Mixed germ cell tumor of the testis with post-chemotherapy perineal tumor recurrence

We present an 18-year-old man who was treated with four courses of BEP [bleomycin, etoposide and cisplatinum] chemotherapy after left orchiectomy for mixed seminomatous and non-seminomatous germ cell tumor of the testis. He presented four months post-chemotherapy with a left scrotal mass which was excised and histologically diagnosed as granulation tissue. A month later he presented with a perineal and left pararectal mass fungating through the skin, which was treated by excision of the mass. Histopathological examination showed mature teratoma with endodermal components but no malignant elements. At 24 months follow-up the patient was diseas-free. It remains speculative whether the scrotal and perineal tumors represent local recurrence or true metastases of post-chemotherapy teratoma

Metastatic penile carcinomas: a study of nine cases and review of the literature

Objective: Primary penile carcinoma is one of the rarest male genital tract tumors in Turkey, because circumcision is performed routinely. In general, metastatic carcinoma of the penis is the second most common penile tumor. Despite the fact that the penis is rarely affected by metastases, there have been 319 cases reported in the literature. This study was carried out to throw light on the main characteristics of the metastatic disease

Patients and Methods: Nine patients aged between 32 and 68 years [median 62.9 years] with metastatic tumors of the penis were the subject of this study. The clinical history of the cases was reviewed, and the patients' data were recorded including location, histology of the primary tumor, presence and location of other metastases, clinical findings, treatment and outcome. The microscopic preparations from both the primary tumor and the penile metastases were reviewed in our pathology department to confirm that the penile lesions showed the same histomorphological characteristics as the primary tumor

Results: The primary tumors were located in the genitourinary system in 7 / 9 patients[transitional cell carcinoma of the bladder], while in the remaining two patients the primary site was the lung [squamous cell carcinoma] and the bone marrow [lymphoblastic leukemia], respectively. Percutaneous needle aspiration cytology was performed in all cases and incisional biopsy in one case for diagnosis. Total penectomy was the treatment of choice in 7 cases and bilateral cavernotomy in the leukemia case. No treatment was given to one patient because of multiple metastases in other organs. Survival after treatment lasted from 4 months to 62 months; the longest survival [5 years] was found in the leukemia case

Conclusion: Metastatic penile carcinomas are relatively rare and present a challenging problem. Total penectomy and local excision of solitary nodules or distal penile involvement still represent the treatment of choice. However, because of the association of a penile metastatic lesion with advanced disease, survival rates are limited, and the majority of the patients die within one year