Auto-amputation of penis due to adv carcinoma penis: BMJ cas
A 82-year-old male patient was referred with complaints of the wound in right inguinal region for the last 15 days. He initially presented to a primary care centre with complaints of a progressive ulcer over penis for 12 months and swelling in right inguinal region for the last two months. He also revealed sloughing of penile tissue 1 month back. The discharged card mentioned that the patient received antibiotics and underwent incision/drainage of the inguinal abscess under anaesthesia. He also had difficulty in micturition.

The patient denied any history of sexually transmitted disease or local trauma. Clinical examination revealed almost complete loss of phallus. There was evidence of abscess in right inguinal region and hard matted nodes palpable in the left inguinal region. Metastatic workup revealed evidence of distant metastases.

Biopsy from the base of residual penile stump revealed squamous cell carcinoma. The patient underwent suprapubic cystostomy and was given palliative care for his symptoms but he succumbed in the next 15 days. In the present case, the patient neglected his initial symptoms and eventually developed penile auto-amputation, inguinal abscess and widespread metastasis.

Learning points
• Auto-amputation of the penis due to carcinoma penis is very rare.

• Auto-amputation of the penis can occur due to advanced and neglected carcinoma penis.

• Despite availability of advanced healthcare technology, advanced presentations of carcinoma penis occur due to ignorance and social stigma.

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