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Auto-amputation of penis due to advanced carcinoma penis
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  1. Gaurav Garg1,
  2. Nupur Bansal2,
  3. Pragya Dixit3,
  4. Ashish Sharma1
  1. 1Urology, King George’s Medical University, Lucknow, Uttar-Pradesh, India
  2. 2Radiotherapy, King George’s Medical University, Lucknow, Uttar-Pradesh, India
  3. 3Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  1. Correspondence to Dr Gaurav Garg, gougarg{at}gmail.com

https://doi.org/10.1136/bcr-2018-226505

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    Description

    A 82-year-old Indian male patient was referred with complaints of the wound in right inguinal region for the last 15 days. He initially presented to a primary care centre with complaints of a progressive ulcer over penis for 12 months and swelling in right inguinal region for the last two months. He also revealed sloughing of penile tissue 1 month back. The discharged card mentioned that the patient received antibiotics and underwent incision/drainage of the inguinal abscess under anaesthesia. He also had difficulty in micturition. The patient denied any history of sexually transmitted disease or local trauma. Clinical examination revealed almost complete loss of phallus. (figure 1). There was evidence of abscess in right inguinal region and hard matted nodes palpable in the left inguinal region. Metastatic workup revealed evidence of distant metastases. Biopsy from the base of residual penile stump revealed squamous cell carcinoma (figure 2). The patient underwent suprapubic cystostomy and was given palliative care for his symptoms but he succumbed in the next 15 days. In the present case, the patient neglected his initial symptoms and eventually developed penile auto-amputation, inguinal abscess and widespread metastasis. Advanced presentations of carcinoma penis occur due to ignorance and social stigma despite availability of sophisticated healthcare technology.1 Auto-amputation of the penis due to carcinoma penis is very rarely reported in the literature.2 Ghosh et al proposed that auto-amputation of the penis can occur either due to tumour emboli blocking end arteries or due to direct tumour invasion.3 Mumoli et al reported a similar case report of metastatic carcinoma penis presenting with auto-amputation in a 75-year-old man.4

    Figure 1
    Figure 1

    Clinical image depicting the almost complete loss of phallus with an abscess in the right inguinal region.

    Figure 2
    Figure 2

    Histopathological image showing malignant epithelial cells disposed of in sheets and clusters. Individual atypical cells are pleomorphic with high nucleo cytoplasmic ratio, hyperchromatic nuclei, inconspicuous nucleoli and a moderate amount of cytoplasm. Occasional keratin pearls are also seen.

    Learning points

    • Auto-amputation of the penis due to carcinoma penis is very rare.

    • Auto-amputation of the penis can occur due to advanced and neglected carcinoma penis.

    • Despite availability of advanced healthcare technology, advanced presentations of carcinoma penis occur due to ignorance and social stigma.

    References

    1. ↵
      1. Skeppner E,
      2. Andersson SO,
      3. Johansson JE, et al
      . Initial symptoms and delay in patients with penile carcinoma. Scand J Urol Nephrol 2012;46:319–25.doi:10.3109/00365599.2012.677473
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      1. Pettaway CA,
      2. Lynch DF,
      3. Davis JW. et al.
      Tumors of the penis. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, . eds. Campbell-Walsh Urology. 9th edn. Philadelphia: Saunders-Elsevier, 2007:959–92.
    3. ↵
      1. Ghosh B,
      2. Manikandan R,
      3. Dorairajan LN, et al
      . Auto-amputation of penis due to carcinoma: still a threat in the era of modern medicine: report of two cases. Indian J Dermatol Venereol Leprol 2013;79:224–6.doi:10.4103/0378-6323.107641
      OpenUrl
    4. ↵
      1. Mumoli N,
      2. Giorgi-Pierfranceschi M,
      3. Porta C, et al
      . Penile self-amputation. Intern Emerg Med 2018.doi:10.1007/s11739-018-1899-6
    View Abstract

    Footnotes

    • Contributors GG and NB: concept, design, supervision, processing, writing manuscript and critical analysis. AS and PD: supervision, processing, writing manuscript and critical analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.