Vol 44 # 4 December 2012 - Kma.org.kw

December 2012
KUWAIT MEDICAL JOURNAL 338
Case Report
Squamous Cell Carcinoma of the Penis:
Magnetic Resonance Imaging Findings
Ibrahim Hamed, Hasan Almutairi, Muneera Al-Adwani
Department of Clinical Radiology, Al-Jahra Hospital, Kuwait
Kuwait Medical Journal 2012; 44 (4): 338 - 340
ABSTRACT
Most primary penile malignancies are squamous cell
carcinoma (SCC) and occur most often during the 6 th and 7 th
decades of life. Uncircumcised men are more often affected,
probably because of the chronic irritative effect of smegma. An
association between human papilloma viruses 16 and 18 and
SCC of the penis has also been reported. We describe a case of
a 43-year-old uncircumcised Asian male patient who presented
with an ulcerating penile mass. MRI images were helpful in
making a preoperative diagnosis of penile cancer. MR imaging
can play an important role in the evaluation of a penile mass.
KEY WORDS: penile mass, penile SCC, MRI of penis
INTRODUCTION
Squamous cell carcinoma (SCC) of the penis usually
begins on the glans as a focal epithelial thickening
with or without ulceration [1] . The lesions are generally
not painful, and affected patients often delay seeking
medical attention [2] . After penectomy with 2 cm
margins, patients with tumors that have not invaded
the corpora cavernosa have a greater than 95% 3-year
survival rate [3] . Survival decreases markedly with
cavernosal invasion or with spread to regional lymph
nodes [4] . Although not often performed in the acute
setting, MR imaging can play an important role in the
evaluation of penile mass [5] . Ultrasound (US) can help
detect solid penile mass in the majority of patients [6] .
CASE HISTORY
An Indian uncircumcised male patient aged 43
years presented with a painless penile mass of sixmonth
duration. The clinical examination revealed
a solid mass lesion underneath the foreskin and the
patient was referred to our department for an MRI. MRI
revealed a solid isointense to low signal intensity mass
lesion both on T1-wieghted (Fig. 1) and T2-wieghted
(Fig. 2) images, mainly located at the left lateral aspect
of the glans of the penis extending to its dorsal aspect
with a definite invasion of the hypointense adjacent
tunica albuginea (Fig. 3). However, the urethra was not
compromised (Fig. 3). After Gd-chelate agent injection,
homogenous enhancement pattern was elicited with
multiple signal void foci that were confirmed to be
hypervascular on color Doppler study (Fig. 3 and
Fig. 4). The clinical examination revealed a solid mass
lesion underneath the foreskin (Fig. 5) with concealed
external meatus and with discharge from cutaneous
fistula from the foreskin.
Diagnosis and Treatment: Circumcision with
excisional biopsy was done and histopathological
examination confirmed penile SCC. So the patient
underwent partial penectomy with 2 cm safety margin.
The patient was planned for bilateral ilio-inguinal
lymph node dissection.
DISCUSSION
Carcinoma of the urethra and penis is extremely
rare, accounting for less than 1% of genitourinary
cancers in males [7] . Histological examination reveals
SCC in more than 95% of cases of penile carcinoma [8] .
At MR imaging, SCC is usually hypointense relative
to the corpora on both T1- (Fig. 1) and T2- (Fig. 2)
weighted images. At contrast-enhanced imaging, these
lesions do increase in signal intensity but less so than
the normal corporal bodies. Although neither MR nor
other imaging is generally needed for diagnosis (the
tumor is usually visible at physical examination), MR
imaging may be performed for staging purposes. In the
commonly used Jackson staging system, stage I lesions
are confined to the glans or prepuce, stage II lesions
Address correspondence to:
Ibrahim Mohamed Ali Hamed, MD, Department of Clinical Radiology, Al-Jahra Hospital (MoH),Jahra Central, PO Box 1807, Jahra 01020, Kuwait.
Fax: 24577198, 97341802 (M), E-mail: imah_77@hotmail.com, mun.adw@windowslive.com