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Pósfai B, Szentkereszty M, Sánta F, Bajory Z, Simon A, Kozéki Z, Csányi I, Akgul M, Kuthi L. Penile melanoma: a pathological report of two cases. Diagn Pathol 2023; 18:117. [PMID: 37898793 PMCID: PMC10613369 DOI: 10.1186/s13000-023-01404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Penile melanoma (PM) is a rare tumor, accounting for less than 2% of all penile cancers. PM can occur on the surface of the glans, foreskin, and opening of the urethra. Furthermore, PM primarily affects older individuals and is not associated with sun exposure. Currently, there is no specific staging system for genitourinary tract melanomas, so these tumors are typically staged using the criteria for cutaneous melanoma. Limited data in the literature suggests that PM generally has a poor clinical prognosis. CASE PRESENTATION Here, we describe two cases of PM. The first case affected a 62-year-old male who presented with hematuria and a painful tumor in the distal urethra, leading to a suspicion of penile cancer. The second case involved a 68-year-old male who noticed a rapidly evolving dark spot on his foreskin. Histological analysis confirmed the presence of melanoma in both patients. The tumors showed a diffuse and strong PRAME-positivity and lacked BRAF mutation in both cases. Additionally, the second tumor harbored an activating CKIT mutation. An enhanced PD-L1 expression was observed in both tumors. CONCLUSIONS We presented two rare forms of mucosal melanoma and highlighted the entities in the differential diagnosis. Based on our experience PRAME is a helpful marker for making the diagnosis of PM, and PD-L1 can predict the success of the immunotherapy. We also emphasize the need for an organ-specific staging system for PMs.
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Affiliation(s)
- Boglárka Pósfai
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1., Szeged, H-6725, Hungary
| | | | - Fanni Sánta
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1., Szeged, H-6725, Hungary
| | - Zoltán Bajory
- Department of Urology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Andrea Simon
- Tumor Pathology Center, National Institute of Oncology, Budapest, Hungary
| | - Zsófia Kozéki
- Department of Dermatology, National Institute of Oncology, Budapest, Hungary
| | - Ildikó Csányi
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Mahmut Akgul
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Levente Kuthi
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1., Szeged, H-6725, Hungary.
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2
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Xing DT, Yilmaz H, Hettige S, Hegde R, Nair R. Successful Treatment of Malignant Priapism by Radiotherapy: Report of a Case, Review of the Literature, and Treatment Recommendations. Cureus 2021; 13:e17287. [PMID: 34552828 PMCID: PMC8448578 DOI: 10.7759/cureus.17287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Malignant priapism is a condition of painful induration and erection of the penis secondary to metastatic infiltration by a neoplasm. This condition is associated with a poor prognosis. We report on a case of an 87-year-old man who presented with a painful, partially erected penis subsequent to a diagnosis of metastatic Gleason 4+5 prostate cancer. Magnetic resonance imaging (MRI) showed diffuse bilateral infiltration of his corpora cavernosa. The core biopsy of the penile nodule revealed it to be a poorly differentiated carcinoma consistent with prostatic origin. The patient's symptoms were completely resolved after treatment with high-dose palliative conformal radiotherapy (40Gy in 16 fractions). We systemically reviewed clinical reports of palliative radiotherapy for malignant priapism with the aim to gain more information on the management of this rare condition.
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Affiliation(s)
- Daniel T Xing
- Oliver Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, AUS
| | | | - Supan Hettige
- Gippsland Radiation Oncology, Latrobe Regional Hospital, Traralgon, AUS
| | - Rajendra Hegde
- Gippsland Radiation Oncology, Latrobe Regional Hospital, Traralgon, AUS
- Radiation Oncology, William Buckland Radiotherapy Centre, The Alfred Health, Melbourne, AUS
| | - Rohan Nair
- Gippsland Radiation Oncology, Latrobe Regional Hospital, Traralgon, AUS
- Radiation Oncology, William Buckland Radiotherapy Centre, The Alfred Health, Melbourne, AUS
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3
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Hosny K, Nosseir M, Pearce I. Malignant priapism: Review of the report in three decades. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819893206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:Priapism is one of the few critical male urological emergencies. There are two main types of priapism, low flow/venous and high flow/arterial priapism. Malignant priapism is a rare subtype of low flow priapism usually secondary to pelvic malignancy, but other extra-pelvic primary cancers cannot be completely excluded.Aim:To assess and highlight the poor prognosis of malignant priapism, with a view to directing management towards both symptomatic relief and improving patients’ quality of life.Method:All reports of malignant priapism between 1998 and 2018 were searched and assessed focusing on the primary cancer, duration of complaint, associated symptoms, method of management and prognosis.Conclusion:Malignant priapism is a rare form of ischaemic priapism, resistant to successful therapies utilized in the management of other forms of ischaemic priapism. Urological cancers are the most common primaries implicated with the most commonly associated symptoms being pain and urinary symptoms. In the absence of any evidence based guidelines and reliably successful treatment options, clinicians should aim to employ supportive treatment strategies including adequate analgesia.Level of evidence:level4
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Affiliation(s)
- Khaled Hosny
- Department of Urology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Mahmoud Nosseir
- Department of Urology, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Ian Pearce
- Department of Urology, Manchester Royal Infirmary, UK
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4
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Tu LH, Spektor M, Ferrante M, Mathur M. MRI of the Penis: Indications, Anatomy, and Pathology. Curr Probl Diagn Radiol 2019; 49:54-63. [PMID: 30704768 DOI: 10.1067/j.cpradiol.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
The purpose of this review is to discuss the role of magnetic resonance imaging (MRI) in the evaluation of penile pathology. Normal penile anatomy as well as the appearance of neoplastic and non-neoplastic entities on MRI will be reviewed. While ultrasound remains the first line imaging modality in evaluating most penile pathology, MR imaging has specific advantages owing to improved soft tissue resolution, ability to evaluate less accessible or complex anatomy (such as at the base of the penis), and the ability to detect subtle enhancement. Therefore, MRI is useful for when ultrasound and/or clinical findings are equivocal or incongruent. In addition, MR imaging is essential for preoperative surgical planning and is the imaging modality of choice in evaluating penile prostheses. The added value of MRI in these settings makes it an integral component to the management of many pathological entities affecting the penis.
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Affiliation(s)
- Long H Tu
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT.
| | - Mike Spektor
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Marc Ferrante
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Mahan Mathur
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
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5
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Carvajal G, Rocha A. Ultrasound-Guided Dorsal Penile Neurolysis for Malignant Priapism Pain Management. J Pain Symptom Manage 2019; 57:e4-e5. [PMID: 30686298 DOI: 10.1016/j.jpainsymman.2018.10.501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Gabriel Carvajal
- Servicio de Medicina Paliativa, Departamento de Hemato-Oncología Hospital México, Costa Rica.
| | - Andrés Rocha
- Clínica de Dolor, Instituto Nacional de Cancerología, México
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6
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Mearini L, Colella R, Zucchi A, Nunzi E, Porrozzi C, Porena M. A review of penile metastasis. Oncol Rev 2012; 6:e10. [PMID: 25992200 PMCID: PMC4419641 DOI: 10.4081/oncol.2012.e10] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/02/2012] [Accepted: 06/07/2012] [Indexed: 12/16/2022] Open
Abstract
Penile cancer as primary disease is relatively rare in developed countries. The penis is a rare site of metastases in spite of its rich vascularization. Approximately 500 cases have been reported in the literature; almost 70% of primary lesions are of pelvic origin (from genitourinary or recto-sigmoid primary tumors). We describe a case of penile metastasis from lung cancer. The rarity of the event prompted us to also explore related reviews and discuss the incidence, physiopathology, diagnosis and therapy of penile secondary cancer.
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Affiliation(s)
| | - Renato Colella
- Pathological Anatomy and Histology Department, University of Perugia, Italy
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7
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Santos GDC, de Alvarenga ML, Borlot VF, Moutinho MAK, de Franco MF. Penile metastasis of urothelial carcinoma diagnosed by fine-needle aspiration. Cytojournal 2009; 6:10. [PMID: 19621093 PMCID: PMC2710761 DOI: 10.4103/1742-6413.52832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 03/02/2009] [Indexed: 11/04/2022] Open
Abstract
Penile neoplasms are rare and can be primary or represent metastasis or local recurrence. The most common primary cancer of the penis is squamous cell carcinoma, accounting for 95% of all cancers. In spite of the rich vascularity of the organ, penile metastases are uncommon. Cutaneous metastasis of urothelial carcinoma (UC) is extremely rare and generally accepted as the late manifestation of a systemic spread. By 1998, approximately 500 cases of penile metastasis had been reported worldwide. However, only few case reports and series of fine-needle aspiration cytology (FNAC) of penile tumors have been documented. We report a case of penile metastasis from UC diagnosed by FNAC and describe the cytomorphological findings with an emphasis on cercariform cells. Although not commonly used, FNA of penile nodules can be effective in diagnosing recurrence or metastasis and avoiding surgical procedures, thus being an excellent initial procedure in the diagnostic approach.
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Affiliation(s)
- Gilda da Cunha Santos
- Department of Pathology, Escola Paulista de Medicina, UNIFESP (Federal University of São Paulo).
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8
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Hizli F, Berkmen F. Penile metastasis from other malignancies. A study of ten cases and review of the literature. Urol Int 2006; 76:118-21. [PMID: 16493210 DOI: 10.1159/000090872] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 05/19/2005] [Indexed: 11/19/2022]
Abstract
Primary penile carcinoma is one of the rarest male genital tract tumors. We rarely encounter this malignancy in Turkey because circumcision is routinely performed as a part of the Islamic tradition. Despite the medical paradox that the penis is rarely affected by metastases, approximately 300 cases have been reported in the literature. The primary lesion is almost 75% of pelvic origin; genitourinary or rectosigmoid primaries and penile metastasis from extrapelvic primaries constitute 25% of other primaries. Furthermore, isolated metastatic penile carcinomas are exceptionally rare. The rarity of the event prompted this study, which describes 10 cases of metastatic tumors of the penis including 7 cases with transitional cell carcinoma of the bladder, and in 1 case each of squamous cell carcinoma of the lung, adenocarcinoma of the prostate and leukemia. The main characteristics of the primary tumor are described, along with the diagnosis, treatment and the outcome of patients.
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Affiliation(s)
- Fatih Hizli
- Department of Urology, Oncology Education and Research Hospital, Ankara, Turkey.
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9
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Kendi T, Batislam E, Basar MM, Yilmaz E, Altinok D, Basar H. Magnetic resonance imaging (MRI) in penile metastases of extragenitourinary cancers. Int Urol Nephrol 2006; 38:105-9. [PMID: 16502062 DOI: 10.1007/s11255-005-0256-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of present study is to evaluate the efficacy of magnetic resonance imaging (MRI) in different types of penile metastases. MATERIALS AND METHODS In this report, we present three cases of penile metastases that have been developed secondary to extragenitourinary malignancies. Two of them did not have any primary malignancy history. RESULTS Penile biopsies were performed in all patients and metastatic penile tumours were found due to extragenitourinary malignancies. Penile MRI was performed before biopsies. The findings of MRI were correlated with histopathologic diagnosis. Moreover, penile MRI was found to be more sensitive in the evaluation of the lesions than ultrasonography. CONCLUSION MRI can be accepted as a reliable non-invasive method for the evaluation of the extent of penile metastases and involvement of tunica albuginea or urethral.
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Affiliation(s)
- Tuba Kendi
- Department of Radiology, Faculty of Medicine, University of Kirikkale, Kirikkale, Turkey
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10
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Kurul S, Aykan F, Tas F. Penile metastasis of cutaneous malignant melanoma: a true hematogenous spread?: Case report and review of the literature. Melanoma Res 2006; 16:259-61. [PMID: 16718273 DOI: 10.1097/01.cmr.0000215032.15565.cc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Penile involvement has been implicated as a metastatic site in several tumors; approximately 300 cases have been reported. Of these, only two cases showed cutaneous melanoma as the primary site. Our patient presented with a painless mass on the penile shaft together with other distant metastases. A magnetic resonance image demonstrated two sites of deposit in the subcutaneous tissue on the radix penis, and fine needle aspiration cytology of the mass confirmed the presence of melanoma cells. The patient died of systemic disease without any further treatment for penile involvement. This unusual involvement is presented with a review of the related literature.
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Affiliation(s)
- Sidika Kurul
- Division of Surgical Oncology, Istanbul University, Istanbul, Turkey.
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11
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Harish K, Alva NK, Arun Kumar SP, Mangala Gouri SR. Cytological diagnosis of nonulcerative penile neoplasms: Report of two cases. Diagn Cytopathol 2003; 29:358-9. [PMID: 14648797 DOI: 10.1002/dc.10396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nonulcerative penile mass lesions are rare. Pathological diagnosis of these lesions would traditionally be a biopsy. We report two such primary penile lesions which were diagnosed by fine-needle aspiration cytology (FNAC). Both lesions were present in the shaft and were diagnosed as squamous cell carcinoma (SCC). The first patient had a recurrence on the penile stump of partial amputation without any ulceration. The second had a primary urethral carcinoma on the terminal penile shaft infiltrating the corpora cavernosa dorsally. Open biopsies were avoided in both cases. FNAC was associated with very little and tolerable discomfort. There were no complications. The aspirate yield was sufficient for cytological diagnosis. FNAC of nonulcerated penile lesions is safe, well tolerated, and capable of providing a cytological diagnosis. Hence, it is a very useful outpatient procedure and could be the procedure of choice for diagnosis.
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Affiliation(s)
- K Harish
- Department of Surgical Oncology, M. S. Ramaiah Medical College and Hospital, Bangalore, India.
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12
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Taylor GB, McNeal JE, Cohen RJ. Intraductal carcinoma of the prostate metastatic to the penile urethra: a rare demonstration of two morphologic patterns of tumor growth. Pathology 1998; 30:218-21. [PMID: 9643510 DOI: 10.1080/00313029800169306] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Penile metastases from prostate cancer are rare and are usually a manifestation of wide-spread cancer dissemination. Isolated urethral metastases form a small fraction of these cases, have a longer survival rate and may represent spread by implantation following instrumentation. We report a case of prostatic carcinoma presenting with an isolated metastasis to the penile urethra after catheterisation and transurethral prostatectomy. The primary tumor had a prominent intraductal component whose architectural features were mimicked in the metastasis. The possible mechanisms of spread and the diverse appearances of cancer associated with an intraductal component are discussed.
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Affiliation(s)
- G B Taylor
- Department of Pathology, University of Auckland, New Zealand
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