Rectal gastrointestinal stromal tumor with metastasis to the penis: Case report and review of literature

We report the case of a 51-year-old gentleman with previously diagnosed gastrointestinal stromal tumor (GIST) of the rectum with metastasis to the penis. The patient underwent abdominoperineal resection of the primary tumor with negative margins and completed a three-year course of imatinib mesylate (Gleevec). Forty months after resection of his rectal tumor, the patient presented to his urologist with worsening testicular pain, mild lower urinary tract obstructive symptoms, and nocturia. A pelvic MRI revealed the presence of an ill-defined mass in the right perineum extending from the base of the penis to the penoscrotal junction. Biopsy of this mass was consistent with metastatic GIST. To our knowledge, this is the first report of metastatic GIST to the penis.     

Penile carcinoma originating from lichen planus on glans penis

A 53-year-old man presented to the urologic department with a small tumor on the glans penis. He had been receiving dermatologic treatment of lichen planus on the glans penis for 10 years. On physical examination, the tumor displayed an irregular surface. Because of a suspicion for malignancy, a biopsy was performed. The pathologic diagnosis was squamous cell carcinoma; therefore, partial penectomy was performed. The detailed pathologic findings revealed that the white raised areas adjacent to the tumor consisted of lichen planus with mild cytologic atypia. The final pathologic diagnosis was squamous cell carcinoma (pT1N0M0) originating from lichen planus. No recurrence had been seen as of 4 years postoperatively.     

Metastatic penile tumor from lung cancer: a case report

A 70-year-old man, who had squamous cell carcinoma of lung, complained of urethral pain. Physical examination revealed an induration of the bulbous urethra and a month later corpora cavernosa were involved. Biopsy was performed and pathological diagnosis was metastatic penile tumor originating from squamous cell carcinoma of lung. Several days after the biopsy the patient died of pleuritis carcinomatosa. Metastatic penile tumor is a rare disease and only 87 cases have been reported in Japan. We review the literature on metastatic penile tumors.     

Penile metastasis secondary to supraglottic squamous cell carcinoma: review of the literature.

We report an unusual supraglottic carcinoma metastasis to the penis. Review of the literature revealed more than 300 cases of metastatic lesions to the penis, excluding primary neoplasms from skin, urethra and blood. Of these metastatic neoplasms 16 originated above the diaphragm, only 4 of which were from the head and neck region. The most common neoplastic metastases to the penis in order of frequency were from the bladder, prostate, rectum and rectosigmoid areas, and kidney in 32, 30, 13 and 8% of the cases, respectively. The incidence of other primary tumor sites that metastasize to the penis is extremely rare.     

Penile metastasis from other malignancies. A study of ten cases and review of the literature

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.     

Penile and urethral metastases from superficial bladder tumor after TUR: a case report

A case of metastasis to the penis and the urethra from superficial bladder tumor of transitional cell carcinoma (TCC), grade 3 is reported. A 52-year-old male patient was diagnosed to have TCC of the urinary bladder (grade 3, stage pT1a) in May, 1985 and was treated initially with transurethral resection followed by adriamycin (ADR) instillation. In February, 1986, urethroscopy showed a papillary tumor in the cavernosal urethra and a metastatic tumor was noted in the corpus spongiosum penis. Biopsy of urethral tumor revealed TCC, grade 3. Therefore partial urethrectomy with resection of penile tumor was performed. Although the patient underwent combination chemotherapy involving CAP (cisplatin + ADR + cyclophosphamide) and M-VAC (methotrexate + vincristine + ADR + cisplatin) regimens, local lesion and metastatic lesions progressed, and he died in June 1986, 20 days after emasculation. The management of superficial bladder tumor with TCC, grade 3 was reviewed and discussed here.     

Sarcomatoid squamous cell carcinoma of the penis: a clinical and pathological study of 5 cases

PURPOSE: We analyzed clinical, morphological and immunohistochemical features in 5 cases of sarcomatoid or spindle cell squamous cell carcinoma of the penis. MATERIALS AND METHODS: The clinical and pathological files of all patients with penile carcinoma treated at our hospital between 1956 and 2002 were reviewed. Cases diagnosed as sarcomatoid squamous cell cancer were selected. RESULTS: Five of 341 patients (1.4%) had sarcomatoid penile carcinoma. Tumor stage was T2N0 in 2 patients, T2N2 in 2 and T4N3 in 1. In all patients partial or total penectomy was eventually performed. Three patients underwent bilateral inguinal lymphadenectomy. Four of 5 patients had distant metastatic disease and died within 1 year after diagnosis. One patient had exclusive hematogenous spread without lymph node involvement. Foci of distant metastatic tumor sites were the lung, skin, bone, pericardium and pleura. In 4 patients the diagnosis was based on the expression of keratin filaments in a predominantly spindle cell penile tumor or by the identification of carcinomatous and sarcomatoid areas on hematoxylin and eosin stained slides of the primary tumor. In 1 case a squamous component in a lymph node metastasis rendered the keratin negative spindle cell primary tumor sarcomatoid squamous cell carcinoma. CONCLUSIONS: Sarcomatoid squamous cell carcinoma of the penis is a subtype of squamous cell carcinoma with a poor prognosis often associated with wide hematogeneous spread. It is a rare malignancy that is often difficult to diagnose, requiring additional immunohistochemical stains.     

Granular cell tumor of scrotum: a rare tumor of the male external genitalia

We report a rare case of granular cell tumor in the scrotum. Granular cell tumors are soft-tissue neoplasms originating from Schwann cells that rarely affect male external genitalia. They are essentially benign; therefore, the treatment is complete excision of the lesion. Although never previously reported in the male external genitalia, malignant variants exist in 2% of cases. Because the clinical presentation is not specific, the diagnosis of malignant granular cell tumors can be made only by the pathologist. To our knowledge, only 5 other cases in the scrotum and 19 cases described in the penis have been reported.     

Adenosquamous carcinoma of the gallbladder with tumor thrombus in left portal trunk

We report a surgically resected case of adenosquamous carcinoma of the gallbladder accompanied by portal tumor thrombosis, which is regarded as a rare complication. A 73-year-old man was admitted to our hospital because of epigastralgia. Preoperative examinations led to a diagnosis of advanced gallbladder carcinoma with liver metastasis, and operation was performed. Since intraoperative ultrasonography showed a tumor thrombus in the left main portal trunk originating from the metastatic lesion in the left medial segment of the liver, extended left lobectomy with extrahepatic bile duct resection and lymph node dissection was performed, instead of right trisegmentectomy, as proposed preoperatively. Histological examination revealed adenosquamous carcinoma of the gallbladder with medullary growth that was similar to the hepatocellular carcinoma, most notably in the metastatic lesion of the liver and in the portal tumor thrombus. We discuss the relation between portal tumor thrombosis and medullary tumors, and note the atypical operative method employed.     

Secondary tumors of penis

The penis, despite its rich vascular supply, is a very uncommon site of metastatic tumor. When present, the prognosis is extremely poor. Four cases of secondary tumors of the penis are presented and the literature reviewed.     

Glomus tumor of the penis

Glomus tumors of the penis are extremely rare. A patient with multiple regional glomus tumors involving the penis is reported. A 16-year-old boy presented with the complaint of painless penile masses and resection of the lesions was performed. The pathologic diagnosis was glomus tumor of the penis. This is the ninth case of glomus tumor of the penis to be reported in the literature.     

以阴茎表现为首发症状的肺癌阴茎转移的诊治特点分析

目的：探讨以阴茎表现为首发症状的肺癌阴茎转移的临床特征及其诊治。方法：回顾性分析2005年2月～2009年1月收治的3例以阴茎表现为首发症状的肺癌阴茎转移患者的临床资料,结合文献复习分析本病的临床病理特征、诊断、鉴别诊断、治疗及预后等。结果：本组3例患者年龄46～68岁,3例均出现阴茎异常勃起伴疼痛,1例伴有龟头溃疡,3例均经病理活检确诊为肺癌阴茎转移。1例行阴茎切除术＋化疗,3个月后死亡;另2例诊断后拒绝进一步治疗,随访i年死亡。结论：肺癌阴茎转移临床上极为罕见,当老年患者初始出现阴茎异常症状时,要注意排除远处肿瘤转移至阴茎的可能性。一旦明确诊断,往往提示疾病到了晚期,治疗上通常采用姑息或支持治疗,但预后并不理想。     

Metastatic adenocarcinoma of the dura mimicking petroclival meningioma--case report

A 27-year-old female presented with gait disturbance and left facial paresthesia. She had a history of breast and lung masses not yet identified. Magnetic resonance (MR) imaging revealed a tumor suggesting a petroclival meningioma. Her symptoms worsened rapidly. MR imaging showed enlargement of the tumor. Subtotal removal of the tumor was performed. Histological examination revealed metastatic adenocarcinoma. Examination of the other masses confirmed adenocarcinoma originating from lung carcinoma. Dural metastases can be difficult to preoperatively differentiate from meningioma clinically or radiographically. MR spectroscopy and laboratory examinations such as cytologic and serologic studies are valuable for differential diagnosis. The final diagnosis of the tumor depends on the histological findings. However, careful monitoring of the patient's course is very important to detect rapid growth of metastases.     

A case of metastatic suprasellar tumor with edema along the optic pathway

A rare case in presented of a patient with edema formation along the optic pathway, which was caused by metastatic suprasellar tumor mimicking craniopharyngioma. A 63-year-old female with visual disturbance, diabetes insipidus, and symptomatic panhypopituitarism was admitted to our hospital. CT images showed a suprasellar mass lesion. MR images demonstrated a heterogeneously enhanced tumor and edema along the optic nerve and tract. Although no cystic component is shown in radiological findings, these features are commonly observed in cases of craniopharyngioma. The patient underwent removal of the tumor by the transcranial approach. Since histological examination revealed adenocarcinoma, the tumor was diagnosed as metastatic brain tumor originating from non-recurrent rectal cancer operated on eight years previously. Conventional radiotherapy with a dose of 50GY was performed for the residual tumor. The tumor size was unchanged, but the edema had disappeared 7 months after the operation. Edema spreading along the optic tract was reported as a characteristic MR finding for diagnosis of craniopharyngiomas as distinguished from other common parasellar tumors. However, it is suggested that edema of the optic pathway seems to be caused not only by craniopharyngioma but also other suprasellar lesions. Even if there was a characteristic radiological finding for some specific diseases, metastasis should be kept in mind as a differential diagnosis, because of its various appearance in neuroimages.     

Successful penile reconstruction after multimodal therapy in patients with primitive neuroectodermal tumor originating from the penis

We herein present an extremely rare case of primitive neuroectodermal tumor originating in the penis. A 16‐year‐old male adolescent presented with painful penile swelling. Pathological, immunohistochemical and cytogenetical examinations of the specimens obtained from total penectomy confirmed the diagnosis of primitive neuroectodermal tumor. After total penectomy, the patient received adjuvant chemotherapy with ifosfamide‐based regimen for 48 weeks. As a series of therapies, the patient underwent penile reconstruction surgery after completing adjuvant chemotherapy. The patient has not shown any evidence of recurrence for the 7 years after penile reconstruction surgery, and voiding function is completely normal. A favorable outcome was observed by multimodal therapy including aggressive resection for local control, intensive adjuvant chemotherapy, and penile reconstruction with cosmetic and functional success. Similar therapeutic approaches might be selected for children with primary malignant tumors of the penis.     

阴茎转移癌18例临床分析

目的探讨阴茎转移癌的临床特点、诊治方法及预后。方法回顾性分析18例阴茎转移癌患者的临床及随访资料并复习相关文献。18例患者原发肿瘤包括膀胱癌8例,前列腺癌4例,直肠癌2例,结肠癌、肾癌、食管癌和肺癌各1例。其中9例患者接受了阴茎切除+静脉化疗,5例患者仅接受静脉化疗未行阴茎切除术,2例患者仅接受了阴茎局部放疗,1例肾癌患者仅接受了索拉菲尼靶向治疗。结果本组18例患者中,从确诊原发肿瘤至出现阴茎转移时间为1~100月,平均(18.7±1.9)月。从确诊阴茎转移至患者死亡时间为4~23月,平均(10.2±1.7)月。所有18例患者均死于出现阴茎转移2年内。结论阴茎转移癌是一种罕见且预后较差的疾病,即使进行治疗,多数患者仍死于确诊阴茎转移1年内。逆行性静脉途经是发生阴茎转移的主要机制。阴茎切除仅限于缓解局部症状而不应常规应用。     

A case of primitive neuroectodermal tumor of the kidney]

A primitive neuroectodermal tumor (PNET) is a solid tumor originating from the neural crest. This tumor is known to occur in the central nervous system and soft tissue, but recently determined to also invade the kidney. Although primary renal PNET is very rare, we encountered a case of primary renal PNET with multiple lung metastasis. This case was a 35-year-old man with a chief complaint of macroscopic hematuria, which he noticed in January 1996. He was hospitalized because of right renal tumor detected with ultrasonography. On CT scan, a low-density solid tumor with a maximum diameter of 8 cm was visualized in the right kidney. Low-signal and high-signal tumorous lesions were demonstrated in the same region on T 1-weighted and T 2-weighted MR images, respectively. Then right radical nephrectomy was performed on Feb. 5, 1996. On histopathological observation, the tumor was composed of small tumor cells with solid growth. Immunohistochemical staining revealed that the tumor was positive for CD 99. Thus our final diagnosis was primary right renal PNET. Although 2 metastatic lesions with a diameter of about 1 cm were observed in the right lower lung before the time of surgery, pulmonary metastatic lesions markedly increased in number 3 months after surgery. Thus we initiated CAP chemotherapy with cyclophosphamide, doxorubicin, and CDDP. After 3 cycles, pulmonary metastatic lesions disappeared at CT scan, indicating complete remission. However, a tumor with a maximum diameter of about 10 cm recurred in the retroperitoneum 7 months after complete remission. Although 2 cycles of CAV/PE therapy with cyclophosphamide, doxorubicin, vincristine, CDDP, and VP-16 were performed following resection of the retroperitoneal tumor, he showed no response and decreased 24 months after surgery.     

A case of metastatic renal tumor originating from a malignant mixed tumor of the submandibular gland]

A rare case of metastatic renal tumor originating from a malignant mixed tumor of the submandibular gland is reported. The patient was a 45-year-old woman with hard masses palpated in the right upper arm and the right upper gluteal region. She had a history of surgical resection of a right submandibular tumor followed by radiotherapy in 1977. Biopsy findings of the gluteal mass suggested a malignant clear cell tumor. A chest X-ray, excretory urogram, CT scan, MRI and renal angiogram were highly suggestive of a right renal cell carcinoma with metastases to the right lung (S1 & S10), the left 4th and 5th ribs, the right upper arm muscle and the right upper gluteal muscle. Right nephrectomy and resection of the right upper arm and right upper gluteal tumors were performed. Microscopic examination showed that all tumors were malignant mixed tumors. When compared to the previous surgical specimen, the tumors were believed to be identical. The tumors of the lung and ribs subsequently resected were malignant mixed tumors. The patient is well with no objective or subjective evidence of recurrent neoplastic disease 7 months post-operatively. To our knowledge only one report of metastatic renal tumor originating from a malignant mixed tumor of the salivary gland has been published in Japan. But metastatic renal tumor originating from the same tumor of the submandibular gland has not been reported previously in Japan.     

A case of urothelial carcinoma associated with penile metastasis

A 71-year-old man, who had been treated with continuous ambulatory peritoneal dialysis due to chronic renal failure for 5 months, visited our hospital with a complaint of penile induration in April, 1998. He underwent wedge biopsy of the penis. On the day after the biopsy, he had an episode of gross hematuria. Cystoscopy revealed a papillary tumor that seemed to have arisen from the right ureteral orifice and another in the trigone. Computed tomographic scan revealed the bladder tumors and swelling of the internal iliac lymph nodes. The bladder tumors were resected transurethrally. The pathological diagnosis of the specimen from the penile induration was metastatic transitional cell carcinoma.     

A case of encapsulated intracerebral hematoma mimicking metastatic brain tumor

We report a case of encapsulated intracranial hematoma (EIH) mimicking metastatic brain tumor. A 77-year-old male with a medical history of prostate cancer was admitted to our hospital presenting with progressive left hemiparesis. Previous head CT scan and MRI findings during 3 weeks before admission revealed a subcortical acute to subacute hematoma under the right precentral gyrus with growing perifocal brainedema. The Head DSA showed tumor-stain with vascular compression corresponding to the hemorrhagic mass, and Tl-201 SPECT study revealed high L/N ratio (3.0) and high L/E ratio (0.8). The preoperative diagnosis was metastatic brain tumor originating from prostate cancer, and total removal of the mass was undergone with the postoperative diagnosis of EIH. Neither tumoral component nor vascular malformation was found even by detailed pathological study. EIH is a rare variant of intracranial hemorrhage and most of cases in past reports are preoperatively misdiagnosed as malignant brain tumor. In our case, even Tl-201 SPECT and DSA, which are reported as key studies for distinguishing EIH from other brain tumors, demonstrated brain tumor-like findings. It is necessary to consider the possibility of EIH when we encounter hemorrhagic mass in the brain parenchyma even with brain tumor-like radiographical images.