A Challenging Surgical and Reconstructive Approach to Locally Advanced Squamous Perineal Carcinoma: A Case Report and Literature Review

Perineal carcinoma of unknown primary origin (CUP) is a rare entity and represents a diagnostic and therapeutic challenge. These tumors may respond well to a combination of surgical resection, when feasible, local radiotherapy, and platinum-based systemic chemotherapy. A 67-year-old male patient consulted for urinary discomfort associated with perineal abscess. The perineal abscess was drained, and the patient was diagnosed with perineal carcinoma of unknown origin. Computed tomography (CT) scan shows a large perineal mass that involves both corpora cavernosa and corpus spongiosum. CT and bone scan excluded the metastatic spread of the disease. Inguinal lymph nodes were not identified. The surgical treatment consisted of two different phases. Phase I: the perineal mass exeresis with total penectomy. Phase II: perineal neourethrostomy with double oral mucosa graft. Coverage of the perineal defect and morphological reconstruction of the penis with fasciocutaneous and gracilis flap. The surgical intervention lasted for nine hours and the estimated blood loss was 500cc. The patient was discharged twelve days after the intervention. Later he received adjuvant treatment with immunotherapy (Cemiplimab) because was not subsidiary to treatment with platinum for renal failure. The patient died after nine months of follow-up due to pulmonary and abdominal metastatic spread.

The Diagnosis and Treatment of Lichen Sclerosus and Bulbous Urethral Squamous Cell Carcinoma: A Case Report

Lichen sclerosus (LS) is a rare disease with malignant potential and has been identified by the European Society of Urology Guidelines as a risk factor for penile squamous cell carcinoma (SCC) cancer. LS combined with urethral squamous cell carcinoma (USCC) is extremely rare. There has been only one case report of this combination in China over the last decade. The prevalence of this combination in East Asian population is unclear. In this report, a 49-year-old patient with the presence of LS, perineal masses, and abscesses was hospitalized. He underwent anti-infectious therapy, meatotomy, perineal abscess incision, and drainage and debridement of the perineal wound. USCC was diagnosed following a series of biopsies and treated with radiation therapy. The patient remains well and alive with no recurrence of USCC 13 months after radiation treatment.

Perineal Rectosigmoidectomy Revisited

Objective: The aim of this study was to evaluate the long-term results of perineal rectosigmoidectomy. Background: Multiple surgical options are available for rectal prolapse Perineal rectosigmoidectomy (Altemeier's procedure) is the procedure of choice in elderly patients and those with multiple comorbidities. Methods: Retrospective review was performed of all patients undergoing perineal rectosigmoidectomy from 1998-2008. Results: Of 128 patients, 125(98%) were women; with mean age 74 yrs. Mean operating time was 76 minutes. Hemostasis was achieved using Ultrasonic scalpel or clamp and tie technique in equal numbers. Ultrasonic scalpel use resulted in shorter operative times (57.9 vs. 94.7 minutes, respectively, p< 0.0001,) and estimated blood loss (18.8 vs. 73 ml, respectively, p <0.0001,) compared to clamp-tie technique. Recurrence was seen in 23(18%) patients. Recurrence was more after a hand-sewn anastomosis compared to a stapled anastomosis. Complications occurred in 3 patients (2%)(1-major bleeding, 1-perineal abscess, and 1-post-operative ileus). Conclusions: Perineal rectosigmoidectomy is associated with low morbidity and mortality. In addition the minimal discomfort to patient, short length of stay and improvement in quality of life makes this a suitable operation for the elderly.

A rare case of male pelvic squamous cell carcinoma of unknown primary origin presenting as perineal abscess and urethral stenosis

Carcinomas of unknown primary origin (CUP) represent a diagnostic and therapeutic challenge. Squamous cell CUP located in the male pelvis are very rare. We describe a case of a locally advanced squamous cell CUP occurring in the male pelvis presenting as perineal abscess and urethral stenosis and diagnosed by means of transperineal needle biopsy.