Download MBBS Final Year Surgery Case Presentation Carcinoma Penis Clinical Examination Discussion and Treatment

FirstRanker.com

PATIENT'S DETAILS

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

--- Content provided by⁠ FirstRanker.com ---

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

--- Content provided by‍ FirstRanker.com ---

• 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

--- Content provided by‌ FirstRanker.com ---

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

--- Content provided by⁠ FirstRanker.com ---

• 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

--- Content provided by‌ FirstRanker.com ---

• 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

--- Content provided by‍ FirstRanker.com ---

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

--- Content provided by FirstRanker.com ---

• 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

--- Content provided by​ FirstRanker.com ---

• 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

--- Content provided by‍ FirstRanker.com ---

• 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

--- Content provided by‌ FirstRanker.com ---

• 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

--- Content provided by FirstRanker.com ---

• 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

--- Content provided by​ FirstRanker.com ---

• 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

--- Content provided by⁠ FirstRanker.com ---

• 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 III – Jackson's staging)

MANAGEMENT

• Investigations

--- Content provided by FirstRanker.com ---

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

--- Content provided by‌ FirstRanker.com ---

6. Renal function test
7. Serology – HIV, HBsAg, VDRL

SPECIFIC

1. Edge wedge biopsy
2. Punch biopsy of proliferative growth
3. USG Abdomen

--- Content provided by FirstRanker.com ---

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

--- Content provided by FirstRanker.com ---

• Lymph nodes palpable after antibiotics- bilateral ilioinguinal node dissection