Adenosquamous carcinoma of the penis

Carcinoma of the male penis is a rare disease. Microscopically 75% of the tumours are squamous cell carcinoma (SCC). Adenosquamous carcinoma is an exceptionally rare variant of penile tumour. This tumour is a highly malignant tumour with histological features of SCC and adenocarcinoma. Possible sources of this tumour are metaplastic urethral mucosa, bulbourethral (cowpers) glands and probably originated in the perimeatal glands surface squamous epithelium. Only seven cases have been reported since 1986. A 62-year-old Iranian man presented with a painful erection and stiffness in the midshaft of the penis. The clinical diagnosis was penile urethral stricture and ventral cordi of the penis. He underwent urethroplasty with oroandiflap technique and repair of cordi with Nesbit manner. The patient was discharged with anticholinergic drugs and antibiotics. At this time on general examination there was no pathological finding and all laboratory data were normal. After about 10 months the patient admitted with a lesion in the glans and discharge of urethra. The culture of urethra was positive for coagulase negative staphylococcus which was sensitive to nitrofurantoin. Abdominal and pelvic CT scans revealed normal findings except for bilateral inguinal hernia. The patient received an adequate course of antibiotics and underwent biopsy of the lesion. The lesion was a small tense papule on the glans. The biopsy revealed SCC with pseudoglandular component. According to pathological report, total penectomy was performed. Histopathology showed a 6 × 4 ×2.5cm mass 2cm from the glans penis. Microscopic evaluation demonstrated an adenosquamous carcinoma with both squamous and glandular differentiation. Lymphatic invasion and involvement of corpus cavernosa were present. One month later the patient underwent bilateral inguinal lymphadenectomy and pelvic lymph node dissection. Metastasis was present in 2 of 11 superficial lymph nodes on the left side and 1 of 9 superficial lymph nodes on the right side. The pathological stage was T2N2M0 (stage III) at this time. The clinical course was uneventful and the patient received six courses of chemotherapy. After 1 year of follow up the only clinical problem was right leg swelling and on examination there was mild to moderate bilateral leg oedema without any evidence of local disease recurrence.