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Preoperative. This photo illustrates the extent of the scrotal abscess and cancer upon presentation. The urethra was obliterated. In addition to multiple areas of infection, there were nodular areas with squamous keratinization.
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A sample of necrotic scrotal tissue was sent for differential diagnosis, and pathology revealed invasive moderately differentiated urethral SCC (Fig. 1).
Preoperative FDG-PET scans. The scans reveal enlarged PET avid bilateral groin LNs, in addition the PET avid scrotal and perineal tissue. (A) Coronal image at level of the positive iliac LNs. (B) Coronal image at level of greater trochanter.
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Further staging involved Computed Tomography (CT) and Fluorodeoxyglucose Positron Emission Tomography (FDG PET) scans, which revealed enlarged bilateral groin Lymph Nodes (LNs) (Fig. 2).
Intraoperative. The photo shows the completed en bloc resection defect prior to flap closure.
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The large tumor resulted in a considerable defect (Fig. 3), requiring anterolateral thigh skin flap closure, performed by plastic surgery.
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Histology specimen. This slide demonstrates the SCC with keratin and both (1) lymphatic invasion and (2) vascular invasion.
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The en bloc resection revealed a large (22 cm maximal diameter) SCC, with lymphovascular and perineural invasion (Fig. 4).
Metastasis to the pubic rami. This histopathology slide demonstrates the multifocal distant metastasis of the primary urethral tumor to the bone, in particular, to the right pubic inferior rami.
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The inferior pubic bones were involved (Fig. 5).
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Postoperative FDG-PET scan. Restaging revealed progression with multiple lung metastasis and recurrent pelvic disease, with left ischial and femoral bone metastases. (A) Coronal image at level of the iliac LNs, corresponding to Figure 2A. (B) Coronal image at level of greater trochanter, corresponding to Figure 2B.
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Restaging by whole-body FDG-PET scan revealed progression with multiple lung metastasis and recurrent pelvic disease, with left ischial and femoral bone metastases (Fig. 6).
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