[A CASE OF PENILE VERRUCOUS CARCINOMA: DIAGNOSTIC DIFFICULTIES WITH BIOPSY]

A 73-year-old male presented to our clinic with a chief complaint of painful urination. He had complete phimosis and a papillary tumor occupying the glans foreskin. Urination occurred through a fistula destructively created by the tumor on the side of his foreskin. Contrast-enhanced computed tomography (CT) and positron emission tomography scans revealed a tumor with irregular margins and a heterogeneous internal contrast effect, measuring 55 mm in its longest diameter within the glans, and a 10 mm lymphadenopathy in the left inguinal region. Magnetic resonance imaging findings suggested that the tumor had invaded the corpus cavernosum of the penis, leading to a diagnosis of penile cancer, cT3N1M0. A pathological examination of a biopsy from the tumor tip initially suggested condyloma acuminatum. However, due to the potential for malignancy and the significant urinary obstruction caused by the tumor, a partial penectomy was performed with an 8 mm surgical margin. Inguinal lymph node dissection was not performed concurrently. The excised specimen revealed a cauliflower-shaped tumor, 45 × 40 mm in size, located peripherally from the annular sulcus of the penis, with no invasion into the corpus cavernosum or urethra. Histopathological analysis confirmed the tumor as verrucous carcinoma, pT1. The postoperative course was uneventful, and the patient's urinary pain resolved. A follow-up CT scan one month later showed no evidence of recurrence or metastasis. The preoperative inguinal lymph node swelling resolved spontaneously after surgery, leading to a retrospective diagnosis of inflammatory lymphadenopathy.Obtaining sufficient and deep tissue samples can be challenging, and biopsy alone has limitations in achieving an accurate diagnosis. Therefore, a comprehensive preoperative diagnosis should incorporate physical and imaging finding along with biopsy results.