Penile metastases from primary lung cancer: Case report and literature review

Abstract

Background: Metastasis to the penis from primary lung cancer is quite rare. To improve the understanding, we present a case diagnosed as penile metastasis from primary lung cancer and review the literature.

Methods: One case report and retrospectively analysis penile cancer patient secondary from primary lung cancer.

Results: The patient complained of perineal pain and burning on urination for about 2 months. On physical examination, painful nodular masses at the base of left side of the corpora cavernosa were found. 18F-fluorodeoxyglucose positron emission tomography/CT (PET/CT) scan showed that maximum standardized uptake value (SUVmax) in left side corpora cavernosa and right hilar increased to 12.0 and 13.5 respectively. On flexible bronchoscopy checking, stenosis of the opening of apical segmental and posterior segmental bronchi of right upper lobe was found. The lateral segmental bronchi of left lower lobe was obstructed by a neoplasm. The pathological result was primary pulmonary adenosquamous carcinoma (ASC). Two months later, total penectomy was performed. The pathological result was penile ASC derived from pulmonary. On reviewing the literature, there are 39 cases reported. The patient we present is the 40 one. The average age at diagnosis was (60.5 ± 10.7) years old. The most common symptom was mass, followed by priapism, pain. The overall survival time was (4.5 ± 3.9) months.

Conclusions: The penis may be a site of metastasis from lung cancer, especially for old patient. Metastasis to the penis usually indicates that the primary lung cancer is at an advanced stage and the prognosis is very poor.

Figure 1

MRI of the pelvis: (A) T1-weighted image shows an isointense tissue mass located at the base of the left corpora cavernosa with irregular margins. (B) T2-weighted image shows slightly hyperintense lesion (about 5.2 cm × 2.4 cm) on the base of the left corpora cavernosa. (C) On DWI, the lesion is demonstrated hyperintense. (D) T1-weighted MR image with fat signal suppression, after Gadolinum injection, shows prominent ring enhancement in the lesion. DWI = diffusion weighted imaging, MRI = Magnetic resonance imaging.

Figure 2

(A) Axial CT, PET-CT fusion, and PET images of pelvis demonstrate focus high uptake of 18F-fluorodeoxyglucose (FDG) in the base of left side corpora cavernosa; SUV_max of lesion is 12.0. (B) Axial CT, PET-CT fusion, and PET images of chest show a mass measured 3 cm × 2 cm with uptake intense in the right hilar; SUV_max of lesion is 13.5. The posterior segmental bronchi of right upper lobe is obstructive. (C) Flexible bronchoscopy image shows stenosis of the opening of apical and posterior segmental bronchi of right upper lobe. (D) Flexible bronchoscopy image shows the lateral segmental bronchi of the left lower lobe obstructed by a neoplasm. CT = computed tomography, PET/CT = 18F-fluorodeoxyglucose positron emission tomography CT, FDG = 18F-fluorodeoxyglucose.

Figure 3

(A–F) Histopathological findings show adenosquamous carcinoma changing for samples from the right upper lobe of the lung. (A) HE × 200, (B) CK5,6 × 200, (C) P40 × 200, (D) CK7 × 200, (E) NapsinA × 200, (F) TTF-1 × 200. (G–L) Histopathological findings show adenosquamous carcinoma changing for samples from penis. (G) HE × 200, (H) CK5,6 × 200, (I) P40 × 200, (J) CK7 × 200, (K) NapsinA × 100, (L) TTF-1 × 200. CK5/6, P40 are markers for squamous carcinoma; CK7, NapsinA, TTF-1 are markers for adenocarcinoma. H&E = hematoxylin and eosin.

Figure 4

The timeline of interventions and outcomes for the case.