Penile Cancer: Squamous Cell Carcinoma In Situ
An 82-year-old man is seen for annual physical examination in the nursing home. He has resided there for 1 year because of the aggregate impact of multiple medical problems including, most prominently, laryngeal swallowing dysfunction associated with vocal cord paralysis.
HISTORY
An 82-year-old man is seen for annual physical examination in the nursing home. He has resided there for 1 year because of the aggregate impact of multiple medical problems including, most prominently, laryngeal swallowing dysfunction associated with vocal cord paralysis. Among many interventions, has had laryngoplasty, arytenoid reduction, and Teflon injection of the vocal cords; despite these, he continues to have recurrent aspiration pneumonia. A percutaneous endoscopically placed gastrostomy (PEG) was performed; subsequently, orders stipulated nutrition and fluid exclusively through PEG tube, but he is often found noncompliant: eating popcorn.
PHYSICAL EXAMINATION
Pleasantly interactive man whose voice is very soft owing to his vocal cord paralysis. PEG site not inflamed. Chest shows good air exchange, and no crackles, rhonchi, or wheezes. Penis as shown.
"WHAT'S YOUR DIAGNOSIS?"
ANSWER: SQUAMOUS CELL CARCINOMA IN SITU OF THE PENIS
Figure 1 – Biopsy from this case shows architectural failure of maturation throughout the epithelium. Miniscule granular layer produces the thin keratin covering. Subepithelium looks edematous and mildly infiltrated with lymphocytes. (Hematoxylin and eosin stain, original magnification ×100.)
Most of the penile shaft shows no abnormality, whereas the area abutting the retrocoronal sulcus looks thickened, pinker, and less wrinkled, as though it formed a kind of collar. Nowhere is its surface markedly irregular or ulcerated. The tiny bit of brown-yellow matter halfway down might be dried serum (or extrinsic dirt, or a tiny residue of urine from underclothing). A minute papular elevation at the inferior margin of this collar is utterly nondescript.
The glans is mostly normal, but a flat red wedge occupies the left edge. The far side of this red area is not in view. The tissue is not moist or macerated; there is no heaped-up border, no central ulcer or exophytic mass, and no satellite lesions. One could well treat empirically for presumptive fungal balanitis; in this instance, such intervention would not yield any healing, for the red patch is a focus of intraepithelial carcinoma (carcinoma in situ).
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