Immune checkpoint inhibitor therapy for advanced HPV-related penile squamous cell carcinoma: a rare case report

Abstract

Background: Human papillomavirus type 16 (HPV-16)-associated penile squamous cell carcinoma (PSCC) poses considerable therapeutic challenges, especially in its advanced stages. Although surgery continues to be the cornerstone of treatment, immunotherapeutic approaches hold a promising alternative for patients unable to endure conventional chemotherapy.

Case summary: A 69-year-old male presented with progressive ulceration of the foreskin over the course of one year, which ultimately extended to the glans, accompanied by inguinal lymph node metastasis. The patient underwent surgical resection, including bilateral inguinal lymph node dissection. Histopathological examination confirmed a diagnosis of HPV-16-related PSCC with concomitant PD-L1 expression. Given the patient's poor tolerance to chemotherapy, he was treated with four cycles of the PD-1 inhibitor tislelizumab, resulting in a partial response.

Conclusion: This case underscores the promising potential of immunotherapy as a viable alternative treatment for advanced PSCC in patients who are unable to tolerate chemotherapy. The synergistic integration of surgical intervention, immunotherapy, and psychological support is essential to achieving the best possible outcomes for patients.

Keywords: advanced cancer; checkpoint inhibitors; human papillomavirus type 16; immunotherapy; lymph node dissection; penile squamous cell carcinoma.

Figure 1

(A) Ulcerative lesion on the glans penis and shaft, accompanied by inguinal lymphadenopathy; (B) CT scan showing enlarged left inguinal lymph nodes; (C) Resected penile tumor and lymph nodes; (D) Surgical site healing at 6 weeks post-operation.

Figure 2

(A, B) Histological appearance of tumor cells under low and high magnification using Hematoxylin and Eosin (HE) staining. The tumor tissue grows in a reticular and islet-like pattern, showing extensive necrosis [(A), magnification: 100x]; the tumor cells exhibit significant atypia, with pathological nuclear division and keratinization bead formation visible [(B), magnification: 400x]; (C) Tumor cell nuclei and cytoplasm demonstrate diffuse P16 positivity(magnification: 400x); (D):Tumor cells show moderate intensity complete cell membrane staining for PD-L1(SP263)(magnification: 400x).

Figure 3

Timeline of the episode of care. This figure organizes the historical and current information from this episode of care into a timeline format, detailing significant events, interventions, and patient outcomes throughout the care process.