|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 241-242
The inside mystery of penile leiomyosarcoma
Anil Kumar Dhull1, Vivek Kaushal1, Satish Dalal2, Sunita Singh3
1 Department of Radiation Oncology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
2 Department of Surgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
3 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
|Date of Web Publication||5-Feb-2016|
Anil Kumar Dhull
Department of Radiation Oncology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhull AK, Kaushal V, Dalal S, Singh S. The inside mystery of penile leiomyosarcoma. Indian J Cancer 2015;52:241-2
A 45-year-male patient presented with 2-month-old history of suprapubic discomfort, dysuria, a mass over the proximal shaft of the penis measuring 4 × 3 cm in diameter and indurated ulcer over the penis with raised edges. Symptoms gradually progressed and resulted in a large unhealed painful wound with moderate intensity pain. Patient also gave a history of bleeding from the local ulcerated site. Patient was chronic bidi smoker and alcoholic. During the local physical examination a non-mobile hard-mass was palpated involving the shaft of the penis. The glans penis was normal and no inguinal or iliac nodes were palpable. Ultrasound and Computed tomography scan of abdomen and pelvis were normal. Patient underwent biopsy and histopathologically the overlying epithelium was ulcerated. The tumor was composed of oval to spindle cells arranged in long-interlacing fascicles. Individual cells had cigar-shaped nuclei with tapering ends [Figure 1]a and [Figure 1]b. The neoplastic cells illustrated wide spread positivity for desmin and vimentin immunocytochemical stain [Figure 2]a and [Figure 2]b and stain for cytokeratin (CK) and leucocyte common antigen (LCA) were negative. The histopathological appearance and immunohistochemical profile of the biopsy tissue confirmed it to be a grade-II leimyosarcoma of the penis. With this diagnosis, the patient underwent partial penectomy with perineal urethrostomy [Figure 3]a and [Figure 3]b. Macroscopically, a tumor measuring 3 × 3 × 2 cm was found to arise from the corpora, making the distinction between them almost impossible. The urethra and glans were free of invasion. Histopathologically, no lymph node metastases were found. The histopathological appearance and immunohistochemical profile of the mass again confirmed the preliminary pre-operative diagnosis. Urethral mucosa was free. Areas of necrosis and degeneration were seen. Resected margins were free. The patient had an uneventful post-operative course and is well, without any evidence of tumor recurrence after 1 year of post-operative follow-up.
|Figure 1: (a) Photomicrograph (H and E stain, original magnification × 40) showing oval to spindle cells arranged in long interlacing fascicles. (b) Photomicrograph (H and E stain, original magnification ×100) showing cells with cigar-shaped nuclei and tapering ends|
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|Figure 2: (a) Photomicrograph (IHC stain; original magnification ×200) of immunohistochemical study showing tumor cells positive for desmin. (b) Photomicrograph (IHC stain, original magnification ×200) of immunohistochemical study showing tumor cells positive for vimentin|
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|Figure 3: (a) Pre-operative clinical photograph. (b) Post-operative clinical photograph|
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The mesenchymal neoplasms of the penis are rare and represent less than 5% of all types of penile malignant disease. Leiomyosarcoma of the penis is a rare disease and only infinitesimal number of cases have been reported sofar. Pratt and Ross were the first authors who classified penile leiomyosarcomas into two distinct pathological and clinical entities, superficial and deep-seated tumors. The patients with superficial type tumors as in our case, usually lack symptoms and involve the prepuce, shaft, coronal sulcus, foreskin and glans. These often occur in middle-aged men and commonly are slowly growing tumor, with low metastatic potential. Surgery remains the mainstay of treatment and should aim at the excision of the tumor mass. Amputation is the most effective treatment to prevent recurrences for both types of penile leiomyosarcoma, but the approach should be individualized, and because superficial tumors tend to appear in younger men, these cases can be managed by partial penectomy or local excision with negative surgical margins whenever this is possible. Hensley et al. reported that the combination chemotherapy with gemcitabine and docetaxel is highly effective in the first and second line settings.
| » References|| |
Lucia MS, Miller GJ. Histopathology of malignant lesions of the penis. Urol Clin North Am 1992;19:227-46.
Pratt RM, Ross RT. Leiomyosarcoma of the penis. A report of a case. Br J Surg 1969;56:870-2.
Pow-Sang MR, Orihuela E. Leiomyosarcoma of the penis. J Urol 1994;151:1643-5.
Hensley ML, Maki R, Venkatraman E, Geller G, Lovegren M, Aghajanian C, et al
. Gemcitabine and docetaxel in patients with unresectable leiomyosarcoma: Results of a phase II trial. J Clin Oncol 2002;20:2824-31.
[Figure 1], [Figure 2], [Figure 3]
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