A 37-year-old single male rural worker was referred to our service from another hospital because he did not have the necessary experience for the treatment of the type of lymphogranuloma in which he was admitted 15 days before.
He had not previously been seen or treated in any other medical center.
During the 10 days admitted to the Urology Department, he was initially treated with Metronidazole and Ceftazidime, and after performing the antibiogram with Amikacin, Trimethoprim/ Sulfamethoxa.
Biopsy diagnosis was verifiable carcinoma of the oral cavity.
When we receive it, the penis presents an exophytic tumor of about 15 cm in diameter.
The patient reported that she had begun 6 months earlier as a small ulceration in the balanopretial sulcus, which grew progressively in the form of cauliflower and tapering the mucosa.
On the penis, the skin was affected, giving birth, Buck's fascia and albug's; the mucosa was affected; the pub-respectful web was also affected; the glans was refractory;
The limits between the affected tissues and healthy tissues were not well defined; in the affected tissues we found a deformed, soft, fungal, ulcerated, violet-colored mass in the affected tissues, peripheral adenopathy and palpable inguinal tissues.
The patient was passing through a non-visible fistulous orifice located between the mass and the remnants of the urethra.
The clinical analyses performed were normal; the serological tests for brucellosis, wools and HIV were negative; the bacteriological culture was positive for bacteroideca aureus, proteus mirabilis and staphylococci.
The anatomopathological study of the biopsy indicated that it was a giant acuminated condyloma of Buschke-L.
Axial computerized tomography (CAT) was used to make axial sections of the skull base from the superior edge of pubic symphysis to the root of the penis.
In the images we found bilateral adenopathies in the internal and external iliac chains and in the inguinal chains; some of these adenopathies exceeded centimeter of diameter.
The solid fat mass located in the penis, scrotum and seemed to show the fascia of the left adductor muscle, but there was no evidence of inflamed periles or subcutaneous tissue in the internal bone wall.
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Given the characteristics of the tumor, the involvement of the ganglionic chains and the possibility of malignancy, it was decided to perform a radical surgical treatment that was carried out 3 days after admission in Plastic Surgery.
Under general anesthesia, with the patient in the supine position and the lower limbs separated, we performed a perilesional incision through the pubis, the inguinal folds and the perineum, en bloc excision of the affected tumor lesion. a
The incisions of the lymphadenectomies were closed by planes and the perineum-inguino-pubic area was covered by a skin graft taken from the left thigh.
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The intraoperative study of an irregular biopsy of 3 x 2 cm reported the existence of a nodular formation with the appearance of lymph node ganglion, due to the presence of metastasis of carcinoma arising from the non-congenital piece.
The anatomopathological study of the excised specimen described: irregular piece with a visible appearance, which on one of its faces shows the penile glans, measuring 18 x 15 x 12 cm in larger dimensions.
The tumor occupies most of the piece, circumferentially encompasses the penis and affects the skin of pubis, scrotum and perineum.
When the tumor is cut, it is friable, with vegetating growth on surface and deep papillomatous, which also deeply affects the glans and perineal tissues; the testicles are encompassed by fibrosis and tumor mass.
Lymph node chains sent for analysis are recurrent but free of tumor metastases.
After the surgical intervention, the patient was admitted to the resuscitation unit for 2 hours and then to the hospital ward for 25 days.
A second intervention was necessary due to partial necrosis of a small area of the wound from the left lymphadenectomy incision and the loss of approximately 25% of the skin graft used for the perineal-inguino-pu closure.
During hospitalization, standard postoperative medical treatment was administered and blood transfusion was not necessary.
The patient was catheterized and discharged from the hospital with a catheter that maintained another month at home.
As a result of the intervention, a small stump was left with a hole in the perineal region, in which the urethra was emptied and by which the tooth was burned.
Although the different types of existing surgical interventions for penile reconstruction have been explained to the patient (5), with its advantages and disadvantages, it has always refused to undergo reconstructive surgery.
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As a consequence of the consolidation, he developed hypergonadotropic hypogonadism, which is why he was treated with testosterone from the intervention (12 years to the present time).
On the other hand, since this is a tumor, no type of postoperative medical treatment has been performed, neither radio or chemotherapy because it is not indicated.
