Myiasis associated with penile carcinoma: a new trend in developing countries?

ABSTRACT Objectives The aim of this study is to report an unusual form of penile cancer presentation associated with myiasis infestation, treatment options and outcomes. Materials and Methods We studied 10 patients with suspected malignant neoplasm of the penis associated with genital myiasis infestation. Diagnostic assessment was conducted through clinical history, physical examination, penile biopsy, larvae identification and computerized tomography scan of the chest, abdomen and pelvis. Clinical and pathological staging was done according to 2002 TNM classification system. Radical inguinal lymphadenectomy was conducted according to the primary penile tumor pathology and clinical lymph nodes status. Results Patients age ranged from 41 to 77 years (mean=62.4). All patients presented squamous cell carcinoma of the penis in association with myiasis infestation caused by Psychoda albipennis. Tumor size ranged from 4cm to 12cm (mean=5.3). Circumcision was conducted in 1 (10%) patient, while penile partial penectomy was performed in 5 (50%). Total penectomy was conducted in 2 (20%) patients, while emasculation was the treatment option for 2 (20%). All patients underwent radical inguinal lymphadenectomy. Prophylactic lymphadenectomy was performed on 3 (30%) patients, therapeutic on 5 (50%), and palliative lymphadenectomy on 2 (20%) patients. Time elapsed from primary tumor treatment to radical inguinal lymphadenectomy was 2 to 6 weeks. The mean follow-up was 34.3 months. Conclusion The occurrence of myiasis in the genitalia is more common in patients with precarious hygienic practices and low socio-economic level. The treatment option varied according to the primary tumor presentation and clinical lymph node status.

Myiasis associated with penile carcinoma: a new trend in developing countries?

OBJECTIVES: The aim of this study is to report an unusual form of penile cancer presentation associated with myiasis infestation, treatment options and outcomes. MATERIALS AND METHODS: We studied 10 patients with suspected malignant neoplasm of the penis associated with genital myiasis infestation. Diagnostic assessment was conducted through clinical history, physical examination, penile biopsy, larvae identification and computerized tomography scan of the chest, abdomen and pelvis. Clinical and pathological staging was done according to 2002 TNM classification system. Radical inguinal lymphadenectomy was conducted according to the primary penile tumor pathology and clinical lymph nodes status. RESULTS: Patients age ranged from 41 to 77 years (mean=62.4). All patients presented squamous cell carcinoma of the penis in association with myiasis infestation caused by Psychoda albipennis. Tumor size ranged from 4cm to 12cm (mean=5.3). Circumcision was conducted in 1 (10%) patient, while penile partial penectomy was performed in 5 (50%). Total penectomy was conducted in 2 (20%) patients, while emasculation was the treatment option for 2 (20%). All patients underwent radical inguinal lymphadenectomy. Prophylactic lymphadenectomy was performed on 3 (30%) patients, therapeutic on 5 (50%), and palliative lymphadenectomy on 2 (20%) patients. Time elapsed from primary tumor treatment to radical inguinal lymphadenectomy was 2 to 6 weeks. The mean follow-up was 34.3 months. CONCLUSION: The occurrence of myiasis in the genitalia is more common in patients with precarious hygienic practices and low socio-economic level. The treatment option varied according to the primary tumor presentation and clinical lymph node status.

Efficiency of diagnostic biomarkers among colonic schistosomiasis Egyptian patients.

The schistosomal parasite plays a critical role in the development of malignant lesions in different organs. The pathogenesis of cancer is currently under intense investigation to identify reliable prognostic indices for disease detection. The objective of this paper is to evaluate certain biochemical parameters as diagnostic tools to efficiently differentiate between colonic carcinoma and colonic carcinoma associated with schistosomal infection among Egyptian patients. The parameters under investigation are interleukin 2 (IL-2), tumour necrosis factor alpha (TNF-α), carcinoembryonic antigen (CEA) levels, tissue telomerase, pyruvate kinase (PK), glucose-6-phosphate dehydrogenase (G-6-PD) and lactate dehydrogenase (LDH) enzyme activities. The results revealed a significant elevation in the level of the tumour markers IL-2, TNF-α and CEA as well as the activities of LDH, telomerase and G-6-PD among non-bilharzial and bilharzial colonic cancer groups, with a more potent effect in bilharzial infection-associated colonic cancer. A significant inhibition in PK activity was recorded in the same manner as compared to normal tissues. The efficacy of this biomarker was also evaluated through detecting sensitivity, specificity, negative and positive predictive values. In conclusion, schistosomal colonic carcinoma patients displayed more drastic changes in all parameters under investigation. The combination of the selected parameters succeeded in serving as biomarkers to differentiate between the two malignant types.

Myiasis infestation in advanced oral squamous cell carcinoma.

Oral myiasis is a rare manifestation in humans and is vulnerable to attack in conditions leading to persistent mouth opening along with poor oral hygiene, suppurating lesions and cancerous wound, mainly in tropical countries. Myiasis is diagnosed clinically based on the presence of maggots and traditional management is the mechanical removal of the larvae. This is a case report of myiasis in a 44-year-old man diagnosed with invasive oral squamous cell carcinoma. The treatment consisted of manual removal of the larvae and cleaning with aqueous chlorhexidin 0.12%. The patient's management was antisepsis, larval removal and general care, performed weekly. The patient died 2 months later. The management of patients by healthcare service and hygiene orientations is recommended to prevent oral myiasis infestation, mainly in patients living in fly breeding habitats and who do not comply with basic oral hygiene measures, which may be make individuals more prone to develop myiasis.

Extensive myiasis infestation over a squamous cell carcinoma in the face. Case report.

Human myiasis is a parasitosis found in tropical and underdeveloped countries. It usually affects the elderly, unhealthy and mentally disabled individuals. It is caused by dipterous that lay their eggs in necrotic or infected tissues, although areas of the body that are apparently healthy can also be affected. Frequently the fly deposits several eggs on the peripheral parts of scratches and wounds. The treatment of myiasis involves mechanical removal of the larvae with hemostatic pincers. Larvae rupture must be avoided. Application of topical ether or similar volatile substance is useful. Preventive approach measures, including basic health care, hygiene, access to primary health service, and safe water and drainage, are fundamental to prevent human myiasis. The authors present a case report of myiasis infestation over an extensive head and neck squamous cell carcinoma from a 72-year-old patient living in a rural area. Approximately 200 larvae were removed and the patient was taken to the hospital's head and neck surgery service.

Urgent penectomy in a patient presenting with epidermoid carcinoma of the penis associated to myiasis.

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.

Urgent penectomy in a patient presenting with epidermoid carcinoma of the penis associated to myiasis

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.