Verrucous carcinoma of the penis

We reviewed 13 cases of verrucous carcinoma, accounting for 5 per cent of the penile cancers seen during a 25-year interval. Although the typical verrucous pattern predominated minute foci of invasive squamous carcinoma were identified in 3 patients. All patients were followed for at least 6 years and none has died of the malignancy. Wide surgical excision, usually requiring partial or total penectomy, is the treatment of choice.     

Radiation-induced bladder carcinoma

Two cases are presented of radiation-induced bladder carcinoma which followed prior irradiation for cervical carcinoma of the uterus. One was a sixty-eight-year-old woman with bladder carcinoma fourteen years after irradiation (total dose of 4,500 rad) for cervical carcinoma of the uterus. The other was a sixty-four-year-old woman with bladder carcinoma twenty-five years after irradiation with 150-K volt apparatus for cervical carcinoma of the uterus. From the late radiation change of the skin, it was estimated that the total dose of prior radiation might be 4,000 rad or more. Both had high-grade, high-stage transitional cell bladder carcinoma, and the former was with marked mucus-forming adenomatous metaplasia.     

Radiation-induced carcinoma of the temporal bone

A case of a patient in whom carcinoma of the right temporal bone developed 39 years after a series of injections of radium chloride is presented. Carcinomas of the temporal bone and paranasal sinuses are a complication of radium administered therapeutically or ingested accidentally by watch dial painters.     

Radiochemotherapy of penis carcinoma

Some authors report successful use of radiochemotherapy in patients with penile cancer. The most promising chemotherapeutic agents in penile cancer are cisplatin, methotrexate, bleomycin, vinblastine, and vincristine. There are different protocols for the use of chemotherapeutic agents such as mono- or polychemotherapy in combination with radiotherapy. Operative treatment is still the primary approach in patients with penile cancer. However, in some patients with relevant co-morbidity who wish to receive organ-sparing therapy, radiochemotherapy may be applied when low-stage tumors (carcinoma in situ or T1) are present. There is no chemotherapeutic agent of choice to be recommended. The results of radiochemotherapy in patients with T2 tumors or higher are not satisfactory because local tumor control often cannot be achieved.     

Radiotherapy of penis carcinoma

Penile cancer is rare. Thus, there are no therapeutic recommendations fulfilling the requirements of evidence-based medicine. The empirically based therapeutic approach consists of local excision, laser therapy, or radiotherapy with comparable local control rates. Radiation is delivered by external beam radiotherapy or as brachytherapy. After radiotherapy, 5-year survival rates of 66–92% and organ preservation in 55–84% are reported. Serious long-term sequelae are necrosis (3–23%) and urethral stenosis (6–45%) requiring surgery. In the adjuvant treatment of the locoregional lymph nodes, lymphadenectomy and radiotherapy of both inguinal regions are therapeutic options. Inguinal lymph node metastases may be irradiated pre- or postoperatively to reduce the local recurrence rates. In addition, palliative radiotherapy of the primary tumor, lymph node, or distant metastases is of use for incurable patients. New combined therapies, e.g., radiochemothermotherapy, are currently under clinical evaluation and may offer a curative and organ-preserving therapeutic option to patients with locally advanced tumors.     

Rapidly growing carcinoma of the penis

After a brief review of the cancer of the penis the case of a 24-year-old man is described. After five months of the rapidly progressing cancer of the penis no radical operation could be performed in the intact tissue. The importance of biopsy is stressed which has to be repeated, occasionally involving the preparation of series of slides.     

Squamous cell carcinoma of the penis

Squamous cell carcinoma of the penis is a rare disease in Western countries. In geographical locations where infantile circumcision is not routinely practised and genital hygiene is poor, penile cancer may comprise 10-20% of all malignancies. Superficial tumours (Ta-Tl) should be treated with organ-preserving therapy. Partial of total penectomy is recommended for invasive penile carcinoma (stage T2 or higher). Currently, management of the ilioinguinal lymph nodes is controversial. The value of radiation therapy and chemotherapy is still uncertain; these treatments are only palliative therapy modalities.     

Urothelial carcinoma involving the distal penis

Urothelial carcinoma (UC) rarely metastasizes to the penis and skin. We report the case of a 73-year-old man with UC metastases to the corpus spongiosum and dermis of the distal penis. We also review the clinicopathologic characteristics and management options for UC metastasizing to the penis. The patient presented with priapism and edema of the genital region. This follows a 5-year history of urothelial carcinoma in situ that progressed to invasive cancer despite intravesical immunotherapy. Seventeen months prior to presentation, the patient underwent a radical cystectomy with adjuvant chemotherapy. The cystectomy specimen demonstrated a pT4a N2 M0 G3 UC and margins were positive for carcinoma in situ. Follow-up had been negative for recurrence until his presentation with priapism. Incisional biopsy of the glans revealed UC and radical penectomy was performed with negative margins. The penile specimen demonstrated extensive involvement of the corpus spongiosum by UC with lymphovascular invasion and subepidermal involvement. Three months after penectomy, the patient presented with inguinal nodal recurrence. Palliative radiotherapy was administered and the patient passed away eight months after surgery.     

Clinical study of carcinoma of the penis

We reviewed six cases of carcinoma of the penis seen at our department during the last 12 years. The mean age and mean followup period were 56 +/- 11 years and 53 +/- 42 months, respectively. Inguinal lymphadenopathy was evident in all patients, one of whom was diagnosed as having nodal metastasis because of the persistence of adenopathy after antimicrobial therapy. Four patients, had Jackson Stage 1, 1 Stage 2 and 1 Stage 3 cancer. The patient with Stage 3 cancer underwent total penectomy and bilateral inguinal lymphadenectomy. He died of cancer 2 years after the operation. The 5 patients with stage 1 or 2 underwent partial penectomy without lymphadenectomy. Pathological examination showed moderately differentiated squamous cell carcinoma (SCC) in 2 patients with stage 2 and 3 cancer, well differentiated SCC in 3 and verrucous carcinoma in the other patient with stage 1 cancer. Prophylactic external radiation therapy to the groin was performed in 3 of the 4 patients with invasion to corpus spongiosum (pT2). Two of the 3 patients developed mild radiation dermatitis, and no major complications were observed. The 5 patients with clinically negative nodes showed no evidence of recurrence after surgery. As reported by others, inguinal node metastasis appears to worsen the prognosis of patients with carcinoma of the penis.     

Basal cell carcinoma of penis

Basal cell carcinoma, common in the head and neck region, rarely occurs on the penis. We report here a case of primary basal cell carcinoma of the penis in a fifty-five-year-old man, apparently representing the eleventh reported case. Review of the literature indicates that most penile basal cell carcinomas were located on the shaft and that the age, race, and other clinicopathologic features were comparable to basal cell carcinomas of other sites. The rarity of penile basal cell carcinomas is probably due in part to the low exposure of this region to sunlight and other predisposing factors. Interestingly, of the 9 reported cases of penile basal cell carcinoma with available information, 6 were associated with local conditions which could have played a predisposing role.