A 53-year-old patient with a medical history of pulmonary tuberculosis was treated until 2007.
He was diagnosed in 2007 with squamous cell carcinoma of the lower third of the esophagus, moderately differentiated, stage T4N1M1, so he received five cycles of chemotherapy according to the Al-Sarraf scheme (cisplatin+5-fluorouracil).
In addition, he had a permanent parenteral nutrition catheter.
He came to the emergency room of our hospital for a sensation of dysuria and voiding of nine days of evolution.
In addition, there was an induration from the perineum to the middle third of the penis unrelated to the aforementioned.
No other accompanying symptoms.
Physical examination revealed an induration of the perineal area that continued to the base of the penis, extending to approximately half of the penis and extending to the semi-ersection area.
A non-painful, well-defined, normal size and consistency prostate without nodules was observed on rectal examination.
The tests were of normal size and consistency, with slight discomfort to palpation of both epididymis.
Complementary tests performed in the emergency room showed a slight increase in LDH16UI/l and microhematuria, leucocyturia and crystals of calcium oxalate (5 in the urine sediment).
Ultrasound and penile fixation showed normal testicles and increased thickness of the corpus remnants throughout its length, with the urethra being observed only in its distal third.
Given the patient's medical history, physical examination, and suspicion of pelvic inversion due to metastases from esophageal squamous cell carcinoma, CT (visceral CT) and MRI of the abdomen were requested.
On CT, progression of the underlying disease was observed, with the appearance of a new nodule in the left adrenal gland of 15mm and in the gastric fundus with adjacent adenopathy, which were not present on previous CT scans.
MRI showed an inguinal malformation in the spongy body from the pelvic region to virtually the glans, with two areas of irregular thickening of the right circumferential bone, also suggestive of a softening of the tunica
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We decided to perform a biopsy of the lesion.
The pathological analysis of the sample showed a malignant epithelial proliferation of cordonant architecture with demoplastic changes in the surrounding stroma.
Tumor cells had large acidophilic and well-defined cytoplasms, with focal phenomena of dyskeratosis.
The nuclei were pleomorphic and common mitoses.
Focally, some intravascular tumor emboli were observed in small blood vessels, all compatible with mildly differentiated epidermoid carcinoma.
All results were treated conservatively.
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The patient came to the emergency room one month later for rectal bleeding and anuria.
In the exploration, care is focused on the progression of the mental illness, showing at this moment that virtually the entire penis is not present.
Probing was performed with a 14 Fch Foley catheter, with stop difficulty at the level of the penile urethra, obtaining 600ml of distal urinary catheter.
During admission an attempt was made to remove the catheter that was unsuccessful, so it was decided to leave the patient with permanent catheterization.
A first cycle of placitaxel was initiated and it was decided to evaluate the response to a possible local radiotherapy establishment to control symptoms.
Due to the good tolerance he was discharged.
Fifteen days later she was readmitted from external consultations due to general deterioration, hypoxia and dizziness.
During admission, symptomatic treatment was adjusted with minimal improvement.
Given the precariousness of general condition and the absence of homes and caregivers, it was decided to end the active treatment.
