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Squamous cell carcinoma of suprapubic cystostomy tract in a male with locally advanced primary urethral malignancy.

Boaz RJ, John NT, Kekre N - Indian J Urol (2015 Jan-Mar)

Bottom Line: He presented to us 3 months later with a fungating ulcer at the site of perineal incision, the biopsy of which revealed squamous cell carcinoma (SCC).He underwent a total penile amputation, wide local excision scrotum, radical urethrocystoprostatectomy, ileal conduit with the en-bloc excision of the SPC tract.Histopathological examination of the suprapubic tract also revealed SCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India.

ABSTRACT
A 65-year-old man with stricture urethra underwent drainage of periurethral abscess and suprapubic cystostomy (SPC) placement. He presented to us 3 months later with a fungating ulcer at the site of perineal incision, the biopsy of which revealed squamous cell carcinoma (SCC). He underwent a total penile amputation, wide local excision scrotum, radical urethrocystoprostatectomy, ileal conduit with the en-bloc excision of the SPC tract. Histopathological examination of the suprapubic tract also revealed SCC. This is the first documented case of SCC of a suprapubic tract in the presence of primary urethral SCC.

No MeSH data available.


Related in: MedlinePlus

(a) Ulceroproliferative growth at the penoscrotal junction and, suprapubic cystostomy (SPC) site with ulcerated, everted mucosal edges; (b) computed tomography scan showing an ill-defined, enhancing mass in the region of posterior urethra infiltrating cavernosae (arrow); (c) Transverse section showing bladder and SPC tract (arrow head)
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Figure 1: (a) Ulceroproliferative growth at the penoscrotal junction and, suprapubic cystostomy (SPC) site with ulcerated, everted mucosal edges; (b) computed tomography scan showing an ill-defined, enhancing mass in the region of posterior urethra infiltrating cavernosae (arrow); (c) Transverse section showing bladder and SPC tract (arrow head)

Mentions: A 65-year-old diabetic male with a long history of urethral stricture developed rapid worsening of his lower urinary tract symptoms and noticed a painful swelling in his upper scrotum for 2 weeks. He was diagnosed with a periurethral abscess and underwent incision and drainage at another center. A suprapubic catheter was placed for urinary diversion. His perineal wound did not heal and over the next 3 months it developed into a fungating ulcer. He consulted his surgeon, who performed a biopsy revealing squamous cell carcinoma (SCC). At presentation to us, he had a 10 × 6 cm, fungating, malodourous, ulceroproliferative scrotal growth fixed to the region of the bulbar urethra. The growth extended anteriorly to the penoscrotal junction [Figure 1a]. There was no palpable inguinal lymphadenopathy. The abdominal entry site of the suprapubic catheter was ulcerated with rolled out edges and induration [Figure 1a]. CT scan showed an enhancing ill-defined soft tissue density in the region of bulbar urethra infiltrating corpora cavernosa, adjacent skin and subcutaneous tissue [Figure 1b]. Transverse section [Figure 1c] at the level of bladder and suprapubic cystostomy (SPC) tract showed induration surrounding the tract. He underwent a total penile amputation, wide local excision scrotum, radical urethrocystoprostatectomy, ileal conduit diversion, and pelvic lymphadenectomy [Figure 2a]. We included wide local excision of the SPC site, en bloc with the cystoprostatectomy specimen. Histopathological examination showed moderately differentiated SCC of the bulbar urethra [Figure 2b] with 2 right external iliac lymph nodes positive for metastasis. The SPC site was also reported to harbor SCC [Figure 2c]. Postoperative staging was T3N1; he was given a course of adjuvant chemotherapy (cisplatin and gemcitabine) and has completed follow-up of 6 months.


Squamous cell carcinoma of suprapubic cystostomy tract in a male with locally advanced primary urethral malignancy.

Boaz RJ, John NT, Kekre N - Indian J Urol (2015 Jan-Mar)

(a) Ulceroproliferative growth at the penoscrotal junction and, suprapubic cystostomy (SPC) site with ulcerated, everted mucosal edges; (b) computed tomography scan showing an ill-defined, enhancing mass in the region of posterior urethra infiltrating cavernosae (arrow); (c) Transverse section showing bladder and SPC tract (arrow head)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300577&req=5

Figure 1: (a) Ulceroproliferative growth at the penoscrotal junction and, suprapubic cystostomy (SPC) site with ulcerated, everted mucosal edges; (b) computed tomography scan showing an ill-defined, enhancing mass in the region of posterior urethra infiltrating cavernosae (arrow); (c) Transverse section showing bladder and SPC tract (arrow head)
Mentions: A 65-year-old diabetic male with a long history of urethral stricture developed rapid worsening of his lower urinary tract symptoms and noticed a painful swelling in his upper scrotum for 2 weeks. He was diagnosed with a periurethral abscess and underwent incision and drainage at another center. A suprapubic catheter was placed for urinary diversion. His perineal wound did not heal and over the next 3 months it developed into a fungating ulcer. He consulted his surgeon, who performed a biopsy revealing squamous cell carcinoma (SCC). At presentation to us, he had a 10 × 6 cm, fungating, malodourous, ulceroproliferative scrotal growth fixed to the region of the bulbar urethra. The growth extended anteriorly to the penoscrotal junction [Figure 1a]. There was no palpable inguinal lymphadenopathy. The abdominal entry site of the suprapubic catheter was ulcerated with rolled out edges and induration [Figure 1a]. CT scan showed an enhancing ill-defined soft tissue density in the region of bulbar urethra infiltrating corpora cavernosa, adjacent skin and subcutaneous tissue [Figure 1b]. Transverse section [Figure 1c] at the level of bladder and suprapubic cystostomy (SPC) tract showed induration surrounding the tract. He underwent a total penile amputation, wide local excision scrotum, radical urethrocystoprostatectomy, ileal conduit diversion, and pelvic lymphadenectomy [Figure 2a]. We included wide local excision of the SPC site, en bloc with the cystoprostatectomy specimen. Histopathological examination showed moderately differentiated SCC of the bulbar urethra [Figure 2b] with 2 right external iliac lymph nodes positive for metastasis. The SPC site was also reported to harbor SCC [Figure 2c]. Postoperative staging was T3N1; he was given a course of adjuvant chemotherapy (cisplatin and gemcitabine) and has completed follow-up of 6 months.

Bottom Line: He presented to us 3 months later with a fungating ulcer at the site of perineal incision, the biopsy of which revealed squamous cell carcinoma (SCC).He underwent a total penile amputation, wide local excision scrotum, radical urethrocystoprostatectomy, ileal conduit with the en-bloc excision of the SPC tract.Histopathological examination of the suprapubic tract also revealed SCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India.

ABSTRACT
A 65-year-old man with stricture urethra underwent drainage of periurethral abscess and suprapubic cystostomy (SPC) placement. He presented to us 3 months later with a fungating ulcer at the site of perineal incision, the biopsy of which revealed squamous cell carcinoma (SCC). He underwent a total penile amputation, wide local excision scrotum, radical urethrocystoprostatectomy, ileal conduit with the en-bloc excision of the SPC tract. Histopathological examination of the suprapubic tract also revealed SCC. This is the first documented case of SCC of a suprapubic tract in the presence of primary urethral SCC.

No MeSH data available.


Related in: MedlinePlus