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Ali EA, Sardar S, Yassin MA. Priapism in Lymphoproliferative Disorders: A Systematic Review. Hematol Oncol Stem Cell Ther 2022; 15:176-182. [PMID: 34157311 DOI: 10.1016/j.hemonc.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 01/14/2023] Open
Abstract
Priapism is defined as a persistent penile erection lasting more than 4 h. We searched the literature for reviews, case reports, and series for patients with lymphoproliferative disorders who developed priapism. The search involved all the lymphoproliferative disorders included in the revised 2016 World Health Organization classification of lymphoid neoplasms including chronic lymphocytic leukemia, multiple myeloma, Waldenström macroglobulinemia, and lymphomas. A total of 16 articles were found. The search included cases up to 4th January 2021. Priapism was seen most commonly as the first manifestation of lymphoproliferative disorders, rarely seen after treatment or after diagnosis.
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Affiliation(s)
- Elrazi A Ali
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Hematology and Oncology, Hamad Medical Corporation, Doha, Qatar
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Aynaou M, Elhoumaidi A, Mhanna T, Boateng PD, Chennoufi M, Barki A. Penile gangrene: an unusual complication of malignant priapism in a patient with renal cell carcinoma. Pan Afr Med J 2019; 34:130. [PMID: 33708299 PMCID: PMC7906551 DOI: 10.11604/pamj.2019.34.130.20447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022] Open
Abstract
A 68-year-old man presented with priapism and penile gangrene. The patient had no history of penis trauma or medications for erectile dysfunction. Corpus cavernosa aspiration cytology were positive for malignant cells. Total penectomy was performed. Enhanced chest and abdominal computed tomography showed a left renal tumor with pulmonary and hepatic metastases. Ultrasound-guided renal biopsy showed clear cell renal cell carcinoma.
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Affiliation(s)
- Mohammed Aynaou
- Department of Urology, Mohamed VI University Hospital Center, Mohamed First University, Oujda, Morocco
| | - Amine Elhoumaidi
- Department of Urology, Mohamed VI University Hospital Center, Mohamed First University, Oujda, Morocco
| | - Tarik Mhanna
- Department of Urology, Mohamed VI University Hospital Center, Mohamed First University, Oujda, Morocco
| | - Paapa Dua Boateng
- Department of Urology, Mohamed VI University Hospital Center, Mohamed First University, Oujda, Morocco
| | - Mehdi Chennoufi
- Department of Urology, Mohamed VI University Hospital Center, Mohamed First University, Oujda, Morocco
| | - Ali Barki
- Department of Urology, Mohamed VI University Hospital Center, Mohamed First University, Oujda, Morocco
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Panwar VK, Mavuduru RS, Devana SK, Vaiphei K, Bora GS. Priapism with penile gangrene: An unusual presentation of multiple myeloma. Indian J Urol 2017; 33:251-252. [PMID: 28717280 PMCID: PMC5508441 DOI: 10.4103/iju.iju_41_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Penile gangrene is very rare sequel of ischemic priapism. Previous published reports have shown its occurrence in patients with sickle cell disease, urethral carcinoma, bladder carcinoma, thrombotic thrombocytopenic purpura, idiopathic, traumatic, etc. Ischemic priapism with penile gangrene as an initial presentation of multiple myeloma has not been reported. We present a 44-year-old patient of multiple myeloma presenting with ischemic priapism and penile gangrene requiring partial penectomy.
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Affiliation(s)
| | | | | | - Kim Vaiphei
- Department of Histopathology, PGIMER, Chandigarh, India
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Sahu KK, Mishra K, Dhibar DP, Ram T, Kumar G, Jain S, Naseem S, Malhotra P. Priapism as the Presenting Manifestation of Multiple Myeloma. Indian J Hematol Blood Transfus 2016; 33:133-136. [PMID: 28194073 DOI: 10.1007/s12288-016-0722-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
| | - Kundan Mishra
- Department of Internal Medicine, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
| | - Deba Prasad Dhibar
- Department of Internal Medicine, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
| | - Tulasi Ram
- Department of General Surgery, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
| | - Ganesh Kumar
- Department of Hematology, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
| | - Sanjay Jain
- Department of Internal Medicine, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
| | - Shano Naseem
- Department of Hematology, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Internal Medicine, P.G.I.M.E.R, Union Territory of Chandigarh, 160012 India
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Bahat G, Tufan F, Akin S, Atay K, Saka B, Kutlu O, Tascioglu C. A rare but significant cause of priapism in the elderly: multiple myeloma. Aging Clin Exp Res 2011; 23:495-7. [PMID: 22526083 DOI: 10.1007/bf03325247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Priapism is a rare symptom with diverse etiological factors. Although most cases in adults are secondary to drug use and intracavernosal injections, blood dyscrasias and hypercoagulable states, vasculitis, penile metastases, neurological conditions, spider bites, carbon monoxide poisoning, and total parenteral nutrition may also result in priapism. We report a case of recurrent and refractory priapism in a 61-year-old man which was diagnosed as multiple myeloma after emergence of hypercalcemia and renal failure due to progression of the underlying pathology. The value of the initial diagnostic approach is emphasized.
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Affiliation(s)
- Gulistan Bahat
- Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.
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Morrison BF, Burnett AL. Priapism in hematological and coagulative disorders: an update. Nat Rev Urol 2011; 8:223-30. [DOI: 10.1038/nrurol.2011.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Priapism is defined as a persistent penile erection (typically 4 h or longer) that is unrelated to sexual stimulation. Priapism can be classified as either ischemic or nonischemic. Ischemic priapism, the most common subtype, is typically accompanied by pain and is associated with a substantial risk of subsequent erectile dysfunction. Prompt medical attention is indicated in cases of ischemic priapism. The initial management of choice is corporal aspiration with injection of sympathomimetic agents. If medical management fails, a cavernosal shunt procedure is indicated. Stuttering (recurrent) ischemic priapism is a challenging and poorly understood condition; new management strategies currently under investigation may improve our ability to care for men with this condition. Nonischemic priapism occurs more rarely than ischemic priapism, and is most often the result of trauma. This subtype of priapism, which is generally not painful, is usually initially managed with conservative treatment.
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Decaux O, Laurat E, Perlat A, Cazalets C, Jego P, Grosbois B. Systemic manifestations of monoclonal gammopathy. Eur J Intern Med 2009; 20:457-61. [PMID: 19712843 DOI: 10.1016/j.ejim.2009.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 01/04/2009] [Indexed: 12/13/2022]
Abstract
Systemic manifestations of monoclonal gammopathies (MG) are rare but extremely varied. This general review focuses on the hyperviscosity syndrome, neurological disorders, skin changes, the POEMS syndrome, and biological manifestations, with the exception of amyloidosis AL and cryoglobulinemia. The hyperviscosity syndrome usually involves a combination of general, hemorrhagic, ocular and central neurological disorders. The principal neurological manifestations are peripheral neuropathies, mainly due to IgM with anti-MAG activity. Skin disorders include overload dermatoses (xanthomatosis, mucinosis), neutrophilic dermatosis, urticaria, edema and the AESOP syndrome. The POEMS syndrome classically consists of polyneuropathy, organomegaly, endocrinopathy, monoclonal plasmocyte proliferation, and cutaneous manifestations. MG interference with assay methods can lead to false hyponatremia, hypoglycemia, hyperbilirubinemia, hypercalcemia and hypertransferrinemia. These systemic manifestations can reveal classical MG-related disorders such as monoclonal gammopathy of undetermined significance (MGUS), solitary plasmocytoma, multiple myeloma, and Waldenstrom's disease. They are due either to the chemicophysical properties of the monoclonal immunoglobulin, or to its antibody activity (especially against autoantigens), with potential therapeutic implications.
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Affiliation(s)
- Olivier Decaux
- Service de Médecine Interne, Hôpital Sud, CHU, 16 boulevard de Bulgarie, 35 203 Rennes, France
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Nand S, Molokie R. Therapeutic plasmapheresis and protein A immunoadsorption in malignancy: a brief review. J Clin Apher 1990; 5:206-12. [PMID: 2229001 DOI: 10.1002/jca.2920050408] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Plasmapheresis is being used with considerable frequency in the management of malignant and non-malignant disorders. More recently, staphylococcal Protein A immunoadsorption has been employed in similar clinical situations. In patients with malignancy, plasmapheresis has been shown to produce alterations in plasma proteins, decrease circulating immune complexes, remove "specific" and "non-specific" blocking factors, change immune reactivity, and affect monocyte function. Partial responses have been reported in a small number of patients with carcinoma of lung, colon, and breast following plasmapheresis. In addition, there are reports of favorable responses in patients with melanoma, head and neck tumors, lymphomas, leukemias, and Kaposi's sarcoma in acquired immune deficiency. All these responses were partial and brief, and the treatment did not alter the course of the disease. Plasmapheresis has been useful in the management of hyperviscosity and occasionally of paraneoplastic syndromes. It may also have a role in the treatment of thrombotic thrombocytopenic purpura associated with mitomycin-C therapy. Protein A immunoadsorption, by which circulating immune complexes are selectively removed, can activate the complement system, increase blastogenic responses, and increase the natural killer cell activity. It has been shown to produce partial responses in breast and colon cancer, as well as Kaposi's sarcoma in acquired immune deficiency. It may have a useful role to play in the management of mitomycin-C-associated thrombotic thrombocytopenic purpura. Both plasmapheresis and Protein A immunoadsorption should be considered investigational interventions at this time. Toxicity of plasmapheresis, though uncommon, can be serious and may rarely be fatal. Toxicity of Protein A immunoadsorption is mild, consisting mainly of influenza-like symptoms and rash.
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Affiliation(s)
- S Nand
- Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois 60153
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Abstract
Indications, results, techniques, laboratory monitoring and complications of therapeutic plasmapheresis in patients with symptomatic paraproteinemia are reviewed. In paraproteinemia associated with severe complications plasma-pheresis has been used successfully as an emergency treatment, as a treatment that reduces temporarily the paraprotein level until reduction of resynthesis is reached by cytotoxic therapy, or as a longterm adjuvant therapy in cases of slowly proliferating plasmacytoma or lymphoma. Plasmapheresis has not been shown to influence the underlying malignant process. Paraprotein-related complications that can be reduced by plasmapheresis are hyperviscosity, hypervolemia, haemorrhagic diathesis, cryoglobulinemic symptoms, rapidly deteriorating renal insufficiency, visual impairment, and neurologic disturbances. Technically, large-pored plasma filters have some advantage as compared to centrifugation techniques. Paraprotein-specific complications of therapeutic plasmapheresis are rare. As an ancillary treatment, therapeutic plasmapheresis has expanded the therapeutic tools in the management of paraproteinemia.
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Stener B, Henriksson C, Johansson S, Gunterberg B, Pettersson S. Surgical removal of bone and muscle metastases of renal cancer. ACTA ORTHOPAEDICA SCANDINAVICA 1984; 55:491-500. [PMID: 6507069 DOI: 10.3109/17453678408992944] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Fifteen men and six women with renal cancer underwent surgical removal of metastatic lesions in bone (19 patients) or muscle (two patients). The operation was carried out 2 years before nephrectomy/renal resection in two patients, on the same occasion in four, and 1-196 months after in 15. Surgical interventions of various kinds were undertaken, resulting in the loss of a lower limb in seven patients and an upper limb in one. The observed 5-year survival was 4 out of 10. Six patients were alive at follow-up, five of them without evidence of disease. Eight of the remaining 15 patients died of an unrelated disease (five without evidence of tumor); the other seven patients died of metastatic tumor disease. Local recurrence was diagnosed, and removed, in two patients. The results compare favourably with reports on surgically removed pulmonary metastases of renal cancer and seem to justify an aggressive attitude towards solitary bone and muscle metastases of renal cancer.
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