Late penile metastasis from primary bladder carcinoma

Berger, Andreas; Rogatsch, Hermann; Hoeltl, Lorenz; Steiner, Hannes; Bartsch, Georg; Hobisch, Alfred

doi:10.1016/s0090-4295(03)00239-5

Cited by 31 publications

(24 citation statements)

References 10 publications

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“…While the most accepted mechanism of penile metastatic spread from primary carcinoma in the bladder is via retrograde venous flow, 6,11,12 we suspect that retrograde lymphatic spread would be more likely in this case. Penile skin, foreskin, and superficial fascia are rich in lymphatic supply.…”

Section: Resultsmentioning

confidence: 78%

“…The optimal treatment for penile metastasis requires a multidisciplinary approach, which offers the best chances for survival at approximately 9.2 months. 6 The treatment options are usually local tumour excision, external beam radiation therapy, brachytherapy, chemotherapy, or partial or total penectomy. …”

mentioning

confidence: 99%

“…The most common sites include the bladder and prostate. [6][7][8] The prognosis for these patients is very poor, as it typically indicates widespread metastatic disease. 4,5,9 We present the first case of penile metastasis from primary transitional cell carcinoma (TCC) of the bladder that spares the urethra.…”

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confidence: 99%

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Penile metastasis from primary transitional cell carcinoma of the bladder sparing the urethra

Oake

Drover

2016

CUAJ

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Metastatic involvement of the penis is relatively infrequent. Metastasis of transitional cell carcinoma (TCC) is extremely rare. We report a case of bladder TCC with metastases to the penis that spares the urethra -a finding that, to the best of our knowledge, has not been previously reported. Of the documented mechanisms of metastatic transmission to the penis, we suspect the cause was retrograde lymphatic spread. In our case, a 59-year-old male presented to our clinic initially with phimosis and later developed gross hematuria. Subsequent cystoscopy noted the appearance of tumour extending into the prostate, as well as the appearance of extensive TCC throughout the bladder. Following transurethral resection of prostate and bladder tissue, which demonstrated high-grade urothelial carcinoma, the patient underwent a radical cystoprostatectomy. A year later, he developed worsening gross hematuria and we noted the appearance of primary penile squamous cell malignancy. He then underwent a partial penectomy. The histopathology evaluation result from the partial penectomy revealed infiltration of TCC in the glans penis, as well as invasion into the corpus spongiosum, with sparing of the urethra. IntroductionPenile cancer is rare in North America and Europe. It accounts for less than 1% of cancers in men in the U.S. The incidence of disease is more common in South America, Southeast Asia, and parts of Africa.1 In the U.S., it is estimated that only 1820 new cases of penile cancer will be diagnosed in 2015.2 Metastatic involvement of the penis is a rare disease, 3,4 with approximately 480 reported cases. 5Nearly 75% of the metastases originate from adjacent urogenital organs. The most common sites include the bladder and prostate. [6][7][8] The prognosis for these patients is very poor, as it typically indicates widespread metastatic disease. 4,5,9 We present the first case of penile metastasis from primary transitional cell carcinoma (TCC) of the bladder that spares the urethra. Case reportA 59-year-old male was initially referred in 2010 with a presentation of phimosis. He had been having increasing difficulties voiding. Patient underwent partial circumcision with a dorsal slit. Pathology revealed lichen sclerosis (balanitis xerotica obliterans) and was negative for dysplasia or malignancy.The patient began to develop gross hematuria in 2013. Subsequent cystoscopy in 2013 revealed a normal distal urethra, while the prostate had an appearance of papillary tumour extending into the prostatic lumen. Proximally, it looked as if the whole prostate was replaced with TCC. There appeared to be extensive TCC throughout the bladder, obscuring the trigone. Prostate and bladder TCC was resected. Transurethral resection of the prostate tissue demonstrated high-grade urothelial carcinoma with focal stromal invasion. Transurethral resection of the bladder lesion revealed invasive high-grade papillary urothelial carcinoma with lamina propria and lymphovascular invasion, however, there was no invasion of the muscularis propria...

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Section: Resultsmentioning

confidence: 78%

mentioning

confidence: 99%

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Penile metastasis from primary transitional cell carcinoma of the bladder sparing the urethra

Oake

Drover

2016

CUAJ

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“…Bladder TCC may metastasize to the vagina through various mechanisms, including through the lymphatic system or blood vessels, in ways that are similar to the metastasis of bladder cancer to the liver, lungs, brain, adrenals and bone (20). Another metastasis mechanism is associated with the retrograde venous blood flow from the bladder to the vagina, which is similar to the mechanism of penile metastases from bladder cancers (21,22). However, vaginal metastasis may occur via another mechanism that involves the implantation of shed tumor cells into the vagina during micturition or transurethral resection, and probably possesses a better prognosis (23).…”

Section: Discussionmentioning

confidence: 99%

Bladder and vaginal transitional cell carcinoma: A case report

et al. 2016

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Abstract. The involvement of the female genital tract in transitional cell carcinoma (TCC) has not been fully elucidated in women, although involvement is usually associated with a poor prognosis. The vagina, in particular, is considered to be the most commonly affected gynecological organ, with an incidence of 4% of total TCC cases. The pathogenesis of vaginal TCC is challenging to determine, although it is essential for the adequate management of the tumor and to determine the appropriate treatment. The present study reports a case of bladder TCC and metachronous vaginal TCC. The patient had a history of high risk non muscle invasive bladder cancer treated by BCG and presented with a recurrent carcinoma in situ. A novel cycle of BCG was initiated but the patient had a persistent disease and a palpable mass on bimanual examination. Radical anterior pelvectomy and bilateral pelvic and inguinal lymph node dissection was performed revealing the presence of TCC of the bladder neck and the invasion into the anterior vaginal wall. The differences between local vaginal invasion and the metastatic spread from a primary bladder TCC, the occurrence of a second primary vaginal tumor and the direct implantation of TCC via urine that contains transitional cancer cells were reviewed and analyzed. Finally, a management plan was determined.

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“…To date, only about 370 cases of penile metastases have been reported [4]. The primary origins of these metastases include the urinary bladder in 30-35 %, the prostate in 30 %, the rectosigmoid colon in 13 %, the kidneys in 8-10 %, and the testes in 5 % [18]. Penile metastases present as a nonulcerative nodule in 51 % of the cases.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of gemcitabine monotherapy in an elderly patient with penile metastasis from bladder carcinoma: a case report

et al. 2013

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We describe the case of an 85-year-old Japanese male with invasive urothelial carcinoma of the bladder treated with radiotherapy and the significant effects of gemcitabine monotherapy on subsequent metastases to the lungs, L5 vertebral body, and penis. The lung and L5 vertebral body metastases were diagnosed 3 months after radiotherapy and were treated with one course of gemcitabine and cisplatin chemotherapy. As the patient was unable to continue the chemotherapy, the chemotherapy was switched to two further courses of gemcitabine monotherapy, and he showed a significant response to the metastasis. The patient's condition was good until he noticed a penile nodule that appeared 2.5 years after the radiotherapy. The penile tumor was pathologically confirmed as metastatic urothelial carcinoma. The patient received one additional course of gemcitabine monotherapy. At a 1-year follow-up examination, he was still alive and had responded completely to the treatment for the penile metastasis. Metastatic involvement of the penis is an exceptionally rare condition. It is important to consider the balance between the tolerability and efficacy of chemotherapy and that gemcitabine monotherapy might be acceptable in an elderly patient with metastatic urothelial carcinoma who is still in good physical condition. The findings in this case suggest that gemcitabine monotherapy may be one possible candidate for the treatment of metastatic urothelial carcinoma, even in patients aged 80 years or older.

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Late penile metastasis from primary bladder carcinoma

Cited by 31 publications

References 10 publications

Penile metastasis from primary transitional cell carcinoma of the bladder sparing the urethra

Penile metastasis from primary transitional cell carcinoma of the bladder sparing the urethra

Bladder and vaginal transitional cell carcinoma: A case report

Efficacy and safety of gemcitabine monotherapy in an elderly patient with penile metastasis from bladder carcinoma: a case report

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