one of such diagnoses, a rare and aggressive malignant tumor originating from sweat glands. A 61 year-old man presented with a nodule in the penoscrotal region which had appeared 1 year before consultation. He had no history of penile lesions, sexually transmitted diseases, or other complaints. Surgical resection revealed a hidradenocarcinoma of the scrotum infiltrating subcutaneous tissue.
Topics: Adenocarcinoma; Genital Neoplasms, Male; Humans; Male; Middle Aged; Scrotum; Sweat Gland Neoplasms
PubMed: 31302136
DOI: 10.1016/j.urology.2019.07.002