Deep-seated sarcomas of the penis

Fibrosarcoma of the corpus cavernosum: case report and literature review

Background

Fibrosarcoma is a very rare tumor that arises from fibrous tissue. Less than 5% of fibrosarcoma originate from the urogenital tract. Penile fibrosarcoma, even more rare, is characterized by pain, enlargement, penile erection and urinary tract obstruction. To our knowledge, this is the second reported case named “fibrosarcoma of the corpus cavernosum”.

Case presentation

A 51-year-old male presented with a 1-month history of penis pain during erection. CT scan showed a soft tissue mass arising from the proximal part of the penis. We diagnosed it as penile sarcoma, performing local excision. The postoperative pathological result was moderately differentiated fibrosarcoma. 3 months later, CT scan showed the recurrence of the tumor, and multiple metastases. Although he received chemotherapy, he died 10 months after surgery.

Conclusions

Fibrosarcoma of the corpus cavernosum is rare and have poor prognosis. Total penile amputation may be the best treatment. The effects of chemotherapy are limited. No more effective treatment has been found for a disseminated disease to date.

Rare urologic tumors

PURPOSE OF REVIEW

Management of genitourinary malignancy is likely to encompass a large portion of most of the urologist's practice. The challenge for the modern urologist is not only in understanding the management of commonly seen genitourinary malignancies, but also in recognizing unusual variants and their differences in management. This is evermore important as new technologies have refined the ability to identify rare entities. This review presents a brief overview of the various genitourinary malignancy subtypes seen within urology.

RECENT FINDINGS

All major organ subtypes are highlighted along with an overview of the current understanding of their associated malignancies. An update on the current state management paradigms as well as future directions is also outlined.

SUMMARY

After reading this review, the urologist should have a deeper understanding of the breadth of disorders in genitourinary oncology and a clearer approach to the management of these problems. Additionally, ongoing avenues for research are highlighted.

[Malignant fibrous histiocytoma of the penis]

According to the most recent World Health Organization (WHO) guidelines a diagnosis of malignant fibrous histiocytoma (MFH) should be made only for lesions composed of tumor cells without evidence of a specific line of differentiation. This is therefore a diagnosis by exclusion which is why the name of undifferentiated high-grade pleomorphic sarcoma (UPS) should be preferred. Soft tissue sarcomas currently have an incidence in all body regions of approximately 20 cases per 1 million inhabitants per year. Soft tissue tumors of the penis represent approximately 5 % of all penile tumors and the incidence of penile sarcomas is estimated to be approximately 0.6-1 case per 100,000 patients. Only seven cases have so far been reported in the literature. This article describes the case of a 61-year-old Caucasian male who presented with a painless mass sited in the upper part of the corpus cavernosa. An incisional biopsy with a subsequent investigation using an extensive immunohistochemical panel were performed and a high-grade undifferentiated pleomorphic sarcoma or pleomorphic storiform MFH was diagnosed. In addition to the case report a literature review is presented to elaborate the discussion on the differential diagnoses of these kinds of lesions.

Dermatofibrosarcoma protuberans of penis: Case report and literature review

Dermatofibrosarcoma protuberans (DFSP) is a rare mesenchymal skin tumor with intermediate to low grade malignancy and occasional distant metastasis and high rate of recurrence locally. It mostly involves trunk, extremities, scalp, and neck. This article describes a middle-aged married male with a DFSP lesion involving ventral aspect of glans and distal shaft of penis who underwent local excision and primary closure. The patient was tumor-free at three years of follow-up.

[Malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma of the penis: a case report]

We report the case of a malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma (MFH/UPS) of the penis in a 78-years-old-man who had undergone previous radical prostatectomy, external beam radiation therapy for prostatic adenocarcinoma. The mass was a 9-cm firm lesion at the base of the penis predominantly composed of malignant spindle cells arranged in sweeping fascicles and storiform pattern. The tumor cells stained for vimentin, beta-smooth muscle actin, S-100, and were negative for keratin, desmin, Melan A, PSA. Despite total penectomy, he developed a local reccurence 4 months after surgery, and died from dissemination 6 months after surgery. This is the 8th case of penile MFH/UPS.

Non-squamous cell carcinoma of the penis: single-center, 15-year experience

PURPOSE

Penile cancer is a rare malignancy with less than 5 % being non-squamous cell carcinoma (SCC) primary malignancies. We report our 15-year experience of treating non-SCC penile cancer at a tertiary care cancer center.

METHODS

We identified 12 patients with non-SCC of the penis from 1996 to 2012. Demographic and clinical data were abstracted, including histological type, surgical treatment, adjuvant therapy, and clinical course.

RESULTS

Five patients had sarcoma (three leiomyosarcoma, one spindle cell carcinoma, and one epithelioid sarcoma), four had melanoma, two had extramammary Paget's disease (EPD), and one had sebaceous carcinoma. Median follow-up was 37.5 months (mean 45.8 months). Tumor staging for melanoma was pT1aN3, pTisNx, pTxNxM1b, and pT3bN0. Patients with melanoma were treated with penile sparing surgery; two are alive without disease, one is alive with disease, and one patient with metastasis at presentation died of disease at 16.3 months. The patients with sarcoma and deep-seated or node-positive disease died of disease at a mean of 49.7 months. Two patients with EPD were treated with wide local excision of the lesions and were both pT1Nx. The remaining patient had sebaceous carcinoma treated with excisional biopsy and was free of disease at 32.0 months.

CONCLUSIONS

Non-SCC of the penis is primarily treated surgically, with the goal of complete excision at the time of treatment. The utilization of lymphadenectomy is less clear in these malignancies, but aggressive approaches should be considered in appropriate patients. Tumor stage and nodal status are important in determining patient outcomes.

Leiomyosarcoma of the corpus cavernosum mimicking a Peyronie's plaque

Peyronie's disease is relatively frequent and can cause pain and penile induration. Penile soft tissue tumors, however, are exceptional, with fewer than 45 cases reported since 1930. Some clinical and imagery elements could lead to earlier diagnosis through biopsy, enabling more extensive resections and, ultimately, better prognosis.

Leiomyosarcoma of the penis presenting as a cutaneous lesion

We report a case of a 68-year-old man with cutaneous leiomyosarcoma of the penis. Leiomyosarcoma of the penis is an extremely rare neoplasm that usually presents in middle to old age, and to our knowledge only approximately 30 cases have been reported in the literature to date. This is an important diagnosis in the differential diagnosis of cutaneous spindle cell neoplasms of the male genital tract.