Total Penectomy and Perineal Urethrostomy Management of Penile Squamous Cell Carcinoma with Paraffinoma in Single Center Hospital: A Rare Case Report

Abstract

BACKGROUND: Penile cancer is a rare condition, affecting less than 1% of the adult male population [1]. The risk of penile cancer increases significantly with age, poor hygiene, and the presence of the prepuce. The most common type encountered is squamous cell carcinoma (SCC). Clinically penile cancer appears as small lesions with induration and erythema or as large infiltrative ulcerative lesions. As the disease progresses, complaints such as itching, bleeding, discharge, foul odor, and pain occurred.

CASE REPORT: A 63-year-old man with poor hygiene and has a history of diabetes mellitus had penis ulcers since 5 years ago. On physical examination, an ulcer with the size of 12 × 12 × 10 cm was found growing pus (-). Biopsy had done and confirmed SCC as a result. Pelvic multiple slice CT shows growth covering the entire shaft of the penis down to the base. The patient had a previous history of using silicone injection 35 years ago and causing Sclerofibromatosis. The patient was planned to undergo surgery with clinical diagnosis T4N0M0. Total penectomy was performed with an elliptical incision around the base with a margin of 2 cm. Sclerofibromatosis and the surrounding tissue were excised to the base of the penis followed by perineal urethrostomy. There was no problem postoperatively. The patient went home after staying in the hospital for 96 h. The surgical specimen revealed SCC with free of tumor excision margin.

CONCLUSIONS: Injections with silicone to enlarge the penis cannot be justified. The process can trigger a chronic inflammatory reaction associated with penile malignancy. Total penectomy and wide excision with urethral perineostomy could be optimal initial treatment.