Metachronous penile metastasis from rectal cancer after total pelvic exenteration

Abstract

Despite its abundant vascularization and extensive circulatory communication with neighboring organs, metastases to the penis are a rare event. A 57-year-old male, who had undergone total pelvic exenteration for rectal cancer sixteen months earlier, demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography. A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia. No other obvious recurrent site was noted except the penile lesion. Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer. A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor. The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7, which strongly supported a diagnosis of penile metastasis from the rectum. The patient is alive more than two years without any recurrence.

Neįprastas tiesiosios žarnos vėžio metastazavimas: atvejo pristatymas

“…The most common symptoms noted, were palpable nodule, lesion/ulceration, priapism and difculty voiding. Two patients had no symptoms [7,8]. In our case, the patient complained of difcult voiding, pain and swelling in the scrotum and penis.…”

“…The favoured non-invasive imaging modality to delineate the extent of involvement of the penis is MRI [5,7]. On T1-weighted images, lesions have low signal intensity, isointense with the surrounding corpus cavernosum.…”

“…On T2-weighted imaging, they appear inhomogeneous with low to intermediate signal intensity, seen clearly against the high background intensity of the cavernosal bodies. Other radiological diagnostic modalities such as CT and PET are useful non-invasive methods for the evaluation of lesions [7,8]. Invasive methods such as cavernosography may be used.…”

“…No single treatment option with superior results has been noted. Total penectomy remains the only treatment to have shown a longer-term survival in patients with localized disease [7]. Surgery might also have a role in palliation where there is intractable penile pain [4].…”

Metastasis to the Glans Penis: An Unusual Site of Rectal Cancer Recurrence

“…7,8 Nevertheless, some authors have reported long survival cases. In 1961, Abeshouse 9 documented two patients surviving over nine years after their cancer diagnosis -in one case, the metastasis to the glans penis was treated with low dose rate brachytherapy and, in the other one, with surgical excision and adjuvant external radiotherapy.…”