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

Carcinoma penis is a rare malignancy accounting 0.5%-1% of cases in the developed countries with a slightly higher incidence in the developing nations. Slow locoregional progression is characteristic of penile carcinoma (PC) and distant metastases are very uncommon. We hereby report a case of highly aggressive squamous cell PC in a 46-year-old male with fulminant upfront distant dissemination to left supraclavicular lymph nodes (LNs) 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 wight-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 PC presents with upfront supraclavicular LN metastasis bypassing the inguinal, pelvic, and retroperitoneal LN chains.

Transitional Cell Carcinoma of Urinary Bladder Manifesting as Extensive Retroperitoneal and Axillary Lymph Node Metastasis: An Extremely Rare Case Scenario Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography Scan

Transitional cell carcinoma (TCC) urinary bladder is known to metastasize to regional lymph nodes (LNs), liver, lung, bone, adrenal glands, and intestine. However, an asymptomatic TCC bladder manifesting as metastatic axillary LN mass and extensive retroperitoneal lymphadenopathy is rarely heard of. A 46-year-old male, smoker, presented with 8 cm × 6 cm right axillary swelling of 1-month duration. Aspiration cytology revealed metastatic deposits of poorly differentiated carcinoma favoring TCC. Metastatic evaluation with ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET) scan showed mass lesion urinary bladder, conglomerate right axillary mass and extensive retroperitoneal LNs with significant metabolic activity, biopsy from which revealed deposits of TCC. Transurethral-resection of bladder confirmed TCC and was exhibited palliative chemotherapy on which he progressed. Received palliative radiotherapy to axilla to which he showed significant symptomatic clinical response. He developed obstructive uropathy and was kept on supportive care. Review of literature reveals that our case may be the second case of TCC bladder with generalized lymphadenopathy and the first case of asymptomatic bladder carcinoma manifesting with upfront disseminated abdominopelvic lymphadenopathy detected by ¹⁸FDG-PET scan ever reported in world literature.