Squamous Cell Carcinoma of the Male Urethra Mimicking a Paravertebral Abscess

Angulo, Javier; Larrinaga, Jose R.; Unda-Urzaiz, M.; Ereño, Cosme; Flores, Nicolás

doi:10.1159/000282308

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…To our knowledge only four other cases have been reported where a urethral abscess was subsequently diagnosed as a Urothelial carcinoma [7][8][9][10]. In 3 out of the previous 4 documented cases the patient was treated with multiple debridements and the administration of broad spectrum antibiotics without resolution, and there was a delayed time to histopathological diagnosis as in our case.…”

Section: Discussionmentioning

confidence: 65%

Urethral squamous cell carcinoma presenting as a Fourniere’s Gangrene

Christie¹,

Lawrentschuk²,

Chauhan³

et al. 2017

Clin Case Rep Rev

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Urothelial carcinoma is a rare but aggressive Urological malignancy that accounts for less than 1% of urological malignancies [1]. The age standardised ratio is estimated as 1.1/1,000,000 [2]. It is often difficult to diagnose given its non-specific symptoms which include pain, dysuria, obstructive voiding, or urethral strictures [3]. We review a case of Urethral Squamous cell carcinoma (SCC) presenting as Fourniere's Gangrene and highlight the challenges in management of the condition.A 47 year old man presented with a 2 month history of scrotal pain. A gangrenous urethra and a perineal abscess with frank pus draining from a sinus were noted on physical examination. Multiple debridements of the left hemiscrotum and perineum were performed at an outside hospital, without resolution of the Fourniers, depite 3 hospital admissions. Eventually, histopathology following a urethrectomy demonstrated a Urethral SCC. Magnetic resonance imaging (MRI) confirmed a lesion involving the Corpora Spongiosum with Spermatic cord involvement and Positron emission tomography showed an FDGavid lesion in the groove between the anterior abdominal wall and the penile bulb. It was noted on Examination under anaesthesia of the rectum that the lower border of the tumour abutted and invaded the sphincter complex. Prominent Inguinal Lymph nodes were biopsied but demonstrated no evidence of SCC.In the absence of distal metastases, the multidisciplinary consensus was for a Total Pelvic Exenteration with curative intent.Intraoperative findings demonstrated a fungating growth at the penoscrotal junction arising from the penile urethra. There was involvement of the scrotal skin, right testicle, spermatic cord and perineum and the tumour extended above the anal sphincter. High anterior resection was performed with en bloc cystoprostatectomy, penectomy and scrotectomy with ileal conduit and end colostomy creation (Figures 1 and 2). A right sided myocutaneous anterolateral thigh flap and a left myocutaneous vertical rectus abdominus flap were used to reconstruct the groin and perineal defects (Figure 3).The Final histopathology demonstrated a 70 mm well differentiated squamous cell carcinoma of the spongy part of the urethra, invading corpus spongiosum and adipose stroma with a maximum radial invasive thickness of 20mm, well clear of surgical margins. The patient had a relatively uneventful recovery and on 3monthly review the abdominal wound and the myocutaneous flaps had healed well. DiscussionCurrent evidence remains inconclusive in regards to long term survival following treatment, however, Urethral SCC is generally associated with a poor 5 year survival rate of 5 -15% [4]. Treatment

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Section: Discussionmentioning

confidence: 65%

Urethral squamous cell carcinoma presenting as a Fourniere’s Gangrene

Christie¹,

Lawrentschuk²,

Chauhan³

et al. 2017

Clin Case Rep Rev

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“…FNAC for urethral lesions have been reported. [12][13][14][15] We do not believe that FNAC would result in a fistula. In addition, as surgery is the treatment of choice for urethral carcinoma, the whole region would be included in the surgical excision.…”

Section: Casementioning

confidence: 86%

Cytological diagnosis of nonulcerative penile neoplasms: Report of two cases

Harish

Alva

Kumar

et al. 2003

Diagnostic Cytopathology

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Nonulcerative penile mass lesions are rare. Pathological diagnosis of these lesions would traditionally be a biopsy. We report two such primary penile lesions which were diagnosed by fine-needle aspiration cytology (FNAC). Both lesions were present in the shaft and were diagnosed as squamous cell carcinoma (SCC). The first patient had a recurrence on the penile stump of partial amputation without any ulceration. The second had a primary urethral carcinoma on the terminal penile shaft infiltrating the corpora cavernosa dorsally. Open biopsies were avoided in both cases. FNAC was associated with very little and tolerable discomfort. There were no complications. The aspirate yield was sufficient for cytological diagnosis. FNAC of nonulcerated penile lesions is safe, well tolerated, and capable of providing a cytological diagnosis. Hence, it is a very useful outpatient procedure and could be the procedure of choice for diagnosis.

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“…A periurethral abscess is a formation of tender inflammed area in the perineum, or under the shaft of penis in the paraurethral glands of Cowper and/or Litre's. These are usually caused by the gonococci to begin with; which are rarely isolated from the pus sample as abscesses soon become secondarily invaded with other pathogens [3]. Cowper gland's abscess is frequently diagnosed as "syringocele", however Litre's gland abscess is very rare.…”

Section: Dear Sirmentioning

confidence: 99%

“…It has been postulated that the pathogenesis of periurethral abscess may evolve into a urethral stricture with subsequent urethral disruption and extravasation of infected urine [5]. Rarely, a urethral carcinoma may be implicated in the pathogenesis [3]. Treatment consisted of abscess drainage, suprapubic urinary diversion and intravenous antibiotic therapy [5].…”

Section: Dear Sirmentioning

confidence: 99%