Penile nodule with inguinal lymphadenopathy: Prostatic adenocarcinoma masquerading as penile cancer
A 68-year-old male presented to the urology out-patient department of our institution with a painless nodular lesion over glans penis of two weeks duration. He had also noticed a small swelling on his right groin in the preceding one week. He denied the presence of any lower urinary tract symptoms. There was no history of hematuria or pyuria. On direct enquiry, he admitted that he was having mild low back pain for some time, to which he did not give much attention. On examination, he was in good general condition. There was a well circumscribed erythematous nodular lesion over the glans penis at the parameatal position []. Genital examination did not reveal any other abnormality. A single 1.5 cm, mobile, hard, non-tender right superficial inguinal lymph node was detected []. On digital rectal examination, the prostate was found to be hard and nodular. There was no vertebral or pelvic tenderness. No other abnormality was detected on physical examination. Incisional biopsy of the penile lesion was suggestive of metastatic adenocarcinoma that stained for prostate specific antigen (PSA) [] indicating that the primary tumor was prostatic adenocarcinoma. Fine needle aspiration cytology of the inguinal lymph node was reported as metastatic prostatic carcinoma. His serum PSA was 50 ng/ml. Prostatic needle biopsy was suggestive of adenocarcinoma with a Gleason score of 8. Radionuclide scintigraphic bone scan revealed diffuse skeletal metastasis. A diagnosis of metastatic prostatic adenocarcinoma was made and the patient was started on antiandrogen therapy with bicalutamide along with bilateral orchiectomy. He did not come back to our hospital for follow-up but on telephonic conversation he reported that there was no change in the size of the lymph node or of the penile lesion nine months after orchiectomy.