Carcinoma Penis Manifesting as Upfront Supraclavicular Lymph Node Metastases Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography Scan: Report of an Extremely Rare and Aggressive Case

Abstract

Carcinoma penis is a rare malignancy accounting 0.5 to 1% cases in the developed countries with a slightly higher incidence in the developing nations. Slow locoregional progression is characteristic of penile carcinoma and distant metastases are very uncommon. We hereby report a case of highly aggressive squamous cell penile carcinoma in a 46-year-old male with fulminant upfront distant dissemination to left supraclavicular lymph nodes without involving the inguinal and pelvic nodes detected by whole-body ¹⁸F-fluorodeoxyglucose positron emission tomography scan. The scan also detected lytic destructive lesion involving the pelvic and adjacent bones with infiltration of skeletal muscles. He was treated with palliative radiotherapy to the weight-bearing sites followed by systemic chemotherapy. A thorough review of literature reveals that our case may be one of the rarest cases ever reported in world literature where an asymptomatic penile carcinoma presents with upfront supraclavicular lymph node metastasis bypassing the inguinal, pelvic, and retroperitoneal lymph node chains. Purkayastha Abhishek conceptualized, designed and prepared the manuscript. Purkayastha Abhishek and Suhag Virender were involved in definition of intellectual content and literature search. Purkayastha Abhishek, Suhag Virender, and Taneja Sachin contributed substantially in clinical studies, data analysis, and statistical analysis. Purkayastha Abhishek, Suhag Virender, and Husain Azhar helped in data acquisition. Purkayastha Abhishek, Suhag Virender, Taneja Sachin, and Husain Azhar were involved in manuscript editing and review. Purkayastha Abhishek, Suhag Virender, Taneja Sachin, and Husain Azhar provided guarantee. The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes that the manuscript represents honest work. Written informed consent to publication was obtained from the patient. Publication Date: 30 April 2022 (online) © 2022. World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India