\iol. 115, February
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright © 1976 by The Williams & Wilkins Co.
LEIOMYOSARCOMA OF THE PREPUCE RICHARD A. BLATH
AND
CHARLES B. MANLEY*
From the Division of Genitourinary Surgery, Washington University Medical Center, St. Louis, Missouri
ABSTRACT
The first reported case of leiomyosarcoma of the prepuce treated with wide circumcision 1s presented. Leiomyosarcoma of the penis is a rare tumor. Only 14 cases have been described and all of these originated in the penile shaft, the glans or deep in the cavernosum or spongiosum. Herein we report a case in which the tumor was confined to the prepuce and was treated by a wide circumcision. CASE REPORT
A 44-year-old uncircumcised man was seen in March 1974 with a 1-year history of an enlarging painless mass on the prepuce, which made intercourse difficult. Examination revealed a firm, well defined lesion within the redundant fore-
DISCUSSION
In a comprehensive review of the world literature Greenwood and associates reported on 13 cases of leiomyosarcoma of the penis and added 1 of their own. 1 Of these 14 cases 7 were superficial on the penile shaft, 5 were deep involving the corporeal bodies and 2 involved the glans. Primary malignant tumors of the prepuce are also rare. In a review of 46 penile sarcomas Dehner and Smith described 6 sarcomas of the prepuce and only 2 were malignant-a Kaposi's sarcoma and a malignant schwannoma. 2 Our case of leiomyosarcoma of the prepuce is unique. Penile leiomyosarcomas appear to fall into 2 clinical groups.• One group of tumors arises from muscle fibers deep in the corpora and occurs near the root of the penis. They tend to invade the urethra and metastasize. The second group arises in the superficial muscle elements of the shaft and presents as painless nodules. Although these superficial tumors usually do
FIG. 1. Photograph of circumcision specimen
skin, consisting of multiple firm nodules. The mass appeared to be confined to the prepuce without any infiltration into the glans or shaft. No inguinal adenopathy was present and the chest x-ray was unremarkable. A wide circumcision was performed, including a 1 cm. skin margin. The patient is well 1 year later and free of recurrence. PATHOLOGY
The specimen showed a 5 by 3 cm. multinodular mass covered by fibrous subcutaneous tissue and normal skin (fig. 1). On cut section these nodules appeared homogenously white and firm. Histologically, the tumor was a moderately well differentiated leiomyosarcoma. Variation in cellularity and pleomorphism were present, and some areas showed extensive interstitial hyalinization. Giant bizarre nuclei and mitotic figures were common. The surgical margin was free of tumor (fig. 2). Accepted for publication August 1, 1975. * Requests for reprints: Division of Genitourinary Surgery, Washington University Medical Center, St. Louis, Missouri 63110.
Fm. 2. Microscopic specimen shows subcutaneous leiomyosarcorna with spindle-shaped cells and prominent mitotic figures.
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not invade deeply or metastasize, they tend to recur locally. The primary treatment in all cases is excision. Partial or total penectomy is necessary if the tumor involves the shaft or deep structures. In our case the tumor was superficial, involving only the prepuce and a wide circumcision was done. All patients should be followed closely since recurrences have been described as long as 18 years postoperatively.•
2. Dehner, L. P. and Smith, B. H.: Soft tissue tumors of the penis. Cancer, 25: 1431, 1970. 3. Pratt, R. M. and Ross, R. T.: Leiomyosarcoma of the penis. A report of a case. Brit. J. Surg., 56: 870, 1969. 4. Ashley, D. J. B. and Edwards, E. C.: Sarcoma of the penis, leiomyosarcoma of the penis: report of a case with a review of the literature on sarcoma of the penis. Brit. J. Surg., 45: 170, 1957. COMMENT
REFERENCES
1. Greenwood, N., Fox, H. and Edwards, E. C.: Leiomyosarcoma of
the penis. Cancer, 29: 481, 1972.
Conservative and successful therapy of a leiomyosarcoma of the prepuce is described, emphasizing that treatment requires planning and is not simply a response to a diagnosis. W.H.H.