TY - JOUR
AR - SCR-2021-1-115
TI - A Challenging Surgical and Reconstructive Approach to Locally Advanced Squamous Perineal Carcinoma: A Case Report and Literature Review
AU - Manuel Hevia , Palacios
AU - Agustín Fraile , Poblador
AU - Manuel Rodríguez , Vegas
AU - Alberto Artiles , Medina
AU - Arturo Vela , Lasagabaster
AU - Rafael Rodríguez , Patrón
AU - Moreno Moreno , Esther
AU - Varona Crespo , Constatino
AU - Ana Saiz , González
AU - Ana Ferrer,  Gómez
AU - Javier Burgos , Revilla
JO - Surgical Case Reports
PY - 2021
DA - Thu 28, Jan 2021
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2021.01.15
UR - https://www.sciencerepository.org/a-challenging-surgical-and-reconstructive-approach-to-locally_SCR-2021-1-115 
KW - Perineal carcinoma, reconstructive surgery, perineal surgery
AB - Perineal carcinoma of unknown primary origin (CUP) is a rare entity and represents a diagnostic and
therapeutic challenge. These tumors may respond well to a combination of surgical resection, when feasible,
local radiotherapy, and platinum-based systemic chemotherapy. A 67-year-old male patient consulted for
urinary discomfort associated with perineal abscess. The perineal abscess was drained, and the patient was
diagnosed with perineal carcinoma of unknown origin. Computed tomography (CT) scan shows a large
perineal mass that involves both corpora cavernosa and corpus spongiosum. CT and bone scan excluded the
metastatic spread of the disease. Inguinal lymph nodes were not identified. The surgical treatment consisted
of two different phases. Phase I: the perineal mass exeresis with total penectomy. Phase II: perineal
neourethrostomy with double oral mucosa graft. Coverage of the perineal defect and morphological
reconstruction of the penis with fasciocutaneous and gracilis flap. The surgical intervention lasted for nine
hours and the estimated blood loss was 500cc. The patient was discharged twelve days after the intervention.
Later he received adjuvant treatment with immunotherapy (Cemiplimab) because was not subsidiary to
treatment with platinum for renal failure. The patient died after nine months of follow-up due to pulmonary
and abdominal metastatic spread.