Pulmonary adenocarcinoma presenting with penile metastasis: a case report

Abstract

IntroductionPenile metastases are an extremely rare occurrence, and most primary malignancies are located in the urinary bladder, prostate, rectum, and rectosigmoid. Although very few cases of penile metastases have been reported, those of lung cancer as the primary tumor are very rare. Among the latter, squamous cell carcinomas constitute the majority, whereas adenocarcinomas are almost exceptions. To the best of our knowledge, only two cases have been reported.Case presentationWe report the case of a 59-year-old Greek man who presented with persistent cough and chest pain that had started one month prior to a medical appointment. A physical examination, complete laboratory work-up, computed tomography scanning (of the chest, brain, and abdomen), pelvic magnetic resonance imaging, penile ultrasonography, bone scanning, and histological analyses were conducted. Afterward, a lung adenocarcinoma metastatic to the bones, brain, adrenals, lymph nodes, and penis was diagnosed. The primary lesion was a mass of 4cm in diameter in the apical segment of the lower lobe of the right lung. The patient was treated with bone and brain radiotherapy and various cycles of first- and second-line chemotherapy, and partial response was achieved five months after the initial appointment.ConclusionsAlthough these metastatic sites are well known to occur from a primary pulmonary malignancy, penile metastasis is extremely rare. Its identification requires prompt awareness by the physician despite the dismal prognosis. Furthermore, since the penis usually is omitted from the physical examination and lung cancer is the leading cause of cancer-related deaths, more penile metastases may be detected in the future, making early detection and appropriate management of great importance.

Penile metastasis of sigmoid colon carcinoma: a rare case report

“…Pain is not a prominent symptom in most of the patients. Other manifestations of penile metastasis include ulceration, obstructive or irritating voiding symptoms, hematuria, enlargement of inguinal lymph nodes, and penile or perineal pain [ 5 , 6 ].…”

“…Radiotherapy is used to reduce the size of lesion as well as to control pain. Second-line chemotherapy with docetaxel, paclitaxel, vinorelbine, gemcitabine, irinotecan, and gefitinib has anindefinite curative effect [ 5 ]. Some patients only receive symptomatic treatment.…”

Palpable Penile Metastases: A Bizarre Presentation of Rectal Adenocarcinoma

“…Retrograde venous route is the most common route [1, 2] and is attributed to the dorsal venous system of the penis being in direct communication with the venous plexuses of the pelvic viscera. Thus, when there is an obstruction proximally (from tumors arising in the prostate, bladder, or rectosigmoid), retrograde flow occurs, allowing spread of tumor cells to the penis.…”

“…The majority of cases involve primary tumors from the pelvic region including bladder (30–35%), prostate (28–30%), rectosigmoid colon (13%), kidneys (8–10%), and testes (5%) [1, 2]. Other less common primary sites include the gastrointestinal and respiratory tract.…”

Malignant priapism: Penile metastasis originating on a primary prostate adenocarcinoma

“…[ 19 ] MRI is more accurate to establish the differential diagnosis, when compared to CT or genital ultrasound,[ 6 ] and it must be this the method chosen. [ 20 ] In the MRI, penile metastases have a low intensity signal in T1, and isointense in relation to the adjoining cavernous bodies. In T2, the metastatic focus is hypointense and contrast with the hyperintese signal of the corpus cavernous.…”