IS Case 218: Pathology proven metastatic penile squamous cell carcinoma to L2

Christopher Mosley, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

Patient is an 80-year-old male with a history of locally advanced penile squamous cell carcinoma. The patient is status post-pelvic nodal dissection and pelvic radiation, completed one year ago. The patient presented most recently with lumbar back pain, increasing for two months.

Findings

Bone Scan: Heterogeneously intense, picture frame-like tracer uptake at the margins of the L2 vertebral body. MRI: The L2 vertebral body is hypointense on T1 imaging and hyperintense on T2 imaging. In addition, there is compression of the L2 vertebral body with mild retropulsion and posterior L2/3 disk bulge causing canal narrowing. There is posterior disc bulge at L2-L3 level which along with facetal hypertrophy is causing moderate canal narrowing. MRI findings are consistent with metastatic involvement of L2 vertebral body. Fluoroscopic Biopsy: Images demonstrate a 13-gauge bone biopsy needle entering the L2 vertebral body via a right transpedicular approach for core biopsy. Subsequently, a 16-gauge Temno® gun biopsy needle was used through the existing tract to obtain soft tissue.

Diagnosis

Pathology proven metastatic penile squamous cell carcinoma to L2

Discussion

Penile cancers are uncommon malignancies, usually not encountered until the seventh or eighth decade of life in Western countries. Squamous cell carcinomas make up the overwhelming majority of these cancers. Penile cancer rarely occurs in circumcised men.

Major categories include exophytic type, papillary cancers and flat, ulcerative type cancers. Penile cancers usually remain confined to the skin for long periods of time. Of the two types, however, ulcerative type lesions tend to metastasize to lymph nodes earlier with resultant lower 5 year survival rates. Femoral and inguinal lymph nodes are usually the earliest sites of metastatic spread. Other sites of metastatic spread include the lung, liver, bone, and brain. These sites are typically not involved until late in the course of the disease.

If untreated, penile cancer is usually fatal within two years. Treatment options include surgery with local resection, lymph node dissection, and radiation therapy.

MRI and CT can both be useful in the initial staging work-up. MRI can accurately demonstrate invasion of the penile corpora. Both MRI and CT can show enlarged pelvic and retroperitoneal lymph nodes.

References

  1. Nelson BA, Cookson MS, Smith JA Jr, Chang SS. Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol. 2004 Aug;172(2):494-7. [PMID: 15247712]
  2. Rippentrop JM, Joslyn SA, Konety BR. Squamous cell carcinoma of the penis: evaluation of data from the surveillance, epidemiology, and end results program. Cancer. 2004 Sep 15;101(6):1357-63. [PMID: 15316902]
  3. Srinivas V, Morse MJ, Herr HW, Sogani PC, Whitmore WF Jr. Penile cancer: relation of extent of nodal metastasis to survival. J Urol. 1987 May;137(5):880-2. [PMID: 3573181]

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