1
|
Masuda Y, Shikata H, Sawachika H, Kaneko M. Priapism as an initial manifestation in an adult patient with chronic myeloid leukemia in Japan: case report and review of the literature. Int Cancer Conf J 2024; 13:289-295. [PMID: 38962033 PMCID: PMC11217260 DOI: 10.1007/s13691-024-00680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/01/2024] [Indexed: 07/05/2024] Open
Abstract
We report the first documented Japanese case in the English literature of chronic myeloid leukemia (CML) in which priapism was the presenting symptom. Priapism, a rare manifestation in CML patients, is particularly uncommon in Japan. This can be attributed to the high quality of medical services and proactive health strategies implemented by the Japanese government. These strategies include recommending regular blood tests for company employees aged 35 and above, thereby facilitating early detection of CML. Hence, it is crucial to consider CML when examining any patient presenting with priapism, particularly among those who have not undergone regular medical check-ups.
Collapse
Affiliation(s)
- Yuya Masuda
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
| | - Hisaharu Shikata
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
| | - Hiroshi Sawachika
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
| | - Masahiko Kaneko
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
| |
Collapse
|
2
|
van der Velde MGAM, Tiellemans SMB, de Lil H, Nieuwenhuizen L. The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia-Case report and review of literature. EJHAEM 2022; 3:1100-1115. [PMID: 36467799 PMCID: PMC9713041 DOI: 10.1002/jha2.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 06/17/2023]
Abstract
Priapism is a rare presenting feature of chronic myeloid leukemia (CML) in male patients. Treatment aims to relieve symptoms and to prevent erectile dysfunction. Several treatment modalities exist, however no standard treatment is recommended. We evaluated literature concerning different treatment approaches and evaluate the value of leukapheresis in treatment of priapism. The literature search resulted in 57 included articles, consisting of 53 studied patients. Patients had a mean age of 25.3 years, average time from onset to presentation at the hospital was 2 days, and mean white blood cell (WBC) count was 344 × 109/L. Most patients (67.9%) were treated with a combined approach (different modalities were radiological, urological, and oncological treatment). Twelve patients, with a mean WBC count of 365 × 109/L, received leukapheresis. Only two of them reported erectile dysfunction after treatment. Priapism is an urological emergency requiring urgent multidisciplinary treatment. We highlight the importance of local urological therapy combined with systemic therapy for CML. Therapeutic leukapheresis should be applied when available and with no other contraindications.
Collapse
Affiliation(s)
- Marleen G. A. M. van der Velde
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
- Department of Health Services ResearchCAPHRI School for Public Health and Primary CareAging and Long Term Care, MaastrichtLimburgThe Netherlands
| | | | - Heleen de Lil
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
| | | |
Collapse
|
3
|
Bintoro SUY, Romadhon PZ, Suryantoro SD, Aminy RZ, Windradi C, Widiyastuti KN. Case Report: Priapism as The Clinical Presenting Feature of Chronic Myeloid Leukemia: Case Report and 20-Year Literature Review. F1000Res 2022; 10:571. [PMID: 35087660 PMCID: PMC8762679 DOI: 10.12688/f1000research.53365.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
Priapism in chronic myeloid leukemia (CML) appears to be an infrequent manifestation as well as a crucial emergency. Here, we report an 18-year-old male presenting with a persistent erection of the penis for 20 days. We evaluated and compared the reported cases within 20 years discussing the management of priapism in CML. Cytoreductive therapy followed by leukapheresis, the administration of tyrosine kinase inhibitor, and intra-cavernosal blood aspiration may resolve the symptoms of priapism. Early intervention for cytoreduction and aspiration are the pivotal keys to successfully impeding the complications.
Collapse
Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia.,General Teaching Hospital Dr. Soetomo, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia.,General Teaching Hospital Dr. Soetomo, Surabaya, East Java, 60286, Indonesia
| | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Rusdi Zakki Aminy
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia
| | - Choirina Windradi
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Krisnina Nurul Widiyastuti
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia
| |
Collapse
|
4
|
Ali E, Soliman A, De Sanctis V, Nussbaumer D, Yassin M. Priapism in Patients with Chronic Myeloid Leukemia (CML): A Systematic Review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021193. [PMID: 34212918 PMCID: PMC8343736 DOI: 10.23750/abm.v92i3.10796] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
Background: Priapism is defined as a penile erection that persists four or more hours and is unrelated to sexual stimulation. Priapism resulting from hematologic malignancy is most likely caused by venous obstruction from microemboli/thrombi and hyperviscosity caused by the increased number of circulating leukocytes in mature and immature forms. In patients with leukemia, 50% of cases of priapism are due to Chronic Myeloid Leukemia (CML). We present a systematic review of priapism in CML. Acquisition of evidence: An extensive literature research was carried out in PubMed, Google Scholar, SCOPUS, and Science Citation Index databases. The search included cases up to 4th August 2020. Synthesis of evidence: A total of 68 articles were found and included in our review, including 3 reviews from three different centers. We found 68 articles (102 patients; figure 1) and several case reports on priapism in CML. Priapism was noticed in some patients at the first presentation of CML. However, it was infrequently reported during the start of treatment, following the stop of medication and post-splenectomy. The mean age at presentation was 27.4 years, and the mean time from onset of priapism to the time to get medical attention (presentation) was 78.2 hours. The mean white blood cell count associated with priapism was 321.29x109/L, and the mean platelet count was 569 x10 9/L. The chronic phase of CML was the most common phase where priapism occurred. Most patients were Asian (>50%). Nearly a quarter of patients (27.4%) developed permanent erectile dysfunction. Conclusions: Priapism is a urological emergency requiring urgent multidisciplinary management to prevent erectile dysfunction. Because of the relatively rare occurrence of priapism in CML patients, there is no standard treatment protocol. (www.actabiomedica.it)
Collapse
Affiliation(s)
| | | | - Vincenzo De Sanctis
- Coordinator of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A), Ferrara, Italy.
| | | | - Mohamed Yassin
- Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
| |
Collapse
|
5
|
Unusual Presentation of Priapism Associated with Acute and Chronic Myeloid Leukemia in Two Patients: Emergency Management. Case Rep Urol 2020; 2020:4982432. [PMID: 32855834 PMCID: PMC7442991 DOI: 10.1155/2020/4982432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/01/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
Priapism is a rare urological emergency. It is rarely a telltale sign of myeloid leukemia. We report two cases of acute myeloid leukemia in a child and chronic myeloid leukemia in a young adult presenting with priapism. Puncture irrigation of the corpora cavernosa followed by systemic treatment to lower the hyperviscosity of the blood due to leukemia provided optimal outcome. Prompt emergency management is required to lower the complication of erectile dysfunction.
Collapse
|
6
|
Qu M, Lu X, Wang L, Liu Z, Sun Y, Gao X. Priapism secondary to chronic myeloid leukemia treated by a surgical cavernosa-corpus spongiosum shunt: Case report. Asian J Urol 2018; 6:373-376. [PMID: 31768325 PMCID: PMC6872760 DOI: 10.1016/j.ajur.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/30/2018] [Accepted: 09/26/2018] [Indexed: 11/26/2022] Open
Abstract
Priapism secondary to chronic myeloid leukemia (CML) is rarely observed in the clinic. Here, we present an 18-year-old patient with priapism for over 72 h due to hyperleukocytosis. Emergent interventions such as therapeutic aspiration and intracorporal injection of phenylephrine failed before a surgical corpora cavernosa-corpus spongiosum shunt was inserted to relieve symptoms. During hospitalization, bone marrow aspiration confirmed the diagnosis of CML.
Collapse
Affiliation(s)
- Min Qu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xin Lu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lei Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiyong Liu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
7
|
Becerra-Pedraza LC, Jiménez-Martínez LE, Peña-Morfin I, Nava-Esquivel R, Villegas-Martínez JA. Priapism as the initial sign in hematologic disease: Case report and literature review. Int J Surg Case Rep 2018; 43:13-17. [PMID: 29414500 PMCID: PMC5907689 DOI: 10.1016/j.ijscr.2017.12.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Priapism is an uncommon sign and sometimes considered a diagnosis challenge into systemic disease; this is defined as ≥4 h continuous penile erection, without sexual stimulation. We state that this work has been reported in line with the SCARE criteria PRESENTATION OF CASE: A Mexican 52-year-old man was brought to the emergency room with priapism of six days of evolution. His medical history reported fatigue and waxy pallor had begun a month ago, the rest of interrogation was unremarked. Hyperleukocitosis (>250,000 cells/ml) was documented on his preoperative evaluation, the initial step was hematology consultation due to malignance suspicion, followed by corpora cavernosa drainage-irrigation and surgery penis shunts. After of procedure, we realized bone marrow aspiration, kariotype and cytogenetic analysis, histopathological and moleculars assay reported myeloid hyperplasia compatible with acute phase CML and Philadelphia translocation t(9:22) (q34;q11.2) with P210 BCR-ABL1 fusion transcriber, patient was discharged with dasatinib for maintenance phase. Actually, he has a satisfactory evolution without relapses. DISCUSSION The majority of reported cases shows the individual importance of hematological diseases in priapism as it is shown in the analysis of the literature of 10 years (2006-2016) that we made. It is imperative to consider the type of priapism, and the genetic and demographic patient aspects due to the early and correct approach improves the short and long term outcome of the hematological patients. CONCLUSION Priapism is an uncommon sign of systemic disease. In the presence of warning signs, malignancy should be considered until proven otherwise.
Collapse
Affiliation(s)
| | | | - Iran Peña-Morfin
- Department of Surgery, IMSS HGZ/MF 1, La Paz Baja California Sur, México
| | | | | |
Collapse
|
8
|
Johnson M, Parnham A, Ralph D. Priapism: A rare initial presentation for chronic lymphocytic leukaemia. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817720355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mark Johnson
- University College London Hospital NHS Foundation Trust, UK
| | | | - David Ralph
- University College London Hospital NHS Foundation Trust, UK
| |
Collapse
|
9
|
Updyke KM, Morales-Lappot J, Lee T. Atypical Presentation of Chronic Myelogenous Leukemia. Cureus 2017; 9:e1280. [PMID: 28656128 PMCID: PMC5484601 DOI: 10.7759/cureus.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Chronic myelogenous leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of the Philadelphia chromosome, t(9;22), which is a constitutively active tyrosine kinase that causes excessive proliferation and differentiation of myeloid cells in the bone marrow. Most patients are either asymptomatic or present with fatigue, abdominal fullness, and splenomegaly. This is a case in which a 72-year-old Caucasian male’s initial presentation of CML was new-onset atrial fibrillation, chronic obstructive pulmonary disease (COPD) exacerbation, and pneumonia. The severity of his symptoms of atrial fibrillation and dyspnea complicated his stabilization, which delayed his diagnosis of CML and initiation of tyrosine kinase inhibitor for treatment. Unregulated proliferation of leukemic cells increases blood viscosity and results in aberrations in blood circulation that may result in atypical presenting symptoms in myeloproliferative disease. Thus, it is important to have a high clinical index of suspicion for CML in patients with leukocytosis and concurrent symptomatology that is unusual for leukemia.
Collapse
Affiliation(s)
| | | | - Theodore Lee
- College of Medicine, University of Central Florida
| |
Collapse
|
10
|
Abstract
This study aims to present the management of priapism in adult men in Port Harcourt, Nigeria. All patients who presented with priapism in 2 hospitals in Port Harcourt from July 2007 to April 2014 were prospectively studied. Treatment was assigned based on clinical presentation. Data analyzed included: age on clinical presentation, risk factor, mode, and outcome of management. There were 18 patients aged 17 to 60 years (median age: 30 years). Three patients (16.7%) presented with stuttering priapism. Most of the patients presented after 24 hours of onset. Sixteen patients (89.9%) had hematological disorders. Five patients (27.8%) took suspected aphrodisiac medications. Seven patients (38.9%) were managed conservatively. The rest achieved detumescence following glandulo-cavernous shunting. Erectile function after treatment was satisfactory in 5 patients (27.8%). The commonest cause of priapism in Port Harcourt was hematological disorder. Most of the patients presented late. Prevalence of erectile dysfunction after treatment was high.
Collapse
Affiliation(s)
- Onyeanunam N. Ekeke
- Division of Urology and Department of Hematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Hannah E. Omunakwe
- Division of Urology and Department of Hematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ndu Eke
- Division of Urology and Department of Hematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| |
Collapse
|
11
|
Shaeer OKZM, Shaeer KZM, AbdelRahman IFS, El-Haddad MS, Selim OM. Priapism as a result of chronic myeloid leukemia: case report, pathology, and review of the literature. J Sex Med 2015; 12:827-34. [PMID: 25630365 DOI: 10.1111/jsm.12812] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Priapism is rare-presenting feature in male patients with chronic myeloid leukemia (CML). Several hypotheses for pathogenesis have been described. Management has been controversial; some authors described resolution following priapism-specific interventions, and others recommended addition of CML-specific therapy or even CML-specific therapy alone. AIM In this report, we describe presentation and management of a man with refractory priapism that was the first presenting manifestation of CML. We also report, for the first time, the pathology sections of the sinusoidal tissue in such cases. Literature is reviewed for similar cases and their outcome. METHODS A 21-year-old male patient presented with painful priapism that started 6 days earlier and failed aspiration-irrigation. CBC revealed marked leucocytosis. Oncology care diagnosed CML, and treatment with Imatinib was commenced with prior semen cryopreservation. Following remission, a penile prosthesis was implanted, assisted by optical corporotomy. Sinusoidal tissue biopsy was stained by hematoxylin/eosin (H&E) and CD34. MAIN OUTCOME MEASURES Pathology sections of cavernous tissue following CML-induced priapism. RESULTS The penile implant survived without complications. H&E examination of the sinusoidal tissue biopsy revealed leukemic infiltration associated with vascular endothelial damage. CD34 staining showed the mixed picture of leukemic infiltrates, intact vascular endothelium with lumena showing leukemic cells, alternating with destroyed vessels, and no vascular lumena and ruminants of endothelial cells. CONCLUSION Priapism can be the first manifestation of previously undetected CML. The pathological picture of sinusoidal tissue in such cases is presented. In the case at hand, a complete blood picture was helpful in early diagnosis of CML and early initiation of targeted chemotherapy along with the corporal irrigation/aspiration or shunt surgery. It is therefore recommended to have a CBC examined at presentation of any case of ischemic priapism of unknown etiology, early initiation of CML therapy along with aspiration/irrigation, preferably cryopreserving a semen sample before CML therapy.
Collapse
|
12
|
Ribeiro IC, Abidu-Figueiredo M, Costa FB, Pereira-Sampaio MA, Chagas MA. Stereological study of the elastic fiber and smooth muscle cell system in the bovine and buffalo penis. PESQUISA VETERINARIA BRASILEIRA 2013. [DOI: 10.1590/s0100-736x2013001300017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Samples of ten penises of Mediterranean buffaloes and ten penises of Red Sindhi cattle were used. The thickness of the tunica albuginea (TA), distribution of smooth muscle cells (SMC) and volume density (Vv) of elastic system fibers in TA, corpus cavernosum (CC) and corpus spongiosum (CS) were evaluated. The Vv of elastic system fibers in buffalo and bovine penis was respectively 4.07% ±0.88% and 3.36% ±1.21% in TA; 17.32% ±2.21% and 13.14% ±1.27% (CC), 26.58% ±4.31% and 31.36% ±3.67% (CS). The CC of buffalo presented higher Vv of elastic fibers than bovine, while in the CS the Vv of elastic fibers in buffaloes was smaller than in cattle. The TA thickness showed a significant difference among the species studied. The arrangement of SMC in the bovine penises and in the water buffalo suggests that this pattern is common to animals that have fibroelastic penises.
Collapse
|
13
|
Hazra SP, Priyadarshi V, Gogoi D, Sharma PK, Pal DK, Chakraborty SC. Pediatric priapism: a rare first manifestation of leukemia. APSP J Case Rep 2013; 4:39. [PMID: 24381835 PMCID: PMC3863828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/26/2013] [Indexed: 11/15/2022] Open
Abstract
Priapism is a rare disease. It is an emergency condition with a poor prognosis, and the risk of impotence is 50% despite appropriate management. Though about 20% cases of all priapism are related to hematological disorders, the incidence of priapism in adult leukemic patients is only about 1-5 percent. The incidence in pediatric leukemia patient is even rarer. Here we present a case of priapism in a 14-year-old apparently healthy boy who found to have chronic myeloid leukemia on subsequent investigations.
Collapse
|
14
|
Chisick L, Seftel M, Kumar R. Algorithm for initial management of priapism in chronic myeloid leukaemia. Br J Haematol 2012; 159:250-1. [PMID: 22924590 DOI: 10.1111/bjh.12015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
15
|
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]
|