Two males presented to our urology department with complaints of bleeding and malodor from buried phallus within a suprapubic fat pad. Although both men had neonatal circumcisions, advanced penile carcinoma was found in both men. Formal penectomies showed high grade, poorly differentiated squamous cell carcinoma invading the corporal bodies and urethra. Buried penis represents a difficulty in early detection of suspicious lesions but may also provide an environment susceptible to poor hygiene and subsequent chronic inflammation. Patients with buried penis may be at a higher risk for development of invasive penile cancer and may benefit from regular and thorough genital exams.
We present two cases of men who presented with advanced penile carcinoma in the setting of a buried phallus. We describe the presentation, clinical course, and pathological findings and discuss the possible etiological agents involved in penile carcinoma.
A 42-year-old Caucasian male with body mass index of 54 presented to outpatient clinic with 70-pound weight loss, hematuria, and purulent, malodorous discharge from the site of his buried penis. He was circumcised as an infant and denied any smoking history. The phallus was contained within a suprapubic fat pad and he had been sitting to void without seeing the phallus for several months. Although overall hygiene was adequate, the suprapubic cavity was impossible to maintain hygiene. Examination caused significant discomfort in attempt to visualize the phallus while in clinic prompting an examination under anesthesia. MRI revealed corporal bodies with a large mass replacing the glans penis and distal shaft (Figure
Coronal section of MRI showing the corporal bodies leading to a large mass buried within the suprapubic fat pad.
Gross specimens showing the buried phallus without identifiable structures (a) and a cross section showing the mass (b).
A 57-year-old Caucasian male with body mass index of 59 presented to the emergency department with complaints of bleeding and purulent discharge from the site of his buried penis. He was also circumcised as an infant and denied history of smoking. Once again, the phallus was contained within a suprapubic fat pad and was unable to be examined due to pain. He had also been sitting to void with a severely weakened stream and lack of phallus visualization for several months. Examination under anesthesia with biopsy was consistent with high grade invasive penile cancer. Total penectomy was then performed. Pathological examination showed moderately differentiated squamous cell carcinoma with corporal cavernosum invasion, pT3 with negative p16 staining. Representative sections are in Figure
Histologic sections showing invasive squamous cell carcinoma of each patient (a) and (c) and immunohistochemistry of p16 with positive result (b) and negative result (d).
Given the rarity of penile carcinoma, these two cases may represent an enlarging demographic at risk that may need further consideration [
Penile cancer was estimated to have 1640 new cases and cancer specific morality of 380 within the USA in 2014 [
As can be seen, both of these patients were younger than median and lacked many of the established risk factors, other than one patient having HPV incidentally found. The buried phallus is difficult to maintain hygiene and provides an area for a chronic inflammation and low grade infections. In a meta-analysis of circumcision performed by Larke [
Human papillomavirus (HPV) infection is a known risk factor for penile carcinogenesis and can be detected via staining with p16 [
Obesity has been a growing problem now affecting over 1/3 of US adults and 17% of the youth [
Penile cancer in the setting of buried phallus represents both an error of early detection and a possible increased risk. Patients and their physicians should routinely examine the buried phallus and evaluate further as indicated.
Patients involved in this paper provided written consent for clinical history, pathology, and clinical image to be used.
The authors declare no conflict of interests in the preparation of this paper.