Journal of Postgraduate Medicine
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Year : 2020  |  Volume : 66  |  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

Correspondence Address:
S Rajaian
Department of Urology, MIOT International, Chennai, Tamil Nadu
India




How to cite this article:
Rajaian S, Pragatheeswarane M, Boopesh P, Jain D. Penile carcinoma with isolated expansile skull metastasis.J Postgrad Med 2020;66:55-56


How to cite this URL:
Rajaian S, Pragatheeswarane M, Boopesh P, Jain D. Penile carcinoma with isolated expansile skull metastasis. J Postgrad Med [serial online] 2020 [cited 2021 Apr 21 ];66:55-56
Available from: https://www.jpgmonline.com/text.asp?2020/66/1/55/274713


Full Text



In general, penile cancer metastasizes in a step-wise fashion affecting predominantly the locoregional lymph nodes before systemic spread.[1] Lungs, liver, and pelvic bones are the predominant sites of systemic deposits.[1] However, even early-stage penile carcinoma can exhibit systemic spread.[2],[3] 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}{Figure 2}

Sparing few autopsy case reports, only two cases of cranial metastasis have been reported till date.[1],[4] The incidence of brain metastases may be underreported as cranial imaging is not performed routinely.[4] 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.[4] Excision of large solitary intracranial or symptomatic metastases should relieve raised intracranial pressure and can relieve neurological deficits, besides prolonging survival.[5] Role of palliative chemotherapy in advanced cases is selected on a case basis.[1] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Misra S, Chaturvedi A, Misra NC. Penile carcinoma: A challenge for the developing world. Lancet Oncol 2004;5:240-7.
2Lutterbach J, Pagenstecher A, Weyerbrock A, Schultze-Seemann W, Waller CF. Early-stage penile carcinoma metastasizing to brain: Case report and literature review. Urology 2005;66:432.
3Murugavaithianathan P, Devana SK, Vaiphei K, Mavuduru R, Bora GS. A neglected reddish penile patch: A wolf in sheep's clothing. Indian J Urol 2018;34:155-7.
4Moiyadi AV, Tongaonkar HB, Bakshi GK. Symptomatic intracranial metastasis in penile carcinoma. Indian J Urol 2010;26:585-6.
5Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain metastases. Histology, multiplicity, surgery, and survival. Cancer 1996;78:1781-8.

 
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