Case Letter
Beefy red asymptomatic penile lesion: unusual presentation of squamous cell carcinoma
Seema Rani
, Kabir Sardana, Arvind Ahuja
Corresponding author
Dr Ram Manohar Lohia Hospital, New Delhi, India
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Células atípicas com empilhamento nuclear, perda de polaridade, falta de maturação na superfície epitelial, alta relação N:C, núcleos hipercromáticos e múltiplas figuras mitóticas. Alteração focal de células claras é observada na junção do epitélio atípico e epitélio normal (Hematoxilina & eosina, 40×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Seema Rani, Kabir Sardana, Arvind Ahuja" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Seema" "apellidos" => "Rani" ] 1 => array:2 [ "nombre" => "Kabir" "apellidos" => "Sardana" ] 2 => array:2 [ "nombre" => "Arvind" "apellidos" => "Ahuja" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059621000647" "doi" => "10.1016/j.abd.2020.06.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621000647?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221000667?idApp=UINPBA00008Z" "url" => "/26662752/0000009600000003/v2_202105280710/S2666275221000667/v2_202105280710/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059621000702" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.06.020" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "351" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Crusted scabies mimicking psoriasis in a patient with type 1 diabetes mellitus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "386" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 560 "Ancho" => 750 "Tamanyo" => 66693 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin biopsy from glans showed hyperkeratosis, acanthosis of stratum malpighii. 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Dermis had inflammatory cell infiltration rich in eosinophils and lymphocytes (Hematoxylin & eosin stain, original magnification, ×20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yuanyuan Wang, Yeqiang Liu, Fu-Quan Long" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Yuanyuan" "apellidos" => "Wang" ] 1 => array:2 [ "nombre" => "Yeqiang" "apellidos" => "Liu" ] 2 => array:2 [ "nombre" => "Fu-Quan" "apellidos" => "Long" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275221000722" "doi" => "10.1016/j.abdp.2020.06.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221000722?idApp=UINPBA00008Z" ] ] "EPUB" => 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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "383" "paginaFinal" => "384" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Seema Rani, Kabir Sardana, Arvind Ahuja" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Seema" "apellidos" => "Rani" "email" => array:1 [ 0 => "drseemashekhar@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Kabir" "apellidos" => "Sardana" ] 2 => array:2 [ "nombre" => "Arvind" "apellidos" => "Ahuja" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dr Ram Manohar Lohia Hospital, New Delhi, India" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 724 "Ancho" => 905 "Tamanyo" => 164083 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Beefy red asymptomatic penile lesion: unusual presentation of squamous cell carcinoma. Atypical cells with nuclear overcrowding, loss of polarity, lack of surface maturation, high N:C ratio, hyperchromatic nuclei, and multiple mitotic figures. Focal clear cell change is noted at the junction of atypical epithelium and normal epithelium (Hematoxylin & eosin, ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 65-year-old male was presented with a lobulated beefy red plaque on his penile shaft with a two-month duration. During the physical examination there was a well-defined non-tender erythematous, lobulated, sessile with a growth of size of approximately 5 × 3 cm involving glans, coronal sulcus and the penis shaft (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no lymphadenopathy. Initially, the patient had mild pruritus and with subsequent interval of time noticed tiny penile growth which gradually progressed to an increased present size in a two-month duration, along with some difficulty to retract the prepuce. No history of dysuria was present. He was otherwise in good health. His family, medical and social history was non-contributory. He had history of smoking for 20 to 25 years, and quit smoking for the last 5-year period.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Even though the patient denied any sexual contact, a differential diagnosis of condyloma acuminate, condyloma lata and granuloma inguinale were kept with other remote differentials, which were verruciform xanthoma and squamous cell carcinoma. All biochemical and haematological investigations including lipid profile, liver function test, kidney function test, serum electrolytes, routine and a microscopic examination of urine and complete blood count were within normal limit. Dark ground microscopy for <span class="elsevierStyleItalic">Treponema pallidum</span> and tissue-smear for Donovan bodies were negative. A serological test for syphilis and Elisa for HIV Type 1 and 2 were negative. The initial biopsy specimen reported condyloma accuminata with squamous cell showing loss of polarity without any cytological atypia. Repeat biopsy was sent, which was consistent with squamous cell carcinoma with papillary features (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). An ultrasound of the abdomen and pelvis was done, which were normal. A surgical excision was done and this re-confirmed the diagnosis of squamous cell carcinoma in situ.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The asymptomatic beefy red lobulated plaque on the penile region has various differentials. As the patient had a negative tissue smear, the possibility of Condyloma acuminata and verruciform xanthoma was kept. Verruciform xanthoma is a rare entity that principally involves the mouth. Genitalia are the next most frequently affected area, where it presents itself as a painless, yellow-brown, or red, verrucous, sessile, or papillary plaque. As the patient had no regional lymph node enlarged, squamous cell carcinoma was not considered as a first differential. Also, there was no pre-existing lesion which can predispose to the development of squamous cell carcinoma. Nonetheless, the biopsy confirmed a diagnosis of squamous cell carcinoma in situ. Squamous cell carcinoma is the most common tumor of the penis, and presents itself either as a flat growth, infiltrating, or papillary growth, or a hard painless lump. Penile carcinoma is mainly a localized disease (39%), with carcinoma-in-situ making up 37% of the total penile carcinoma cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is most commonly diagnosed in elderly patients (50–70 years).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It has a higher incidence in the developing countries and is most commonly on the glans penis (48%), followed by the prepuce (25%), the glans and the prepuce (9%), coronal sulcus (6%) and on the shaft (< 2%). Ninety-five percent of these malignancies are squamous cell carcinomas.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our case was initially seen in the STD referral center, hence the diagnosis of squamous cell carcinomas was not considered as a first differential. The lack of any other predisposing factors and lack of regional lymph node involvement might have been a reason for a clinical diagnosis of condyloma acuminate and granuloma inguinale. The short history with no associated risk factors for malignancy is another reason for not considering squamous cell carcinoma.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The treatment of squamous cell carcinomas in situ is local excision, though partial penectomy and monthly follow-ups for at least 1 year is appropriate for patients with small, well-differentiated primary tumors. Patients who have large or moderately to poorly differentiated primary tumors probably should undergo partial or total penectomy and immediate ilioinguinal lymphadenectomy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the absence of inguinal metastases, patients with invasive squamous cell carcinomas of the penis involving the glans or the distal part of the shaft who undergo adequate partial amputation have a long-term survival rate of 70%–80%. Of patients with involved lymph nodes, 40%–50% can be cured with lymph node dissection, whereas untreated patients usually die within 2–3 years.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In this case, partial penectomy was done.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This case elegantly demonstrates the possibility of squamous cell carcinoma even without any predisposing factors, which can mimic common sexually transmitted disease, herein Condyloma acuminata and granuloma inguinale. Needless to say, in doubtful cases a repeat biopsy is warranted, as demonstrated in our case, to enable correct management in such circumstances.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Seema Rani: Approval of the final version of the manuscript; collection, analysis, and interpretation of data; critical review of the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Kabir Sardana: Approval of the final version of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Arvind Ahuja: Approval of the final version of the manuscript; collection, analysis, and interpretation of data.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-23" "fechaAceptado" => "2020-06-16" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Rani S, Sardana K, Ahuja A. Beefy red asymptomatic penile lesion: unusual presentation of squamous cell carcinoma. An Bras Dermatol. 2021;96:383–4.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Department of Dermatology, Dr Ram Manohar Lohia Hospital, New Delhi, India.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 681 "Ancho" => 905 "Tamanyo" => 85359 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Well defined, erythematous, fleshy, lobulated, sessile growth involving glans, coronal sulcus and shaft of penis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 724 "Ancho" => 905 "Tamanyo" => 164083 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Beefy red asymptomatic penile lesion: unusual presentation of squamous cell carcinoma. Atypical cells with nuclear overcrowding, loss of polarity, lack of surface maturation, high N:C ratio, hyperchromatic nuclei, and multiple mitotic figures. Focal clear cell change is noted at the junction of atypical epithelium and normal epithelium (Hematoxylin & eosin, ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contemporary management of penile squamous cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.K. Kroon" 1 => "S. Horenblas" 2 => "O.E. 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Prakasam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7860/JCDR/2013/4098.2826" "Revista" => array:6 [ "tituloSerie" => "J Clin Diagn Res" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "563" "paginaFinal" => "565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23634424" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer of the penis. Prognosis and treatment plans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.E. Fraley" 1 => "G. Zhang" 2 => "R. Sazama" 3 => "P.H. Lange" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(19850401)55:7<1618::aid-cncr2820550735>3.0.co;2-r" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1985" "volumen" => "55" "paginaInicial" => "1618" "paginaFinal" => "1624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3978557" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Penile amputations for the management of primary carcinoma of the penis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Das" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Urol Clin North Am" "fecha" => "1992" "volumen" => "19" "paginaInicial" => "277" "paginaFinal" => "282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1574818" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009600000003/v2_202106040718/S0365059621000647/v2_202106040718/en/main.assets" "Apartado" => array:4 [ "identificador" => "82769" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009600000003/v2_202106040718/S0365059621000647/v2_202106040718/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621000647?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 8 | 29 |
| 2024 October | 129 | 71 | 200 |
| 2024 September | 173 | 79 | 252 |
| 2024 August | 181 | 116 | 297 |
| 2024 July | 139 | 113 | 252 |
| 2024 June | 107 | 81 | 188 |
| 2024 May | 88 | 69 | 157 |
| 2024 April | 120 | 81 | 201 |
| 2024 March | 97 | 81 | 178 |
| 2024 February | 87 | 83 | 170 |
| 2024 January | 71 | 46 | 117 |
| 2023 December | 61 | 65 | 126 |
| 2023 November | 66 | 77 | 143 |
| 2023 October | 63 | 75 | 138 |
| 2023 September | 84 | 78 | 162 |
| 2023 August | 84 | 54 | 138 |
| 2023 July | 66 | 34 | 100 |
| 2023 June | 74 | 45 | 119 |
| 2023 May | 84 | 35 | 119 |
| 2023 April | 110 | 24 | 134 |
| 2023 March | 144 | 45 | 189 |
| 2023 February | 90 | 34 | 124 |
| 2023 January | 131 | 47 | 178 |
| 2022 December | 95 | 30 | 125 |
| 2022 November | 133 | 48 | 181 |
| 2022 October | 163 | 66 | 229 |
| 2022 September | 111 | 66 | 177 |
| 2022 August | 86 | 54 | 140 |
| 2022 July | 78 | 59 | 137 |
| 2022 June | 96 | 68 | 164 |
| 2022 May | 109 | 47 | 156 |
| 2022 April | 105 | 47 | 152 |
| 2022 March | 95 | 77 | 172 |
| 2022 February | 88 | 42 | 130 |
| 2022 January | 97 | 70 | 167 |
| 2021 December | 80 | 58 | 138 |
| 2021 November | 86 | 63 | 149 |
| 2021 October | 118 | 89 | 207 |
| 2021 September | 115 | 64 | 179 |
| 2021 August | 95 | 60 | 155 |
| 2021 July | 71 | 62 | 133 |
| 2021 June | 117 | 97 | 214 |
| 2021 May | 63 | 81 | 144 |
| 2021 April | 224 | 254 | 478 |
| 2021 March | 33 | 55 | 88 |
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