Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Carcinoma Penis Clinical Examination Discussion and Treatment
Mr.Babu ,64 years old male from
Aminjikarai, Auto driver by occupation
belonging to lower middle socioeconomic
class
CHIEF COMPLAINTS
? Ulcer in the penis for 2 months
HISTORY OF PRESENTING ILLNESS
? Patient was apparently normal 2 months
back after which he developed ulcer over
the penis
? Insidious onset, initially small in size ,
gradually progressed to attain the
present size
? Not associated with pain
? Not able to retract skin over the penis
contd.....
? H/o discharge for the past one week-
Serousanguineous discharge which is foul
smelling
? No h/o trauma
? No h/o fever
? No h/o difficulty in passing urine
? No h/o pain while passing urine
? No h/o loss of weight /appetite
contd........
? No h/o abdominal distension/jaundice
? No h/o bone pain
? No h/o cough with hemoptysis
? No h/o swelling in the inguinal region or
elsewhere in the body
PAST HISTORY
? No h/o similar complaints in the past
? No h/o multiple sexual partners
? No h/o circumcision done
? No h/o Diabetes mellitus , hypertension ,
asthma, tuberculosis, epilepsy , jaundice,
sexually transmitted diseases,
cardiovascular diseases
? H/o hospitalization for hernia surgery on
right side 30 years back in GRH
PERSONAL HISTORY
? Consumes non veg diet
? Normal bowel and habits
? Not a smoker
? Consumes alcohol 180ml-3 times a week
? No h/o drug abuse
? No h/o tobacco/betel nut chewing
FAMILY HISTORY
? No relevant family history
ALLERGY HISTORY
? No h/o allergy to any drug or food
GENERAL EXAMINATION
? Patient is conscious, oriented moderately
built and nourished
? No pallor, icterus, cyanosis,
clubbing, pedal edema,
generalised lymphadenopathy
VITALS
? Pulse rate-76/min,regular in rhythm
normal volume and character, no vessel
wall thickening,no radioradial /
radiofemoral delay, felt in all palpable
peripheral vessels
? Respiratory rate-16/min
? Blood pressure-110/80 mmHg measured
in right upper arm in sitting posture
? Temperature-afebrile
LOCAL EXAMINATION
? After getting consent and explaining the
procedure to the patient ,with a male
attender by the side the patient was
exposed from midchest to midthigh and
was examined in bright light
INSPECTION
? A irregular ulcer of size 5x5cm seen on
the dorsum of the shaft of penis
? Margin-ill defined
? Edges-everted and rolled out
? Floor-necrotic tissue
? Extent-from 4cm from the shaft of penis
to the glans
? Serosanguineous discharge present
? A small oval ulcer of size 1x1cm seen
above the lesion 3 cm from the shaft of
the penis
? Margins are well defined
? Floor- pale pink in colour
? Surrounding skin edematous
? No pigmentation , scars, sinuses seen
? Inguinal region: a linear scar of size 6cm
present in the right inguinal region which
is healthy
PALPATION
? Warmth (+)
? Tenderness (+) present over the lesion and the
skin surrounding the skin
? Inspectory findings of site, size, shape, extent
are confirmed on palpation
? Bleed on touch
? Base is indurated
? Glans , prepuce, urethral meatus - not able to
find
PALPATION OF INGUINAL LYMPH NODES
? Multiple,bilateral, hard, mobile lymph
nodes in the inguinal region
? Largest node ? 2x2cm present in the right
inguinal region with well defined margins
5cm from the pubic symphysis and 7cm
from the anterior superior iliac spine
? Not warm ,not tender
? Node is discrete and mobile, hard in
consistency
? Skin over the node-normal and pinchable
? From the level of umblicus to the inguinal
region-no other lesions found
OTHER SYSTEM EXAMINATION
? RS- normal vesicular breath sounds heard no
added sounds
? CVS- S1,S2 heard no murmurs
? CNS-no focal neurological deficit
? Abdomen- soft,non-tender,no organomegaly,
no palpable mass ,no free fluid, hernial
orifices are free
? Spine and cranium-normal
DIAGNOSIS
? Carcinoma penis involving shaft of
penis with bilateral palpable lymph
nodes ( Stage I I ? Jackson's staging)
MANAGEMENT
? Investigations
BASELINE
1)Blood- total count , differential count, ESR,
bleeding time , clotting time,Hb%
2)Blood ? sugar
3)Urine-sugar,urea,albumin
4)Chest X-ray
5)ECG
6)Renal function test
7)Serology ? HIV , HBsAg, VDRL
SPECIFIC
1)Edge wedge biopsy
2)Punch biopsy of proliferative growth
3)USG Abdomen
4)FNAC of lymph node
5)CT abdomen
6) Sentinel node biopsy of cabana
TREATMENT
? Total penectomy with perineal
urethrostomy
? Lymph nodes-antibiotics for 4 to
6 weeks -resolves then observe
? Lymph nodes palpable after
antibiotics- bilateral ilioinguinal
node dissection
This post was last modified on 08 August 2021