Penile cancer in 26-years old men

CASE REPORT

Francesco Passaro 1, Francesco Di Bello 1, Giovanni Grimaldi 2, Alessandro Izzo 2, Giuseppe Quarto 2, Luigi Castaldo 2 , Raffaele Muscariello 2, Dario Franzese 2, Antonio Tesone 2, Luigi Napolitano 1, Sisto Perdonà 2 .

1 Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, Naples, Italy; 2 Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy.

SUMMARY

Background: Penile squamous cell carcinoma (SCC) is rare in Europe. The age group affected is between the sixth and eight decades of life, with two-thirds of cases occurring in patients aged over 65 years. The main risk of factor for the development of penile SCC is human papillomavirus (HPV)

infection. Case report: This case report presents an uncommon case of a 26-year-old man with a penile SCC HPV 16 correlated. The patient underwent excisional biopsy of the glans in a suspicious lesion. The biopsy was positive for SCC of the penis in situ with focal interruption of the lamina propria associated with HPV. He was subsequently treated for widening of the excision with extemporaneous histological examination of the margins and sentinel lymph node. Conclusion: After three years of follow-up the patient is fully satisfied with the cosmetic and functional results.

KEY WORDS: Penile cancer, case report, young men.

INTRODUCTION

Penile squamous cell carcinoma (SCC) is rare in Europe. The age group affected is between the sixth and eight decades of life, with two-thirds of cases occurring in patients aged over 65 years (1, 2). The main risk of factor for the development of penile SCC is human papillomavirus (HPV) infection. However, the disease could be misdiagnosed and up to 50% of patients can be symptomatic for more than 1 year before the diagnosis (1). We report a case of penile cancer in a 26 years-old Caucasian male with a suspect of lymph node involvement.

CASE REPORT

At age of 26, a young and healthy Caucasian male, presented to his primary care physician with a lesion on his uncircumcised penis. The naive lesion, clinically compatible with Bowen disease, appeared as a centimetric verrucous scar surrounded by erythematosus margin, close to urethral meatus on the gland apex. Patient history was negative for immunodepressive disorders and other major comorbidities, but he was sexually active. Firstly, the HPV-DNA test after a cytobrushing of the suspicious lesion was performed and resulted positive for HPV 16 and HPV 56. Secondly, the gland punch biopsy confirmed the suspect: intraepidermal carcinomatous neoplastic lesion compatible with clinic diagnosis of Bowen disease. Moreover, the inguinal ultrasound (US), performed after a month, showed iperplastic lymph nodes (14 mm of diameter on the right and 11 mm of diameter on the left) with ovul shape, wavy edges, inhomogeneous structure, hypoechoic with preserved ilo and vascularization. The patient underwent to penile rod biopsy. The histological examination showed SCC of the penis in situ with focal interruption of the lamina propria associated with HPV concurrent with severe dyskeratosis. The patient received the diagnosis of penis SCC and opted for a stringent follow-up. After 2 months from surgery, the patient performed the scintigraphy exam with 99mTc-NANOCOLL for the detecting of sentinel lymph node (Figure 1). The imaging showed a suspect focus of uptake on the left inguinal region. Moreover, a not-clear spot of uptake was measured in

paramedian zone of suprapubic region. The following decision was clear: the patient received a widening of resection margins with sentinel lymph nodes dissection. In addition, a meatoplasty was performed for aesthetic and functional outcomes. Fortunately, the histological examination resulted negative for lymph nodal invasion. After three years of follow-up the patient is alive, fully satisfied with the cosmetic and functional results.

DISCUSSION

Early diagnosis and treatment was essential for long-term cure in SCC of the penis. Several studies had shown that the 6-year survival drops from 65% to 15% with development of nodal metastasis (3). As noted, up to half the men with this disease had symptoms for more than 1 year before presentation. The primary care physicians were required to an early-diagnosis. Furthermore, this disease is rare in the young Caucasian population. As evidenced by our patient, the correct diagnosis, the sudden treatment, and the strict follow-up represented the gold key for the SCC patient management. We presented this case to alert physicians of the possibility of penile cancer in young Caucasian males and to share our approach to the current available information.

CONCLUSION

SCC is a rare tumor worldwide, despite this it should be better investigated mostly in young men.

REFERENCES

1. Narasimharao KL, Chatterjee H, Veliath AJ. Penile carcinoma in the first decade of life. Br J Urol. 1985; 57(3):358. 2. Hakenberg OW, Dräger DL, Erbersdobler A, et al. The Diagnosis and Treatment of Penile Cancer. Dtsch Arztebl Int. 2018; 115(39):646-52. 3. Culkin DJ, Beer TM. Advanced penile carcinoma. J Urol. 2003; 170(2 Pt 1):359-65.

Figure 1. The scintigraphy exam of suspicious sentinel lymph nodes.

CORRESPONDENCE

Luigi Napolitano, MD Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples “Federico II”, Naples, Italy Via Sergio Pansini n 5, 80131 - Naples (NA), Italy E-mail: dr.luiginapolitano@gmail.com Phone: +390817462611 - Fax: +390815452959