title: Myiasis associated with penile carcinoma: a new trend in developing countries?
abstract: OBJECTIVE
  The aim of this study is to report an unusual form of penile cancer presentation associated with myiasis infestation, treatment options and outcomes.
  
  
  METHODS
  We studied 10 patients with suspected malignant neoplasm of the penis associated with genital myiasis infestation. Diagnostic assessment was conducted through clinical history, physical examination, penile biopsy, larvae identification and computerized tomography scan of the chest, abdomen and pelvis. Clinical and pathological staging was done according to 2002 TNM classification system. Radical inguinal lymphadenectomy was conducted according to the primary penile tumor pathology and clinical lymph nodes status.
  
  
  RESULTS
  Patients age ranged from 41 to 77 years (mean=62.4). All patients presented squamous cell carcinoma of the penis in association with myiasis infestation caused by Psychoda albipennis. Tumor size ranged from 4cm to 12cm (mean=5.3). Circumcision was conducted in 1 (10%) patient, while penile partial penectomy was performed in 5 (50%). Total penectomy was conducted in 2 (20%) patients, while emasculation was the treatment option for 2 (20%). All patients underwent radical inguinal lymphadenectomy. Prophylactic lymphadenectomy was performed on 3 (30%) patients, therapeutic on 5 (50%), and palliative lymphadenectomy on 2 (20%) patients. Time elapsed from primary tumor treatment to radical inguinal lymphadenectomy was 2 to 6 weeks. The mean follow-up was 34.3 months.
  
  
  CONCLUSIONS
  The occurrence of myiasis in the genitalia is more common in patients with precarious hygienic practices and low socio-economic level. The treatment option varied according to the primary tumor presentation and clinical lymph node status.
authors.affiliation: Hospital Municipal Aguiar Souza, RJ, Brasil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Koifman
authors.affiliation: Hospital Municipal Aguiar Souza, RJ, Brasil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Barros
authors.affiliation: Hospital Municipal Aguiar Souza, RJ, Brasil.
authors.forename: Lucas
authors.initials: L
authors.lastname: Schulze
authors.affiliation: Serviço de Urologia, Hospital Mário Kröeff, RJ, Brasil.|Departamento de Urologia, Instituto Nacional de Câncer, RJ, Brasil.
authors.forename: Antonio Augusto
authors.initials: AA
authors.lastname: Ornellas
authors.affiliation: Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro, Brasil.
authors.forename: Luciano A
authors.initials: LA
authors.lastname: Favorito
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000469:parasitology* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D006920:Hygiene; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009198:Myiasis / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000469:parasitology* / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D012959:Socioeconomic Factors; D047368:Tumor Burden
keywords: Lymph Node Excision; Myiasis; Penile Neoplasms