Scrotal abscess as initial presentation of squamous cell carcinoma

Multimodal Therapy for Locally Advanced Scrotal Cancer: A Case Report With a Literature Review

Cancer of the scrotum is a rare tumor. It is often not diagnosed early, and its treatment poses difficulties for practicing oncologists. We report the case of a patient treated for locally advanced squamous cell carcinoma (SCC) of the scrotum, with a review of the literature. It's about a 66-year-old man, who had been complaining two years ago of an ulcerated lesion at the scrotal region neglected by the patient. However, he presented with a large ulceration on the left inguinal region, for which, the pathological study showed an SCC. CT scan found a left inguinal tumoral process invading the adjacent soft tissues and infiltrating the left spermatic cord without distant localizations. Surgical excision of the inguinal lesion was considered unfeasible, then, an excision of the scrotal lesion was done and the pathological study identified an SCC of the scrotum with clear margins classified T1 N3 M0. Given that inguinal lymph node dissection (LND) was not feasible, concomitant chemo-radiotherapy was indicated at a total dose of 70 Gy in 35 fractions of 2 Gy concomitantly with weekly platinum-based chemotherapy, with good evolution after four months.

Squamous cell carcinoma of the scrotum in HIV: two case reports

Background

Squamous cell carcinoma (SCC) of the scrotum was the first malignancy known to be associated with exposure to an occupational carcinogen—in this case, soot trapped in the breeches of chimney sweeps. Better civil rules and regulations and the replacement of hearths with other forms of heating have rendered SCC of the scrotum a rarity. We report two cases of scrotal SCC with vastly differing clinical presentations and management.

Case presentation

Case 1 had T1 N0 M0 disease and presented with a small (< 2 cm), innocuous-looking, non-healing ulcer of eight years duration. A punch biopsy revealed a superficially invasive SCC confirmed on immunohistochemical profiling. A wide local excision of the lesion was subsequently performed. Follow-up at three years showed no signs of recurrence. Case 2 presented with T4 N1 M1 disease and rapidly progressing locally destructive mass. A punch biopsy of the scrotal lesion confirmed invasive moderately differentiated focally keratinising SCC. The metastatic evaluation confirmed the presence of metastatic, extensive para-aortic lymphadenopathy. He was managed with cisplatin-based chemoradiotherapy.

Conclusion

Early detection and management of patients with SCC of the scrotum are essential. If the diagnosis is delayed, treatment options become limited, and the prognosis is poor. Notwithstanding the rarity of this disease, multicentre trials are needed to provide more precise guidelines as to the optimal management of these patients.

Fournier's Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature

Most case series of Fournier's gangrene (FG) do not list malignancy as a cause; however, isolated cases with underlying malignancy of the soft tissue, genitourinary, and gastrointestinal systems have been described. After a review of recently published literature, 20 case reports and 15 case series or review articles included relevant information and were included in this literature review.

Malignancy is overlooked in 10% (2/20) of patients, resulting in a delayed diagnosis and initiation of cancer treatment. All patients with FG should have a thorough cancer history, digital rectal examination, appropriate local and systemic imaging, as well as tissue biopsies, to reduce the likelihood of a missed cancer diagnosis. Delay in management of the local malignancy may lead to persistence or recurrence of the infection and significantly worsens overall outcome and survival.

SCROTAL SQUAMOUS CELL CARCINOMA AND ASSOCIATED BLINDNESS: A CASE REPORT AND LITERATURE REVIEW

BACKGROUND

Carcinoma of the scrotum is a rare disease which has been linked with occupational exposure to certain industrial carcinogens. Scanty reports of scrotal carcinoma exist in literature but in very few places worldwide. To our knowledge, there has been one documented report of scrotal carcinoma in our country and this is the first report of scrotal carcinoma in over 45years existence of our tertiary Health institution. We present the clinical evaluation, investigations and surgical intervention of a blind elderly welder with squamous cell carcinoma of the scrotum at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.

CASE PRESENTATION AND MANAGEMENT

A 65 year-old blind welder presented to us with a painless fungating scrotal mass of two years' duration. He had prior incision and drainage of the swelling in a primary health centre but this failed to heal, with copious purulent discharge. The mass measured 20cm x 15cm x 8cm and was inseparable from the right testis and cord structures, with infiltration of the root of the penis. The inguinal lymph nodes were not enlarged. CT scan confirmed localized scrotal tumour and biopsy confirmed squamous cell carcinoma.He subsequently had wide local excision of the scrotal tumour (with at least 2cm free margins), right total orchidectomy and advancement flap closure of scrotal defect. Histopathological reports corroborated the earlier findings and confirmed tumour free margins. He has remained well 18 months after surgery.

CONCLUSION

Squamous cell carcinoma of the scrotum, though rare, is the commonest malignancy affecting the scrotum worldwide. Surgery still remains the mainstay of treatment and early intervention improves the chances of a favourable outcome.

[Reconstructive methods after Fournier gangrene]

BACKGROUND

Fournier's gangrene is a variant of the necrotizing fasciitis restricted to the perineal and genital region. It presents as an acute life-threatening disease and demands rapid surgical debridement, resulting in large soft tissue defects. Various reconstructive methods have to be applied to reconstitute functionality and aesthetics. The objective of this work is to identify different reconstructive methods in the literature and compare them to our current concepts for reconstructing defects caused by Fournier gangrene.

METHODS

Analysis of the current literature and our reconstructive methods on Fournier gangrene.

RESULTS

The Fournier gangrene is an emergency requiring rapid, calculated antibiotic treatment and radical surgical debridement. After the acute phase of the disease, appropriate reconstructive methods are indicated. The planning of the reconstruction of the defect depends on many factors, especially functional and aesthetic demands. Scrotal reconstruction requires a higher aesthetic and functional reconstructive degree than perineal cutaneous wounds. In general, thorough wound hygiene, proper pre-operative planning, and careful consideration of the patient's demands are essential for successful reconstruction.

CONCLUSIONS

In the literature, various methods for reconstruction after Fournier gangrene are described. Reconstruction with a flap is required for a good functional result in complex regions as the scrotum and penis, while cutaneous wounds can be managed through skin grafting. Patient compliance and tissue demand are crucial factors in the decision-making process.