Penile metastasis from rectal cancer by PET/CT

A Case Report and Review of the Literature of Penile Metastasis From Rectal Cancer

Background

Metastatic involvement of the penis in cases of rectal cancer is exceptionally rare condition. Our clinical case report and review of the literature will contribute in complementing currently limited data on penile metastasis from rectal cancer.

Case report

We report a case of a 64-year-old male diagnosed with penile metastasis from rectal cancer. The patient was treated with neoadjuvant chemoradiotherapy followed by total mesorectal excision (TME). However, penile metastasis developed 3 years later, clinically presenting as penile pain and solid formations along the entire length of the penis with visible tumor in the head of the penis. The amputation of penis was performed, and adjuvant chemotherapy was prescribed. The patient survived only 6 months.

Conclusion

Penile metastasis from rectal cancer in most cases is a lethal pathology that indicates wide dissemination of oncological disease and has a very poor prognosis. Aggressive surgical treatment is doubtful in metastatic disease as this will negatively affect the quality of life.

Ovarian Inflammation Mass Mimicking Recurrent Rectal Cancer 17 Years After Surgery: PET/CT and MRI Findings

ABSTRACT

A 58-year-old woman diagnosed with rectal cancer received surgery and chemotherapy 17 years ago, and since then, she has been tumor-free. However, 1 month ago, she complained of progressive abdominal and pelvic pain. MRI scans revealed a soft-tissue ovarian mass with heterogeneous signals in the right pelvis, showing obvious enhancement after contrast injection. On PET/CT images, the lesion presented with intense FDG accumulation. Above imaging findings raised the possibility of tumor recurrence, and thus exploratory laparotomy was performed. Pathological results confirmed the diagnosis of active inflammation with fibrous tissue hyperplasia.

Penile secondary lesions: a rare entity detected by PET/CT

While penile metastases are rare, PET/CT has facilitated their detection. We aimed to describe penile secondary lesions (PSL) identified by PET/CT. We reviewed 18F-FDG and Ga68-PSMA PET/CT records performed in a single center during May 2012-March 2020, for PSL. Of 16,774 18F-FDG and 1,963 Ga68-PSMA-PET scans, PSL were found in 24(0.13%) men with a mean age of 74. PSMA detected PSL in 12 with prostate cancer; FDG identified PSL in 4 with lymphoma, 3 with colorectal cancer, 2 with lung cancer, and one each with bladder cancer, pelvic sarcoma, and leukemia. Mean SUVmax of PSL was 7.9 ± 4.2 with focal uptake in 13(54%). Mean lesion size was 16.5 ± 6.8 mm; 8 at the penile root, 4 along the shaft, and 1 at the glans. CT detected loss of the penile texture in 15(63%). PSL were observed only during relapse or follow-up of disseminated disease. Among those with prostate cancer, PSA varied widely. Fifteen (62.5%) died, at a mean 13.3 ± 15.9 months following PSL demonstration, nine had non-prostate malignancies. PET/CT identified and characterized PSL in a fraction of cancer patients, most commonly those with prostate cancer. PSL universally surfaced in advanced disease, and signaled high mortality, especially in non-prostate cancers.

Penile Metastasis From Prostate Cancer Detected by 18F-Fluorocholine PET/CT

F-Fluorocholine (F-FCH) PET/CT is widely used to study patients affected by prostate cancer. F-FCH PET/CT is suitable for the detection of pelvic and abdominal nodal and skeletal metastases. Indeed, F-FCH PET/CT sensitivity for other organs, such as the liver and the urinary tract, is lowered by the radiopharmaceutical urinary washout and intense liver uptake. Herein, we report the case of a patient affected by oligometastatic prostate cancer in good clinical condition treated with total androgen blockade. F-FCH PET/CT showed a diffuse and intense uptake in the shaft of the penis, which was an evidence of a rare penile metastasis.

Diffuse Metastases in Bilateral Penile Corpus Cavernosum From Renal Cancer Diagnosed by 18F-FDG PET/CT

We report a rare case of a 60-year-old man with diffuse metastases in bilateral penile corpus cavernosum after radical nephrectomy for left renal carcinoma. F-FDG PET/CT demonstrated diffuse hypermetabolic lesions in bilateral penile corpus cavernosum, hypermetabolic tumor recurrences in left renal operation region, and left pulmonary metastasis. Biopsy confirmed penile metastasis from renal clear cell carcinoma. Diffuse penile metastatic carcinoma from renal cancer is extremely rare and associated with poor prognosis. F-FDG PET/CT is helpful for diagnosis of penis metastasis and accurate staging of primary cancer.

Congenital Penile Rhabdomyosarcoma on FDG PET/CT

Primary penile malignancy is uncommon. Congenital primary penile rhabdomyosarcoma diagnosed in an infant is extremely rare. We present the FDG PET/CT findings in a 1-month-old boy with penile mass. The images showed hypermetabolic lesion at the base of the penis and left inguinal lymph node. Pathological examination demonstrated rhabdomyosarcoma.

Penile Metastasis from Rectal Carcinoma: Case Report and Review of the Literature

Background

Metastasis of rectal cancer to the penis is a very rare condition with less than 40 cases found in the literature.

Case Report

We here report a case of a 41-year-old man who was diagnosed with rectal cancer which later metastasized to the penis. The patient was treated with neoadjuvant radiotherapy, underwent rectal resection, had adjuvant chemotherapy, and, despite that, had penile metastasis 2 years later. Palliative penectomy as well as bilateral orchiectomy with suprapubic cystostomy were performed. The patient died 2 months after the diagnosis. All the previous cases mentioned in the literature are reviewed as well.

Conclusion

The prognosis of penile metastasis from rectal cancer is poor and life expectancy is short. The mechanism of rectal cancer metastasis spread to the penis is unknown. The most acceptable theory is retrograde venous spread. There are several treatment options; however, no single treatment option is associated with superior results.

A rare case of metachronous penile and urethral metastases from a rectal mucinous adenocarcinoma

Metastatic lesions in the penis are uncommon in patients with prostate or bladder cancer but penile metastatic lesions from rectal tumours are rare with only 65 cases reported in the literature. We describe the case of a 70-year-old man who developed metastatic lesions within his corpus cavernosum 2 years after being diagnosed and treated for a mucinous adenocarcinoma of the rectum and a year after a wedge resection of an isolated lung metastasis. He proceeded with total penectomy and intraoperatively two skip lesions were also found within the wall of his urethra; histological analysis proved that these were also metastatic lesions. A perineal urethrostomy was formed with the remaining macroscopically healthy urethra. He made a good recovery from his operation and continued his treatment under the oncology team.