The 12th Uro-Oncology Update

Total Penectomy and Perineal Urethrostomy

Management of Penile Squamous Cell Carcinoma with
Sclerofibromatosis: A Rare Case Report
• Erwin Aritama Ismail1, Muhammad David Perdana Putra1,
• Syaeful Agung Wibowo2, Suharto Wijanarko2

• 1 Surgery Resident of Sebelas Maret University, Surakarta, Indonesia

• 2 Urology Division, Department Of Surgery, dr. Moewardi General Hospital, Surakarta, Indonesia
 Background

• Penile cancer is a rare condition, affecting less than 1% of the adult male population, The most common type
encountered is the squamous cell carcinoma (SCC). (Kiptoon et al, 2009).

• The risk of penile cancer increases significantly with age, poor hygiene, and chronic penile inflammation.
(Solakhan And Bulut, 2018).

• 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 occured.
(Solakhan And Bulut, 2018).

• Treatment may be delayed due to patient psychological factors, with estimated 15 to 60% of patients delaying
treatment for at least one year from the onset of lesions. (Solakhan And Bulut, 2018).

Kiptoon et al. Cancer of the penis : case report. East African Medical Journal Vol. 86 No. 4 April 2009

Solakhan, Bulut E. Penile cancer : Case report. International Archives of Urology. 2018. doi: 10.23937/2469-5742/1510045
 Case Presentation

• A 63-years-old man with poor hygiene and has a history of

Diabetes Mellitus had penis mass with ulcers since 35 years
ago.
• On physical examination, penile mass with ulceration with
the size of 12x12x10 cm, Sclerofibromatous lesion
throughout the base of the penis to the Glans.
• Patient had previous history of using silicone injection 30
years ago and causing sclerofibromatosis.
 Case Presentation

Contrast pelvic multiple slice computed tomography (MSCT) shows mass growth
covering the glans, entire shaft of the penis down to the penile base and the
scrotum.
 Case Presentation

The following investigations were performed

Haemogram

• Hb 10.7 g/dl
• K 3.7 mmol/L
• WBC 12300
• Na- 132 mmol/L
• Platelets 357.000
• CI 98 mmol/L
• Ureum 15
• Urinalysis -Normal
• Creatinin 0.7
• Random blood sugar + 166 mg/dl
• Albumin 3.6
• Chest radiograph -Normal
Case Presentation

Biopsy had been done and confirmed

squamous cell carcinoma with Supuratif
Inflammation as a result.
 Case Presentation

• Patient with Diagnosis Ca Penis T4N0M0 With

Sclerofibromatous and DM Type II.

• Total penectomy was performed with intraoperative frozen

section (for intraoperative surgical margin assesment).

• Sclerofibromatosis and the surrounding tissue were excised to

the base of the penis and affected scrotum followed by perineal
urethrostomy.

• There was no post operative complication.

• The patient was discharged within 96 hours.
• The surgical specimen revealed squamous cell carcinoma with
free of tumour excision margin.
 Discussion

• The etiology of penile cancer has not been explained clearly, there are conditions associated
with penile cancer such as uncircumscised prepuce, chronic inflammatory conditions, and
exposure to the human papilloma virus. Poor hygiene, history of smoking, and history of
phymosis also found in 25% of patients with penile cancer (Kiptoon, 2009).
• Many cases of granulomatous reactions occurring after injection of liquid silicone were given
to enlarge the penis (Dachlan, 2007).
• Penile granulomas can occur after injection of high viscosity fluids, such as liquid silicone
(siliconoma), paraffin (paraffinoma), vaseline or other mineral oils (Loughlin,2006).
• In this case, the Sclerofibromatous reaction after silicone injection in the patient developed
into squamous cell carcinoma. This is associated with chronic inflammation.
Kiptoon et al. Cancer of the penis : case report. East African Medical Journal Vol. 86 No. 4 April 2009
Dachlan, I. 2007. Penile granuloma caused by liquid silicone Injection Ishandono Dachlan. Berkala Ilmu Kedokteran Dachlan et al, Penile granuloma caused by liquid silicone injection Vol. 39, No. 1, Maret 2007: 53-58
Loughlin KR. 2006. Surgical management of penile carcinoma: the primary lesion. BJU Int 2006;97:655-67.
 Conclusions

• Injections with silicone to enlarge the penis, cannot be justified . The process can
trigger a chronic inflammatory reaction that associated with penile malignancy.
• Total penectomy and wide excision with urethral perineostomy could be an optimal
initial treatment.
The 12th Uro-Oncology Update

Thank You

Many Greetings From UNS Department Of Surgery