Partial priapism secondary to idiophatic segmental thrombosis of corpora cavernosa

A 51-year-old man presented at our department 2 days after the onset of a painful mass in the perineum and dysuria. Diagnosis of partial priapism secondary to proximal segmental corpora cavernosa thrombosis was made through colordoppler ultrasound (CDU) and magnetic resonance imaging (MRI). Treatment consisted of administration of systemic anticoagulation drugs (acenocumarol) and local injection of ethylephrine chloridrate. The thrombosis resolved after two months with incomplete restoration of erectile function (loss of rigidity). In conclusion, on the basis of previous reports (23 cases reported in literature) and our experience, in presence of painful mass in the perineum, CDU and MRI evaluation allows to make diagnosis of the rare proximal partial priapism that as first option should be treated conservatively.     

Metastasis to the penis from carcinoma of the bowel

Summary and Conclusions Metastatic carcinoma to the penis from various segments of the intestinal tract is not a common phenomenon. A total of 15 cases have been reported in the literature (rectum, 13; colon, 1; anal canal, 1). Metastatic lesions to the penis from carcinoma of the rectum are rarely observed and, owing to the existence of freely anastomosing lymph and blood vessel channels between the anal canal, the rectum and the penis, it is remarkable that this complication does not occur more frequently.     

Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa

By real-time RT-PCR and Western blot analysis, we found that phosphodiesterase type 5 (PDE5) mRNA and protein abundance was several fold higher in human male than in female reproductive tracts. The highest mRNA level (>1 x 10(7) molecules/microg total RNA) was detected in human corpora cavernosa (CC), where PDE5 protein was immunolocalized in both muscular and endothelial compartment. The possible role of androgens in regulating PDE5 expression was studied using a previously established rabbit model of hypogonadotropic hypogonadism. In this model, hypogonadism reduced, and testosterone (T) supplementation restored, CC PDE5 gene and protein expression. In addition, T supplementation completely rescued and even enhanced cyclic GMP conversion to metabolites, without changing IC(50) for sildenafil (IC(50) = 2.16 +/- 0.62 nm). In control CC strips, sildenafil dose-dependently increased relaxation induced by electrical field stimulation, with EC(50) = 3.42 +/- 1.7 nm. Hypogonadism reduced, and T increased, sildenafil effect on electrical field stimulation, again without changing their relative EC(50) values. CC sensitivity to the NO-donor NCX4040 was greater in hypogonadal rabbit strips than in control or T-treated counterparts. Moreover, sildenafil enhanced NCX4040 effect in eugonadal rabbit strips but not in hypogonadal ones. This suggests that androgens up-regulate PDE5 in rabbit penis. We also measured PDE5 gene expression and metabolic activity in human CC from male-to-female transsexual individuals, chronically treated with estrogens and cyproterone acetate. Comparing the observed values vs. eugonadal controls, PDE5 mRNA, protein, and functional activity were significantly reduced. In conclusion, we demonstrated, for the first time, that androgens positively regulate PDE5, thus providing a possible explanation about the highest abundance of this enzyme in male genital tract.     

Metastasis to the esophagus.

Tumor metastatic to the esophagus is a rare lesion. Two cases, primary in pancreas and rectum, are described. There are no distinguishing radiologic features.     

Cancer of the penis

Cancer of the penis is rare in Europe, accounting for less than 0.5% of all cancers. Phimosis and poor hygiene are strong risk factors whereas neonatal circumcision is a contributing factor in the prevention of this disease. More than 95% of penile carcinomas are squamous cell carcinomas. Early disease (stage I-II) is curable in most patients, who can be treated by conventional penile amputation or, in selected cases, by organ preserving techniques, including Moh's micrographic surgery, laser ablation or radiation therapy (external-beam, brachytherapy). For more advanced primary tumours, penile amputation is required. Survival of patients with penile cancer is strongly related to the presence and extent of nodal metastases. Bilateral inguinal lymphadenectomy is recommended for palpable lymph nodes that persist 3 or more weeks after removal of the primary tumour and a course of antibiotic therapy. In patients with proven inguinal lymph node metastases, bilateral ileoinguinal dissection should be performed. When the nodes are clinically negative, "prophylactic" inguinal lymphadenectomy may be a reasonable approach in patients with invasive tumours (T2 or greater), high grade tumours, or tumours exhibiting vascular invasion. The role of chemotherapy, as adjuvant and neoadjuvant or primary treatment in metastatic disease, needs to be further explored in prospective clinical trials.     

Metachronous metastasis to the penis from carcinoma of the rectum

A case of metastasis from carcinoma of the rectum to the penis is presented and details of its pathology are discussed.     

Metastasis to the colon from bronchogenic carcinoma

Two cases of primary carcinoma of the lung with clinically demonstrated colon metastases are presented. Such metastases may present with intermittent or continuous colonic obstruction, lower gastrointestinal tract bleeding, or anemia. The metastases may be synchronous or metachronous with respect to diagnosis of the lung lesion. Potential problems in management are discussed and the literature, relating to colonic metastasis from bronchogenic carcinoma, is reviewed.     

Renal Cell Carcinoma Metastasis to the Left Atrium

Only 13 cases of renal cell carcinoma metastasis to the left atrium of the heart have been described. We report the case of a man in his 50s who had undergone radical nephrectomy for renal cell carcinoma in 2006 and presented with amnesia at our neurology department in 2020. Magnetic resonance images of the brain showed metastatic lesions; subsequent computed tomograms of the chest, abdomen, and pelvis revealed a mass in the left atrium and multiple metastases in the lung, pleura, and pancreas. Our cardiologists advised against surgical removal of the left atrial mass because of a poor prognosis, so radiation therapy and immunotherapy were initiated instead.