Secondary penile tumours revisited

Abstract

ObjectiveTo highlight the salient features of metastatic malignancies involving the penis, with special reference to the primary tumour sites, metastatic mechanisms, clinical features, differential diagnosis, treatment and prognosis.MethodsA comprehensive search of the literature was performed using MEDLINE and EMBASE, using the keywords 'penis', 'secondary malignancy', 'metastasis' and 'malignant priapism' to identify reviews and case reports of secondary penile malignancy. A case of rare clinical presentation of metastatic penile lesion is presented along with the review of the literature.ConclusionSecondary malignancy of the penis is a rare clinical entity, despite the rich vascularisation of this organ. The majority of metastatic lesions take their origin from the neighbouring genito-urinary organs, mainly prostate and bladder. These lesions are often associated with disseminated malignancy and hence have a poor outcome. Nodular or ulcerative lesions involving the corpora cavernosa or priapism are the main modes of clinical presentation. In most cases, only palliative or supportive therapy is indicated.

Malignant priapism secondary to isolated penile metastasis from a renal pelvic carcinoma

“…Various mechanisms for penile metastasis have been suggested, which include retrograde venous spread, retrograde lymphatic spread, arterial spread, direct extension, implantation and secondary to instrumentation. 9 Accumulating clinical evidence indicates that retrograde venous spread from the pudendal into the dorsal venous system of the penis is the most likely mechanism. About two-thirds of all penile metastasis are detected at a mean time of 18 months after the detection of the primary tumour; the remaining third present at the same time as the primary tumour.…”

“…[1][2][3]9,16 More than 80% of patients die within 6 months, irrespective of the primary tumour and treatment. 16 However, in our case, the imaging studies did not show other metastases; therefore, we concluded that the penis was the isolated metastatic site.…”

“…5 Extra-pelvic sites, including the lung, pancreas, stomach, esophagus, melanoma and testis, have been noted. [6][7][8][9] Fewer than 20 cases of penile metastasis from renal cancer have been reported, most of them were renal cell carcinoma in origin. 10,11 On the other hand, penile metastasis has been a part of more widespread disease in about 90% of reported cases.…”

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

“…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. …”

“…[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. …”