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RESIDENT CORNER
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 56-57

Penile metastases in a case of carcinoma colon: A rare occurrence


1 Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
2 Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
3 Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Date of Submission20-May-2021
Date of Acceptance18-Jun-2021
Date of Web Publication31-Jul-2021

Correspondence Address:
Dr. Ankush Jajodia
Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Sir Chotu Ram Marg, Rohini Institutional Area, Sector 5, New Delhi.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jco.jco_15_21

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How to cite this article:
Goyal J, Jajodia A, Goyal S, Pasricha S. Penile metastases in a case of carcinoma colon: A rare occurrence. J Curr Oncol 2021;4:56-7

How to cite this URL:
Goyal J, Jajodia A, Goyal S, Pasricha S. Penile metastases in a case of carcinoma colon: A rare occurrence. J Curr Oncol [serial online] 2021 [cited 2021 Dec 3];4:56-7. Available from: https://www.journalofcurrentoncology.org/text.asp?2021/4/1/56/322890




  Introduction Top


The liver, peritoneum, and lungs are the favored sanctuary of metastasis in colon cancer. Recent literature shows penile metastasis as a very rare occurrence, with approximately 400 cases and less than 60 cases in association with carcinoma colon.[1]

In our case, a 32-year-old diabetic man and known case of ulcerative colitis was diagnosed with carcinoma of the transverse colon. He underwent total proctocolectomy with ileal pouch-anal anastomosis and loop ileostomy. Histopathology showed multifocal moderately differentiated adenocarcinoma with regional nodal metastasis. The extra tumoral venous invasion was absent. The final histopathological staging was mpT2N2. He received FOLFOX-based adjuvant chemotherapy and was on regular follow-up. The patient developed a recurrence at the anastomotic site [Figure 1]: histopathological images] after 4 years for which he underwent local surgical clearance after an 18 FDG PET-CT ruled out any other disease elsewhere. Presently the patient presented with urinary retention, deranged kidney function tests, and raised serum carcinoembryonic antigen is 11.2 ng/mL. He was evaluated with contrast magnetic resonance imaging (MRI) of the abdomen and pelvic region with T1-weighted spin-echo (T1W SE), T2-weighted turbo spin-echo (T2W TSE), and short tau inversion recovery (STIR) sequences using body matrix coil, for superior soft-tissue resolution offered by MRI.
Figure 1: Ileal pouch resection specimen (post Colectomy) showing recurrence of adenocarcinoma with tumor deposit in submucosa (Right). Overlying mucosa shows dense inflammation (Left)

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MRI study [Figure 2] revealed altered signal intensity lesion in the corpus and glans involving corpus spongiosum of penis. There was the involvement of the penile urethra resulting in an upstream moderate upstream dilatation of urethra with an over-distended bladder and bilateral moderate hydroureteronephrosis [Figure 1]. Simultaneously enlarged mesenteric lymph nodes were noticed in the right lumbar region near the ileostomy site, which was proven as recurrence on tissue sampling.
Figure 2: Axial and sagittal MRI images showing an altered signal intensity lesion showing hyperintense signal on T2WI involving the corpus and glans of corpus spongiosum of penis causing moderate upstream dilatation of urethra with over-distended bladder. Few enlarged mesenteric lymph nodes are seen in right lumbar region near ileostomy site (proven as recurrent disease)

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  Discussion Top


Penile metastasis in colon cancer is an extremely rare incident. The primary sites of penile metastasis are about 75% of cancers of genitourinary origin include the prostate, bladder, kidney, and 13% cases of colorectal cancers.[2] Route of penile metastasis can be disseminated by venous, lymphatic, arterial routes, direct extension, and even by iatrogenic implantation. The venous route is the most common mechanism of metastasis to the penis due to retrograde venous flow.[3] The clinical manifestations are priapism, nodules over the penis, and obstructive voiding with urinary retention.[1],[3] Our patient presented with urinary retention that leads us to believe metastatic involvement of retroperitoneal nodal region encasing urinary tracts or a nonmetastatic cause, like infection of the genitor-urinary tract. The MRI findings were a surprise to both the reading radiologist and clinician. The gold standard diagnosis is histopathology but we attempted the same from the nodal site in the mesentery, for its better feasibility when discussed with an interventional radiologist.

Noninvasive modalities like ultrasound, computerized tomography (CT), and MRI can detect and helpful in the staging of disease, but MRI is the best modality for assessing the loco-regional extent and infiltration due to better soft-tissue resolution. Treatment depends on the general condition of the patient with the extent of metastatic spread of disease including local excision, chemotherapy, or radiotherapy. Timely detection of these penile metastases from nonurological origin carries a dismal prognosis with an overall low survival rate.[3],[4]

Acknowledgement

We thank the patients and their families for their munificence in contributing to this study. We would also like to thank all members of the IRB committee who gave their approval for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Xian GL, Tan LK, Lee GE. Penile metastasis of colorectal cancer mimicking priapism with acute urinary retention: A rare case. Open J Urol 2021;11:1.  Back to cited text no. 1
    
2.
Lee TG, Son SM, Kim MJ, Lee SJ. Penile metastasis in rectal cancer with pathologic complete response after neoadjuvant chemoradiotherapy: The first case report and literature review. Medicine (Baltimore) 2020;99:e21215.  Back to cited text no. 2
    
3.
Mearini L, Colella R, Zucchi A, Nunzi E, Porrozzi C, Porena M. A review of penile metastasis. Oncol Rev 2012;6:e10.  Back to cited text no. 3
    
4.
Marcu D, Iorga L, Mischianu D, Bacalbasa N, Balescu I, Bratu O. Malignant priapism: What do we know about it? In Vivo 2020;34:2225-32.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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