陰莖鱗狀上皮癌:病例報告及12年單一醫學中心之案例及文獻回顧

陳冠宇^1,2、王紹全^1,2、謝佐宜^1,2、陳文榮^1,2、宋文瑋^1,2、楊旻鑫^1,2、何承儒^1,2、陳順郎^1,2

¹中山醫學大學附設醫院 泌尿科；²中山醫學大學醫學院

Penile squamous cell carcinoma: a case report and a 12-year single-center cases series and literature review.

Kuan-Yu Chen^1,2, Shao-Chuan Wang^1,2, Tuzo-Yi Hsieh^1,2, Wen-Jung Chen^1,2, Wen-Wei Sung^1,2, Ming-Hsin Yang^1,2, Cheng-Ju Ho^1,2, Sung-Lang Chen^1,2

¹ Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan;

² School of Medicine, Chung Shan Medical University, Taichung, Taiwan

Introduction: Penile squamous cell carcinoma (SCC) is an uncommon malignancy in resource-abundant countries. It accounts for less than 1 percent of all malignant tumors in men in Europe ^[1] and in the USA ^[2]. By contrast, in resource-limited areas such as parts of Africa, Asia, and South America, it accounts for up to 20% of all malignancies in males ^[3]. Associated risk factors include phimosis, obesity, human papillomavirus infection, tobacco exposure, and trauma. The mean age at diagnosis is 60 years, and the rates increase with age ^[4].In Taiwan, the crude incidence rate of penile cancer was 0.98 per 100000 males in 2021, and squamous cell carcinoma accounted for the majority in histopathology (38.94%), followed by Paget’s disease (31.86%) ^[5]. Management of the primary tumor includes organ-preserving treatment and penile amputation. Here, we are going to present a case of penile squamous cell carcinoma with an ulcer appearance. In addition, we retrospectively reviewed the cases diagnosed as penile cancer undergoing partial penectomy or penile amputation from January 2012 to January 2024 in our institution.

Case presentation: A 72-year-old man with a history of coronary artery disease status post percutaneous coronary intervention. This time, he noticed a painless ulcerative lesion at the penile glans for six months. He didn’t pay much attention to it since there was no itchiness, bleeding, or other discomfort. The size of the lesion progressed in one month. Being worried about the nature of the lesion, he came to our outpatient clinic for consultation in December 2023. Physical examination showed a 1*1 cm oval-shaped whitish ulcer with an irregular margin at the dorsal side of the glans. The lesion was surrounded by an erythema change of the skin up to 2.5*2.5 cm in size. After an explanation and discussion with the patient, a penile biopsy was performed on December 19^th, 2023, and the pathology report showed HPV-associated squamous cell carcinoma without perineural invasion. Abdomen CT scan on January 6^th, 2024 showed a suspicious residual tumor at the dorsal portion of the penis, and no obvious abdominal or pelvic lymphadenopathy. After a discussion with the patient, partial amputation of the penis was performed on January 31^st, 2024. The pathology report showed HPV-associated squamous cell carcinoma, moderately differentiated, pT1aNxM0. The patient has regular follow up after the operation at our outpatient department. No evidence of recurrence or distant metastasis is noted to date.

Discussion: Given the relatively low incidence of penile cancer, there are limited publications associated with penile cancer in Taiwan. Most of the studies are case reports or retrospective reviews. Chiu, T. Y. et al reviewed 54 patients during 20 years (1977-1996) and found 26(48%) patients had stage I penile cancer, 13 (24%) had stage II, 7 (13%) had stage III, and 8(15%) had stage IV cancer. The five-year survival rate was 78% among patients with SCC ^[6]. Being curious about the data in our institution, we reviewed the 6 patients who underwent partial penectomy (n=4) or penile amputation (n=2) with pathology-confirmed SCC from January 2012 to January 2024. The patient’s age ranged from 35 to 75 years old, and the surgery time ranged from 65 to 190 minutes. Two patients had stage I, three patients had stage IIB, and one patient had stage IV disease. One patient had adjuvant chemotherapy with cisplatin, leucovorin, and fluorouracil, and he survived more than 5 years. No disseminated disease (M1) was noted in these patients. Only one patient’s histopathology reports showed non-HPV-related sarcomatoid SCC. One patient had long-term Foley catheterization and one patient suffered from urethral stricture. Survival analysis was inexecutable due to the limited number of cases.

Conclusion:

This case demonstrated the presentation and management of a patient with penile squamous cell carcinoma. Organ-preserving treatment and penile amputation play an important role in the treatment of the primary tumor. Further multicenter with extended period study would help establish contemporary data and outcomes of penile squamous cell carcinoma in Taiwan.