PMC8337126_01
Physical exam findings prior to surgery demonstrated ventral urethral erosion and a visible Foley catheter (a). Postsurgical outcome after debridement and a visible Penrose drain at the base of ventral penile shaft (b).
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Sloughing of the skin was present and the wound was foul smelling (Figure 1(a)). A Penrose drain was left, and the wound was packed with wet to dry gauze (Figure 1(b)).
CT of the abdomen and pelvis with IV contrast demonstrating hepatic metastatic disease with an enlargement of the hepatic lobe mass. Right adrenal mass consistent with metastatic disease. Development of portacaval adenopathy consistent with metastatic disease (a). Expansile osteolytic right posterior ilium lesion (b).
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This demonstrated several new hepatic lesions, a right adrenal mass, and portacaval adenopathy (Figure 2(a)). There was also enlargement of a right posterior ilium osteolytic lesion (Figure 2(b)).
CT of the abdomen and pelvis with IV contrast obtained on postoperative day one demonstrating enlargement of the penis, likely consistent with metastatic, inflammatory, and postsurgical changes (a, b).
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Additionally, enlargement of the penis at the base was noted (Figures 3(a) and 3(b)).
Histologic stains demonstrating hematoxylin and eosin stain of penile biopsies showing poorly differentiated carcinoma with dyscohesive malignant epithelioid cells demonstrating pleomorphism in a background of necrosis (a). Positive PAX-8 stain (b). Positive EMA stain (c).
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Pathology from the intraoperative biopsies demonstrated poorly differentiated carcinoma with dyscohesive malignant epithelioid cells demonstrating pleomorphism in a background of necrosis (Figure 4(a)). Additionally, the cells stained positive for pan-keratin, paired box gene 8 (PAX-8) (Figure 4(b)), and epithelial membrane antigen (EMA) (Figure 4(c)) confirming a dedifferentiated or anaplastic process related to the patient's known history of metastatic follicular cell carcinoma of the thyroid.