URGENT
PENECTOMY IN A PATIENT PRESENTING WITH EPIDERMOID CARCINOMA OF THE PENIS
ASSOCIATED TO MYIASIS
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ANTONIO J. TAVARES, RODRIGO BARROS, LUCIANO A. FAVORITO
Section of Urology, Souza Aguiar Municipal Hospital, Rio de Janeiro, RJ, Brazil
ABSTRACT
The objective of this study is to describe the case of a patient presenting advanced epidermoid carcinoma of the penis associated to myiasis. A 41-year-old patient presenting with a necrotic lesion of the distal third of the penis infested with myiasis was attended in the emergency room of our hospital and was submitted to an urgent penectomy. This is the first case of penile cancer associated to myiasis described in the literature. This case reinforces the need for educative campaigns to reduce the incidence of this disease in developing countries.
Key
words: penis; penile cancer; myiasis; amputation
Int Braz J Urol. 2007; 33: 521-2
INTRODUCTION
Penile cancer is a rare neoplasia with low incidence in developed countries (0.1 - 0.9/100.000 in Europe and 0.7 - 0.9/100.000 in the United States). In developing countries, the incidence of this neoplasia is alarming with indexes that reach 2.9 - 6.8/100.000 in Brazil and 2 - 10.5/100.000 in India (1). Myiasis is defined as a disease caused by the infestation by larvae or maggots, of numerous species of flies (2). The occurrence of myiasis in the genitalia is rare. The objective of this article is to describe a case of myiasis in a patient presenting carcinoma epidermoid of the penis.
CASE REPORT
A
41 year-old patient came to the emergency room of our hospital presenting
with dehydration, fever, paleness and claiming of strong pain in the genital
region. On physical examination, we noticed an extensive necrotic lesion
affecting the distal third of the penis (Figure-1A). We have also observed
the presence of gross keratinizations in the lesion and an intense infestation
due to myiasis (Figure-1B). The patient was previously healthy and had
been hospitalized 2 years before to be submitted to a postectomy in another
hospital. At the time of postectomy, a suspicious lesion in the gland
was biopsied; however, the patient abandoned the treatment without knowing
the result of the biopsy.
The patient was admitted, receiving hydration
and venous antibiotic therapy, being immediately sent to the surgical
unit, after the laboratorial exams were assessed. An urgent partial penectomy
was performed with a safety margin of 2 cm and preservation of approximately
4 cm of the penile stump. The result of the pathology examination revealed
a high-grade epidermoid carcinoma of the penis. The patient presented
good evolution and is now in an outpatient follow up.
COMMENTS
Myiasis
is the infestation of the organs or tissues of host animals by the larval
stages of dipterous flies, usually known as maggots or grubs. The fly
larvae feed directly on the host’s necrotic or living tissue, or
in ulcerated mucosa and cavities (2). The most common form in men is in
the skin, where the species Dermatobia hominis is the most common. The
severity of the condition depends on the location and the degree of tissue
destruction (2).
Penile cancer is very common in Brazil and
the main risk factors of this neoplasia is phimosis, local chronic irritation,
lack of personal hygiene and HPV types 16 and 18, that are present in
around 50% of the patients with penile cancer. Neonatal postectomy is
a significant protection factor for the occurrence of penile cancer (3).
In the present case, we observed a typical
example of a misinformed individual, with precarious hygiene habits, leading
to the aggravation of a condition that could have a less aggressive treatment
in the initial phase. This is the first case of myiasis in a penile carcinoma
described in the literature and serves as a warning, reinforcing the need
to implement educating campaigns on penile cancer in developing countries.
CONFLICT OF INTEREST
None declared.
REFERENCES
- Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T; European Association of Urology: EAU Guidelines on Penile Cancer. Eur Urol. 2004; 46: 1-8.
- Passos MR, Barreto NA, Varella RQ, Rodrigues GH, Lewis DA: Penile myiasis: a case report. Sex Transm Infect. 2004; 80: 183-4.
- Schoen EJ, Oehrli M, Colby C, Machin G: The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics. 2000; 105: E36.
_____________________
Accepted after revision:
November 24, 2006
Correspondence address:
Dr. Luciano Alves Favorito
Rua Professor Gabizo 104/201
Rio de Janeiro, RJ, 20271-320, Brazil
E-mail: favorito@uerj.br