Penile metastasis in rectal cancer with pathologic complete response after neoadjuvant chemoradiotherapy

Abstract

Rationale: Penile metastasis in rectal cancer is very rare and often originates from prostatic or bladder cancer. The prognosis of penile metastasis is poor and its treatments are more often palliative than curative due to association with disseminated metastases. Pathologic complete response (pCR) in rectal cancer with neoadjuvant chemoradiotherapy (CRT) has been shown to be surrogate marker of favorable long-term outcomes and currently has no report of penile metastasis. Here, we first report isolated penile metastasis in rectal cancer with pCR after neoadjuvant CRT. Patient concern: The patient was a 74-year-old male with metastasis to the glans penis from rectal cancer diagnosed 9 months after abdominoperineal resection. Physical examination revealed palpable multiple nodules on the glans penis. Diagnosis: Penile biopsy revealed metastatic carcinoma from the rectal cancer. Intervention: Chemotherapy was started as soon as possible, because patient suffered urinary discomfort by rapid growing metastatic lesions. He is currently receiving palliative chemotherapy with modified FOLFOX-6 (mFOLFOX-6; oxaliplatin with 5-fluorouracil and folinic acid) plus bevacizumab. Outcome: The patient is still alive 4 months after diagnosis with markedly decreased metastatic lesions. Lesson: We propose that although penile metastasis in rectal cancer with pCR after preoperative neoadjuvant CRT is extremely rare, it might help to start early palliative chemotherapy and clinicians should be aware of this possibility.

Surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy of rectal adenocarcinoma with penile metastasis: a case report

“…Metastases can present as plaques, wart-like nodules, ulceration, erythema, or induration of the penis ( 5 ). The mass ordinarily progresses to involve the corpora cavernosa with extension into the neighboring perineal subcutaneous tissue, the corpus spongiosum, and bulb ( 6 ). Although pain is not the patient’s initial symptom, it is often the most prominent symptom in the later stage.…”

“…A patient underwent palliative chemotherapy treatment and still alive 4 months after diagnosis of penile metastases ( 5 ). Lee et al reported a patient with metastatic carcinoma from the rectal cancer and the patient was still alive after receiving palliative chemotherapy with modified FOLFOX-6 (mFOLFOX-6; oxaliplatin with 5-fluorouracil and folinic acid) plus bevacizumab ( 6 ). On average, penile metastasis from rectal adenocarcinoma can occur within 2 years after the diagnosis of the primary tumor ( 7 ).…”

A Case Report and Review of the Literature of Penile Metastasis From Rectal Cancer

“…As this entity is very rare, there are no international or national treatment guidelines. Possible treatment modalities alone or in combinations include local excision of the tumor, total penectomy, chemotherapy, radiotherapy, and palliative treatment only ( 14 , 39 , 50 , 67 , 69 ). In our review, chemotherapy (alone or in combination with radiotherapy or surgical treatment) was the most often suggested treatment.…”