Malignant refractory priapism in case of urothelial cancer. Case report

Cover Page

Cite item

Full Text

Abstract

Background. Malignant priapism is a painful lesion and persistent erection of the penis due to metastatic infiltration by a neoplasm. Secondary penile malignancy, as a consequence of metastatic disease, is a rare event. This indicates the progression of the main disease and an unfavorable outcome. Most cases of metastatic penile cancer are from the urogenital region: the prostate – 33%, the urinary bladder – 30%, the kidneys – 8% and gastrointestinal tract – 8%.

Aim. To describe the case of malignant refractory priapism in bladder cancer patient.

Materials and methods. A 49-year-old patient with pT4aN3M0 stage IIIB low-grade bladder cancer received the complex treatment and was under observation. Combined 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) using GE Healthcare Optima PET/CT 560 scanner was performed.

Results. The patient with poorly differentiated bladder cancer underwent transurethral resection followed by 3 cycles of neoadjuvant polychemotherapy using Gemzar plus cisplatin scheme. The surgery concerning cystprostatectomy, pelvic lymphadenectomy, urethrectomy and the Bricker operation was performed after the development of relapse. The histological examination of the bladder tissue showed the presence of poorly differentiated urothelial cancer, invading all the layers with invasion into the seminal vesicles and prostate. The lesion in the root of the penis that were growing and associated with the tensive pain was diagnosed 7 months after the surgical treatment. The intensity of these manifestations was increasing within 2 weeks. During the physical examination the penis was enlarged, solid, rigid and painful on palpation. According to 18F-FDG PET/CT study the metastatic penile cancer complicated with priapism was diagnosed.

Conclusion. Malignant priapism is a rare condition. The most often cause of malignant priapism development is urogenital tract tumors, in particular urothelial cancer. Refractory priapism is characterized by the increase of the local manifestations over time. 18F-FDG PET/CT is the method of choice for the diagnosis of malignant priapism.

About the authors

Nikolai A. Ognerubov

Derzhavin Tambov State University; Tambov Regional Oncological Clinical Dispensary

Author for correspondence.
Email: ognerubov_n.a@mail.ru
ORCID iD: 0000-0003-4045-1247
SPIN-code: 3576-3592

D. Sci. (Med.), Cand. Sci. (Law), Prof.

Russian Federation, Tambov; Tambov

Tatiana S. Antipova

"PET-Technology" Ltd

Email: antipovats@gmail.com
ORCID iD: 0000-0003-4165-8397

doctor

Russian Federation, Tambov

References

  1. Kamaleshwaran KK, Balasundararaj BKP, Jose R, Shinto AS. Penile metastasis from prostate cancer presenting as malignant priapism detected using gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography. Indian J Nucl Med. 2018;33:57-8. doi: 10.4103/ijnm.IJNM_107_17
  2. Cocci A, Hakenberg OW, Cai T, et al. Prognosis of men with penile metastasis and malignant priapism: a systematic review. Oncotarget. 2017;9:2923-30.
  3. Lin YH, Kim JJ, Stein NB, Khera M. Malignant priapism secondary to metastatic prostate cancer: a case report and review of literature. Rev Urol. 2011;13(2):90-4.
  4. Zhang K, Da J, Yao HJ, et al. Metastatic tumors of the penis: a report of 8 cases and review of the literature. Medicine (Baltimore). 2015;94:e132.
  5. Mearini L, Colella R, Zucchi A, et al. A review of penile metastasis. Oncol Rev. 2012;6:e10. doi: 10.4081/oncol.2012.e10
  6. Eberth C. Krebsmetastasen des corpus cavernosum penis. Virchows Archiv. 1870;51:145-6.
  7. Triki W, Kacem A, Itami A, et al. Penile metastasis of colon carcinoma: A rare case report. Urol Case Rep. 2019;24:100875.
  8. Cherian J, Rajan S, Thwaini A, et al. Secondary penile tumours revisited. Int Semin Surg Oncol. 2006;3:33.
  9. De Luca F, Zacharakis E, Shabbir M, et al. Malignant priapism due to penile metastases: case series and literature review. Arch Ital Urol Androl. 2016;88:150-2. doi: 10.4081/aiua.2016.2.150
  10. Peacock AH. Malignant priapism due to secondary carcinoma in the corpora cavernosum. Northwest Med. 1938;37:143-5.
  11. da Silva MC, Vilares AT, Dias SC, et al. Penile Metastatic Disease Presenting as Malignant Priapism: A Case Report. J Urol Surg. 2021;8(4):297-9.
  12. Sibarani J, Syahreza A, Wijayanti Z, et al. Malignant priapismus induced by adenocarcinoma of the prostate. Urol Case Rep. 2020;29:101102.
  13. Lam KO, Huang J. Malignant priapism and germ cell tumour. Lancet Oncol. 2019;20(4):e224. doi: 10.1016/s1470-2045(19)30075-0
  14. Aynaou M, Elhoumaidi A, Mhanna T, et al. Penile gangrene: an unusual complication of malignant priapism in a patient with renal cell carcinoma. Pan Afr Med J. 2019;34:130. doi: 10.11604/pamj.2019.34.130.20447
  15. Prabhuswamy VK, Krishnappa P, Tyagaraj K. Malignant refractory priapism: An urologist's nightmare. Urol Ann. 2019;11(2):222-5.
  16. Xing DT, Yilmaz H, Hettige S, et al. Successful Treatment of Malignant Priapism by Radiotherapy: Report of a Case, Review of the Literature, and Treatment Recommendations. Cureus. 2021;13(8):e17287.
  17. Огнерубов Н.А., Огнерубова И.Н. Злокачественный приапизм. Вестник ТГУ. 2017;22(1):171-3 [Ognerubov NA, Ognerubova IN. Cancerous priapism. Tambov University Reports. 2017;22(1):171-3 (in Russian)].
  18. Dubocq FM, Tefilli MV, Grignon DJ, et al. High flow malignant priapism with isolated metastasis to the corpora cavernosa. Urology. 1998;51(2):324-6.
  19. Al-Mufarrej F, Kamel MH, Mohan P, Hickey D. Tricorporal priapism postradical cystoprostatectomy: first sign of recurrent urogenital malignancy. Int J Urol. 2006;13:460-2.
  20. Галимов Р.Д., Иванцов А.О., Павлов Д.Г., и др. Приапизм, вызванный метастатическим поражением полового члена, при раке толстой кишки. Клиническое наблюдение. Экспериментальная клиническая урология. 2014;4:120-3 [Galimov RD, Ivantsov AO, Pavlov DG, et al. Priapizm, vyzvannyi metastaticheskim porazheniem polovogo chlena, pri rake tolstoi kishki. Klinicheskoe nabliudenie. Eksperimental'naia klinicheskaia urologiia. 2014;4:120-3 (in Russian)].
  21. Osther PJ, Lontoff E. Metastasis to the penis: Case reports and review of literature. Int Urol Nephrol. 1991;23:161-7.
  22. Wong HL, Shi H, Koh LT. Solitary metastasis to the penis from prostate adenocarcinoma – a case report. J Radiol Case Rep. 2019;13:20-8. doi: 10.3941/jrcr.v13i12.3846
  23. Fujita N, Kurokawa R, Kaneshima R, et al. Patient with penile metastasis from prostate cancer and survival over 5 years: A case report with longitudinal evaluation using computed tomography and magnetic resonance imaging. Radiol Case Rep. 2021;16(6):1255-8.
  24. Broderick GA, Kadioglu A, Bivalacqua TJ, et al. Priapism: Pathogenesis, epidemiology, and management. J Sex Med. 2010;7:476-500.
  25. Salonia A, Eardley I, Giuliano F. European Association of Urology guidelines on priapism. Eur Urol. 2014;65(2):480-9.
  26. Cante D, Franco P, Sciacero P, et al. Penile metastasis from prostate cancer: a case report. Tumori. 2014;100:0-6.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. A 49-year-old patient E. MIP and axial and sagittal computed tomography, positron emission tomography/ computed tomography images show symmetrical uptake of radiopharmaceutical measuring 33 mm (SUVmax 9.82) in penile corpora cavernosa on both sides, closer to the root of the penis. In the distal direction, there is a region with increased uptake of radiopharmaceutical (SUVmax 12.44) measuring 80 mm, associated with signs of priapism.

Download (230KB)
Indexing metadata

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies