Coresponden: Patricia Prabawati
Email: [email protected]
INTRODUCTION
Penile cancer is
a rare malignancy in Indonesia and most of the globe (Lestari
& Armerinayanti, 2018). In 2020, there were 1,017
new cases of penile cancer, and it caused 0.15% of deaths among cancer patients
in Indonesia (Ferlay et al., 2020). While penile carcinoma is found
more often in men aged from 50 to 70 years, any men can be affected (Brouwer
et al., 2023); (Borque-Fernando
et al., 2023). It can occur anywhere on
the penis, although most cases arise from the squamous epithelium of glans,
coronal sulcus, and prepuce or foreskin (Hadidi,
2022). The glans are the most
common site of penile carcinoma, accounting for up to 48% of cases, followed by
the prepuce (21%), glans and prepuce (9%), coronal sulcus (6%) and uncommonly
the penile shaft (<2%) (Douglawi & Masterson, 2017). Squamous cell carcinoma (SCC) is
the most common histopathology and is responsible for 95% of all cases (Deo et al., 2023); (White et al., 2023). Histological diagnosis may be made
by punch, excisional, or incisional biopsy (White et al., 2023).
Predisposing
factors for penile cancer include phimosis, chronic inflammatory diseases such
as balanoposthitis, xeroderma balanoposthitis obliterans, ultraviolet light
phototherapy, multiple sexual partners,�
early age at first intercourse, and history of warts (Thomas
et al., 2021). Risk factors also include
smoking and having sex with a partner infected with human papillomavirus (HPV)
types 6, 11, 16, or 18 (Douglawi & Masterson, 2017). This disease is of great importance
to affected men, as significant cosmetic and functional defects often accompany
its treatment (Burnett,
2016). Early metastasis to
regional lymph nodes can be life-threatening (Rizwan et al., 2015). Delays in diagnosis and initiation
of treatment are not uncommon due to patient and treating physician factors (Hakenberg et al., 2018).
Case Presentation
A 62-year-old
circumcised male patient presented to the emergency department with a penile
mass, present since two months ago and growing progressively. He admitted to a
history of dysuria and penile pain. He denied any urethral discharge. He
married once and had three children, smokes cigarettes one pack/day. He has no
known chronic illness. Physical examination was significant for a well-looking
man. Urogenital examination revealed a palpable mass with unclear borders
measured 2x1 cm, reddish colour, and odourless. The lesion is located in the
shaft penile with a dense yet tender consistency. An orifice of the urethral
fistula in the perineum was observed. The testicles were normal. An enlargement
of the right and left inguinal lymph nodes was also found in this patient. The
biochemical results were as follows: White blood cell count, 28.100/μl
(normal range, 4.0�11.0/μl); haemoglobin, 7,2 g/dl (normal range,
12.8�15.5 g/dl); platelet count, 346,000/l (normal range, 150,000�450,000/l);
glucose, 265 mg/dl (normal range, 70�101 mg/dl); blood urea nitrogen, 19 mg/dl
(normal range, 8�20 mg/dl); creatinine, 2.31 mg/dl (normal range, 0.6�1.2
mg/dl).
The patient's clinical findings point to a diagnosis of penile cancer; an
open biopsy was performed to identify this lesion by histopathological
examination. Histopathological examination after an open biopsy on the patient
reported the discovery of verrucous carcinoma. After 23 days, the patient
underwent a partial penectomy and a histopathological examination was
performed. The latter histopathology result suggested a penile squamous cell
carcinoma with inguinal lymph node metastases.
Figure 1. After an open biopsy in
this patient by taking a small part of the lesion
Figure
2.
Histopathological specimen from open biopsy
Figure
3. After
partial penectomy
Figure
4.
Histopathological specimen from partial penectomy
METHOD
This type of research is a
case report. This research method describes case reports found by discussing
related theories. Data was collected from patients who were diagnosed with
penile carcinoma through history-taking, physical examination, and supporting
examinations directly after the patient stated that he was willing to be
examined through informed consent.
RESULTS AND DISCUSSION
The research
results underscore the noteworthy effects of penile cancer on those afflicted,
stressing the possibility of physical, psychological, and emotional anguish in
addition to the mortality risk. This fits theoretically with the body of
research showing that penile cancer is a serious condition, especially for some
high-risk individuals. According to previous reserach, the physical deformity
brought on by cancer can disrupt regular sexual activity, cause psychological
and emotional distress, and alter typical male urination patterns (Morrison,
2015).
Based on
empirical research, Squamous Cell Carcinoma (SCC) is the most common subtype of
penile cancer, accounting for approximately 95% of cases. This is consistent
with earlier research which also found that SCC was the most prevalent subtype (Wang
et al., 2022). The study also emphasizes
the existence of other, less frequent subtypes, such as verrucous carcinoma,
which makes up only 5% to 16% of squamous cell carcinomas in the penis. This is
consistent with the body of research showing that verrucous carcinoma is an
uncommon kind of penile cancer linked to phimosis, tight prepuce, lack of
circumcision, and poor hygiene.
Additionally, the
study finds a correlation between high-risk HPV infections-specifically,
strains 16 and 18�and penile SCC. This is in line with earlier research showing
that HPV infection-more especially, strains 16 and 18 is a major risk factor
for the development of penile cancer. As actively transcribed by HPV-infected
cells, viral oncogenes E6 and E7 are most likely the mechanism through which
HPV causes penile cancer.
The study also
recognizes technical issues that could affect the precision of diagnostic
evaluations, especially in the context of procedures like partial penectomy,
such as sampling errors and neglect to examine correctness. This emphasizes how
crucial comprehensive assessment and quality control procedures are to the
management of penile cancer cases (Ahmed
et al., 2021).
In summary, the
research findings advance our knowledge of penile cancer, including its
subtypes, risk factors, and related difficulties. While empirical data supports
the incidence of SCC and its link to HPV infection, theoretical insights
highlight the seriousness of the condition. The research's underlying
presumptions highlight the significance of early detection, precise diagnosis,
and quality control in the successful management of penile cancer.
CONCLUSION
Penile carcinoma is an
uncommon occurrence and is usually diagnosed late. It generally affects older
men, so the treatment given should not be aggressive, except in cases with
aggressive behaviour. This case highlights the complexity of penile cancer and
emphasizes the value of thorough assessment, precise diagnosis, and prompt
intervention in maximizing patient outcomes. In order to better understand the
disease mechanisms, improve diagnostic methods, and improve treatment
strategies for those affected by penile cancer, more research and clinical
efforts are necessary.
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Received: 07-02-2023 �������������������� ������������� Accepted: 01-03-2024 �������������������� ��������������Published: 25-03-2024����� 